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