The genuine works of Hippocrates, Vol. 1 · Hippocrates
CLASSIS IV.
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.
“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?
Ideas discussed in this chapter
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