The genuine works of Hippocrates, Vol. 1 · Hippocrates
CLASSIS IV.
There is some difficulty in determining accurately what was the nature of the ancient _Iatrium_ ιητρεῖον. See an interesting disquisition on this subject in Littré’s edition of Hippocrates, t. v., p. 25. It most probably was an establishment kept by the physician, in which were contained not only all sorts of medicines, but also all kinds of surgical apparatus. Mention of the _Iatrium_ is made by Plato (Legg. iv., p. 720, and i., p. 646; ed. Tauch.) Aristotle is said to have possessed an _Iatrium_, which, if the story be true, he had no doubt acquired from his father, who was a medical practitioner.[159] From what is stated by Plato, it would appear that the assistants were qualified to administer professional assistance in the absence of their superior, and were also called doctors. (Legg. iv.) So it appears that the modern abuse of this title was sanctioned by classical usage! It must be recollected that, in the time of Hippocrates, eminent physicians were _periodeutæ_, that is to say, wanderers from place to place, and consequently they would stand in need of such an establishment as we have described the _Iatrium_ to be. See further the Argument to this work. XIV. Περὶ φύσεως ἀνθρώπου--_On the Nature of Man_.
Erotian, Galen, Palladius, and Macrobius[160] do not hesitate to quote the doctrines contained in this treatise as being those of the great Hippocrates, but its authenticity has long been considered very questionable, owing to the circumstance that a passage in it of considerable length, relative to the anatomy of the venous system, is quoted by Aristotle[161] as being the production of Polybus, and it is accordingly received as such by Haller,[162] Gruner, Littré, and most of our recent authorities on ancient medicine. Galen, however, contends that the passage quoted by Aristotle is not the work either of Hippocrates or of Polybus, but an interpolation, and that the rest of the treatise is genuine.[163] But Galen, at the same time, admits that Dioscorides, the Commentator (he must not be confounded with the celebrated author of the Materia Medica), had marked the first part of this treatise with the sign of the obelisk, as indicating his suspicion of its being spurious, and that he held it to be the work of Hippocrates, the son of Thessalus, that is to say, of a grandson of the great Hippocrates. But, whatever may be decided regarding its authorship, a careful perusal of the treatise will satisfy any one that it is a piece of patchwork; made up of several fragments, which do not cohere properly together. It certainly also appears to me that many of the philosophical dogmata which are delivered in it do not accord well with the doctrines contained in those treatises which are universally admitted to be genuine.
After alluding briefly to the opinions of those philosophers who held that the human body is formed from the four elements, that is to say, fire, air, water, and earth, the writer proceeds to state his own doctrines regarding the four humors, namely, blood, phlegm, yellow and black bile, and the diseases which are occasioned by the prevalence of one or other of them, according to the seasons of the year, and other circumstances. The doctrines, as herein stated, are very hypothetical, and certainly, as already hinted, not in accordance with those delivered in the genuine works. It is proper to mention, however, that Galen, in several parts of his works, makes Hippocrates to be the author of the theories of the elements and of the humors.[164] The treatise contains certain general truths and rules of practice not unworthy of some consideration, such as this, that diseases are cured by their contraries, that is to say, that diseases arising from repletion are removed by evacuation, and _vice versa_; and that diseases in general are occasioned either by the food we eat, or the air we breathe, those which prevail epidemically being produced by the latter cause. All sudden changes of diet are held to be attended with danger, and to be avoided.
It is also an important rule of practice that, in venesection, blood should be abstracted from a part as distant as possible from the seat of the pain and of the collection of blood. There can be no doubt, in a word, as we have stated in the preceding section, on the authority of Galen, that Hippocrates was well acquainted with the principle of revulsion in the practice of medicine. The natural heat, or, as it is now called, the animal heat, is stated to be greater the younger the body is--a physiological doctrine strenuously advocated by Galen in several parts of his works, but more especially in the treatise “Against Lycus.”[165] The theory of the formation of urinary calculi is also discussed. The same occurs in the treatise “De Aëre,” etc., and in the work “De Morbis” (iv., 28). Allusion is likewise made to the occurrence of substances in the urine resembling hairs.[166] The last fragment of which this treatise is composed relates to fevers, the greater part of which are held to be occasioned by bile. It is said that there are four varieties of them, namely, synochus, quotidian, tertian and quartan; that the synochus is formed from the most intense bile, and comes soonest to a crisis, and the others in the order we have stated them.
This is very unlike the doctrines of fever laid down in the genuine works, and accordingly this portion of the treatise was a great stumbling-block to those among the ancient commentators who contended for the genuineness of the treatise.[167] Altogether, then, I must say, that a careful perusal of the work leads me to the conclusion that, notwithstanding the high authorities in its favor, it does not deserve to be received as a genuine production of Hippocrates.[168] XV. Περὶ διαίτης ὑγιεινῆς--_On Diet in Health_. This work is passed over unnoticed by Palladius and Erotian; and Galen, although he wrote a commentary on it which still remains, informs us that some of the elder commentators had assigned it to Polybus, the son-in-law to Hippocrates.[169] He further mentions that it had been variously referred to Euryphon, Phaon, Philistion, and others; ancient authority in its favor is, therefore, very equivocal. The modern critics are pretty unanimous in rejecting it; indeed, Littré, improving on the hint cast out by Galen, does not scruple to refer it and the preceding treatise to Polybus. Though the subject-matters of it are not, in the main, of much importance, it contains some directions for the regulation of the diet, which are by no means injudicious. One of his directions, with regard to clothing, is very different, however, from what we might have expected, considering the fondness of the ancients for the use of oil to counteract the effects of cold.[170] The author of this work directs oily garments to be used in summer, but clean ones in winter. Emetics are recommended to be taken by persons of a gross habit of body, but to be avoided by those who are slender. This rule is expressed by Celsus in the following terms: “Vomitus inutilis gracilibus et imbecillum stomachum habentibus, utilis plenis et biliosis omnibus, si vel nimium se repleverint vel parum concoxerint.”[171] The author of this treatise recommends hyssop as an emetic, and we find its use in this way not infrequently noticed in the Hippocratic treatises, but not in the works of subsequent authorities, as far as I am aware. The work concludes with a passage on diseases of the brain, which also occurs, “De Morbis” (ii.), and seems much out of place here. It is said that they are first manifested by stupor of the head, frequent passing of urine, and other symptoms of strangury; and it is added, that a discharge of water or of mucus by the nose or ears relieves these complaints.
Altogether, considering how slender the evidence is, both external and internal, in favor of the authenticity of this treatise, I can have no hesitation in rejecting it as spurious. XVI. Προρῥητικον, α’--_First Book of Prorrhetics_. XVII. Κωακὰι προγνώσεις--_Coan Prognostics_. These two works are so evidently allied to one another, that I have judged it expedient to treat of them together. The greatest difference of opinion has prevailed among the critics, both ancient and modern, with regard to them. Erotian declares expressly that the “Prorrhetics,” both first and second, are not genuine; and Galen, although he writes a commentary on the first book, complains of the difficulty he experienced in explaining certain vocables of dubious meaning contained in it,[172] and elsewhere states that the treatise is composed of extracts from the “Prognostics,” “Epidemics,” and “Aphorisms.” Foës is almost the only modern scholar of any note who stands up for the genuineness of the first book of the “Prorrhetics;” and it is decidedly rejected by Grimm, Ackerman, Haller, Littré and nearly all the other modern authorities. The “Coacæ Prænotiones” have very little ancient authority in their favor, and even Foës rejects the work with greater disdain than it would seem to merit. Of late years, the opinion has gained pretty general assent that these two treatises are more ancient than the days of Hippocrates;[173] that, in fact, they constitute the materials out of which he composed the “Prognostics,” and are the results of the observations made by the priest-physicians in the Asclepion, or Temple of Health, at Cos.
This idea is followed out with great ability by Dr. Ermerius, in his “Specimen Historico-Medicum Inaugurale de Hippocratis doctrina a Prognostice oriunda,” where, by a most ingenious and convincing process of comparison, he appears clearly to make out that the “Coacæ Prænotiones” are formed from the first book of the “Prorrhetica,” and the “Prognostics” from the “Coacæ Prænotiones.” These positions, I repeat, he seems to me to have established most satisfactorily, and I cannot hesitate to declare it as my opinion that Dr. Ermerius has thereby thrown great light on this department of the Hippocratic literature. M. Littré has justly appreciated the labors of Dr. Ermerius, and adopted his views without reserve. (v. i., p. 351.) As I shall have occasion to compare the contents of these two treatises now under consideration with the subject-matters of the “Prognostics” in my Argument to the latter, I shall confine myself at present to a few observations, selected in a good measure from M. Littré’s argument to the “Coacæ Prænotiones.”
In the first place, M. Littré makes some interesting remarks on vomicæ of the chest after pneumonia and pleurisy; but this subject will come to be treated of in the notes on the “Prognostics.” He next gives some important observations on the following passage in the “Coacæ Prænotiones,” § 418: “All sprains are troublesome, and cause intense pains at the commencement, and in certain cases occasion after-consequences; the most troublesome are those about the breast, and the most dangerous are those in which there is vomiting of blood, much fever, and pain about the mammæ, chest, and back; when all these occur, the patients quickly die; but in those cases in which they do not all occur, nor are severe, they are longer protracted; the inflammation at farthest is protracted to forty days.” He relates, in illustration of this passage, a case very much in point, from the “Journal de Médecine,” Juillet, 1843, of a healthy person who, in lifting a log of wood, strained the parts about the chest so as to experience a cracking sensation about the breast; it was followed by intense inflammation, which, in spite of plentiful depletion, ended in an empyema which opened by the fifth intervertebral space. The patient recovered.
This case is a good illustration of a species of accident frequently described in the Hippocratic Collection. He then briefly considers the question whether or not Hippocrates was acquainted with _the croup_, on which he does not give any decided opinion. In my opinion, the term _croup_ is now used in a vague sense, being applied to cases of angina, in which the inflammation spreads down to the glottis and trachea, and also to cases of bronchitis attended with a croupy cough. I am confident that pure _cynanche trachealis_, that is to say, acute disease originating in the trachea, is of very rare occurrence, at least, it certainly is so in the north of Scotland. That the ancients were well acquainted with that species of cynanche in which the disease spreads down to the windpipe there can be no doubt. See the Commentary on §§ 26, 27, Book III., of PAULUS ÆGINETA. It may reasonably be doubted whether they were not fully as well acquainted with diseases of the fauces and windpipe as the moderns are. M. Littré’s observations on sphacelus of the brain do not at all accord with the opinions of Dr. Coray,[174] nor with those advanced in the Commentary on PAULUS ÆGINETA, B. III., § 7. He thinks that Hippocrates meant by it necrosis of the cranium. Although I still so far adhere to my former opinion that by sphacelus was generally meant _ramollissement_ of the brain, I must admit that some of the passages in the Hippocratic Collection, where it is described, would bear out M. Littré’s ideas regarding it. On the subject of sphacelus, see “De Morbis,” near the beginning.
M. Littré draws, from a variety of sources, much interesting matter in illustration of § 500 of the “Coacæ Prænotiones:” “Amaurosis is produced by wounds in the eyelash, and a little above it; the more recent the wound, they see the better; but when the cicatrix becomes older the amaurosis increases.” Plattner[175] held that in this case the amaurosis is connected with lesion of the frontal nerve. Beer[176] shows that the affection of the sight is not connected with injury of the nerve, but is rather the result of concussion of the ball of the eye. Walker, and Littré himself, are rather disposed to question altogether the truth of the statement made by Hippocrates. M. Littré concludes his argument with some observations on the lethargus of the ancients, which he holds, and correctly, as I think, to be a pseudo-continual fever. My own opinion, as delivered in the Commentary on Book III., § 9, of PAULUS ÆGINETA, will be found to be very similar. Lethargus is there stated to have been a species of remittent fever, resembling the causus. M. Littré, further in illustration of this subject, gives from the works of Mr. R. Clark, an English physician at Sierra Leone, an interesting account of a sleepy-dropsy, to which the Negroes there are subject. The greater part of the contents of these treatises are mixed up by Clifton with his translation of the “Prognostics;” and Moffat gives a complete translation of this book of the “Prorrhetics.” The latter, like all the other translations by the same hand, is utterly worthless. Clifton is only culpable for having introduced confusion into the contents of works which had been so admirably arranged by Hippocrates.
XVIII. Προῤῥητικόν, β’--_The Second Book of Prorrhetics_. The reception which this work has met with from the critics, ancient and modern, appears rather singular. Erotian and Galen, who, in general, are too facile in admitting the claims of suspected works, in the present instance reject a work which many modern authorities acknowledge as genuine; as, for example, Haller, Gruner, Grimm, and, with certain qualifications, Ackerman and Kühn. I must say, however, with Foës, Littré, and Greenhill, that I cannot see how we can consistently recognize as genuine a work which has so large an amount of ancient authority against it, and none in its favor. At the same time, all must admit that the treatise in question contains nothing unworthy of the name of Hippocrates, and that, if estimated by the value of its contents, it is one of the most important works in the whole Collection. I will, therefore, give an abstract of its contents, along with my translation of the “Prognostics.” It is deserving of much attention, as being the only work we possess which gives us an insight into the method taken by the ancient physicians to gain the confidence of their patients by their mode of conducting the preliminary examination of every case. In my younger days I knew an old physician, who was an adept in this art of conciliating the confidence of his patients by anticipating their histories of their own complaints.
XIX. Περὶ ἑλκῶν--_On Ulcers_. This treatise is decidedly admitted as genuine by Galen,[177] Erotian, Celsus, and by Foës, Lemos, Mercuriali, Schulze,[178] and Vidus Vidius,[179] but is rejected by Haller, Gruner, Ackerman, and Kühn, on internal evidence, the nature of which we shall presently examine. M. Littré in so far concurs in the judgment of the authorities who reject it, although he does not admit the grounds of their decision. Gruner’s principal, indeed I may say his sole, argument against the authenticity of this work is founded on the nature of the substances recommended by the author for the treatment of ulcers; namely, such acrid and (as Gruner chooses to call them) _absurd_ medicines as arsenic, black hellebore, and cantharides. But how does it appear that these are “absurd” applications to ulcers, when even at the present day the two strongest of them, namely, arsenic and cantharides, are the means often resorted to for the cure of indolent and malignant ulcers? The same articles are recommended by Celsus (v.), and by Paulus Ægineta.[180] It is true that the titles given to certain of the prescriptions contained in this treatise are not appropriate, such as _emollient_ (μαλθακώδεα), applied to applications which contain many acrid ingredients. But in this case, as is remarked by Foës, we should consider the text to be in so far corrupt, for certainly this does not constitute a legitimate reason for rejecting the treatise _in toto_.
Vidus Vidius, in his interesting commentary on this work, mentions, as a proof of its authenticity, that most of the principles laid down by Galen for the treatment of ulcers, are taken from this part of the works of Hippocrates. In a word, agreeably to the rules laid down by me for testing the authenticity of these treatises, I do not see that I am warranted in refusing to admit the claims of this work to be considered genuine. I hold myself bound, therefore, to give a translation of it. It may be proper in this place to mention that the term ulcer (ἕλκος) is used in this treatise to signify both a wound inflicted by an external body, and a solution of continuity from any internal cause. This usage of the word is sanctioned by the older poets, as, for example, Homer (Iliad, ii., 723; Ib., xiv., 130); Pindar (Nem., viii., 50; Pyth., iii., 84); and Bion (Adonis). XX. Περὶ συρίγγων--_On Fistulæ_.
Though this work be acknowledged as genuine by Erotian, Dioscorides, Celsus, Paulus Ægineta, and by Foës and Vidus Vidius, it is set down for spurious by Haller, Gruner, and Ackerman; and even by Littré and Greenhill its claims are not fully recognized. I can see no good reason, however, for rejecting it, since, as I have stated, the ancient authority in favor of it is very strong, and I can detect nothing in the doctrines and rules of practice delivered in it which are at variance with those laid down in the treatises which all admit to be genuine. Ackerman, indeed, pretends that the theory of bile and phlegm, as being the cause of disease, does not belong to Hippocrates or his school. But this is evidently begging the question; and, moreover, Galen, who must be admitted to be a high authority in such a case, decidedly holds Hippocrates to be the author of the Theory of the Humors.[181] Galen seems to say that this treatise, and the following one on hemorrhoids, constituted one work in his time; and he does not throw out the slightest suspicion against the genuineness of either, as the words of Ackerman would lead one to suppose.[182] Vidus Vidius, although he acknowledges Hippocrates as the author of this work, holds that it had not been published by him, but had been left in an unfinished state. The argument, however, which he uses in proof of this opinion, is by no means convincing; he contends that the part which relates to inflammation of the anus is quite out of place in a work devoted to the consideration of fistulæ. But few who have much practical acquaintance with the subject will agree with him on this point, for it is well known that fistulæ, for the most part, originate in inflammation and abscess about the verge of the anus.
XXI. Περὶ αἱμοῤῥοιδων--_On Piles_. This little tract has experienced the same reception from the critics as the preceding one, that is to say, it is acknowledged as genuine by ErotianΠερὶ αἱμοῤῥοιδων and Galen, and by Foës and Vidus Vidius, but is decidedly rejected as such by Mercuriali, Gruner, Grimm, and Ackerman. I can remark nothing in it, however, which appears to me at all inconsistent with the doctrines contained in the genuine works, unless it be that in this tract the author appears to direct that in operating upon hemorrhoids they should be all extirpated, whereas in one of his Aphorisms, which is quoted by Paulus Ægineta, in his chapter on this subject, he recommends that one should be left, as an outlet to the superfluous blood. (vi., 79.) I do not know how this divergence of opinion is to be explained, but, at all events, such an apparent contradiction would not warrant us in rejecting the treatise altogether. XXII. Περὶ ίερῆς νούσου--_On the Sacred Disease_.
This work is acknowledged as genuine by Erotian, Galen,[183] and Cælius Aurelianus,[184] but is rejected by Lemos, Mercuriali, Haller, Gruner, Ackerman, Kühn, and even by M. Littré, although the last of these admits that the grounds upon which it had been refused a place among the genuine works are very equivocal. I feel very much at a loss what to decide with regard to it. It is unquestionably the work of a man possessed of a highly cultivated mind, free from the popular superstition of his age, and familiarly acquainted with comparative anatomy, and having no contemptible knowledge of human physiology. There is, in fact, no name, whether in ancient or modern times, to which it might not do honor. That it is not unworthy, then, of the great Hippocrates, all must allow, but whether or not he be the actual author of it, there is much difficulty in determining satisfactorily. That, in certain respects, it is very unlike his other works, must be admitted; the talent which it displays is more of a reflective than of a perceptive nature, which is the reverse of the common character of Hippocrates, who, in his genuine works, evidently evinces a disposition to trust to accurate observation rather than to acute ratiocination.
The style, too, I must admit, is more diffuse than the true Hippocratic style generally is. All this might, no doubt, be accounted for, upon the supposition that the work was addressed to the general reader, and not to the professional. Other reasons might be imagined, to account for the diversity of style and matter, but these I shall not occupy time in discussing, as I have decided upon giving a translation of it, so that the English reader may be enabled to judge for himself as to its genuineness. Whether the tract in question be the work of Hippocrates, or, as some have supposed, of his philosophical friend Democritus,[185] there can be little or no doubt that it is a production of that age, for it appears to me that their contemporary, Plato, has evidently made reference to it. Thus, in that portion of his “Timæus” which treats of the causes of diseases, he clearly seems, in accounting for epilepsy, to have had in view the doctrines contained in this treatise. For although he uses the term “sacred disease,” and applies “most divine,” as an epithet to the cavities (_ventricles_?) of the head, he still, in imitation of the author of this work, accounts for the disease upon natural causes, that is to say, from derangements of the pneuma and phlegm.[186]
Ideas discussed in this chapter
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