Chapter XIII: Appendix: TO

THE BOOK OF PROGNOSTICS.

As announced in the Preliminary Discourse (Sect. II., 18), I shall now proceed to give an abstract of the principal matters contained in the SECOND BOOK OF PRORRHETICS, which appear to me to be highly interesting, and as they relate to the subjects treated of in the Prognostics, they may be more suitably introduced here than in any other place.

The author commences the treatise with expressing his disapproval of certain modes of making prognostics which he had seen practiced. He says he had heard of many and famous predictions having been made by physicians, such as he himself did not pretend that he could make. Such, for example, as for a physician to call in upon a patient who was looked upon as being in a desperate condition by another physician, and predict that he would not die, but would lose his sight. Or to predict with regard to another patient supposed to be in a bad way, that he will recover, but will become lame of a hand. And of a third who, to all appearance, cannot recover, to predict that he will get well, but that his toes will blacken and putrefy. Similar predictions are related under this class. Another mode of prediction is to prophecy to buyers and traders, to one death, to another madness, and to the rest diseases, and that from what is now occurring, or has occurred before, and all the predictions to turn out true. Another kind of predictions relates to Athletæ, and those who practice gymnastic and laborious exercises for the cure of diseases, where the practitioner pretends to so much exactness, that if the patient is guilty of any act of omission or commission in regard to food, drink, or venery, the physician will detect it. He himself makes no pretensions to any such skill in divination, but announces it as his object to describe the symptoms by which it may be known whether a man will die or live, and whether his disease will be of short or of long duration. With regard to the predictions of abscesses, lameness, death, or madness, the author holds that they can only be made after the morbid conditions leading to them have fairly set in. He strongly disapproves of all ostentatious modes of making predictions, and gives it as his advice that in all such cases the greatest prudence and reserve should be observed, since if a man become an adept in this art of prognostications, he will gain great credit with his patient, whereas if he fall into mistakes, he will incur odium, and will be looked upon as being deranged.

With regard to the prognostics made by those who practice gymnastics, he recommends them not to be made in a charlatan manner, but with suitable caution, and directs minute attention to be paid to the circumstances of the patient, which one has superior advantages in observing under this system. He says, for example, that a physician who feels a patient’s belly and pulse, pays attention to the breathing at the nostrils, and listens to the speech, and sound of the respiration, will be less likely to be deceived in forming a prognostic on his patients than he who neglects these things. He expresses himself, however, as being incredulous as to the possibility of detecting any little transgressions of orders which a patient may commit, although greater departures from instructions may be suspected. After some general observations in respect to diet, and other matters relating to it, he proceeds to a more circumstantial description of the symptoms upon which a prognosis is to be founded. And first, with regard to the alvine dejections, those of persons who live a laborious life, and use food and drink sparingly, are small and hard, and are passed every day, every third day, or every fourth day, but if they pass the last period there is danger of the man’s being seized with fever or diarrhœa. When the stools are so liquid that they do not assume a shape, they are all of a worse character in these cases. The dejections of persons who lead an active life are less copious than those of the indolent, provided they use the same amount of food. Liquid dejections taking place on the seventh day, and quickly coming to a crisis, are beneficial, if they occur all at once, and are not repeated. But if accompanied with fever, or if the diarrhœa is prolonged, all such dejections are bad, whether bilious, pituitous, or of indigested matters, and require a particular regimen and mode of treatment.

With regard to the urine, it should be in proportion to the drink that is taken, and somewhat thicker than the fluid that is drunk. If it be more copious than natural, this indicates either that the patient has disobeyed orders as to the amount of his drink, or that his body is in a state of atrophy. If the urine is passed in deficient quantity, with a noise, it indicates either that the man stands in need of purging, or that the bladder is diseased. A small quantity of blood passed without fever and pain does not indicate anything bad, but proves a solution to a state of lassitude. But if in large quantity, with the addition of any of these symptoms, it is to be dreaded. But if the urine be passed with pain, and if pus be passed along with the urine in a fever, the physician should announce that the patient will thus be relieved of his complaints.[521] Thick urine having a thin sediment indicates some pain and swelling about the joints. All the other sediments which occur in the urine of persons who practice exercises are connected with disease about the bladder; this will be clearly shown by the obstinate pains with which they are accompanied. The author, although he states that he had been conversant with the teachers of prognostics from urine, and their children and disciples, seems to express himself doubtful as to the possibility of acquiring a great degree of accuracy in regard to these matters.

Respecting dropsy, consumption, gout, and epilepsy, he states generally that if they are hereditary they are difficult to remove. A favorable prognosis is to be formed in dropsy when the patient’s viscera are sound, when his strength is firm, the digestion and respiration natural, when he is free of pain, the temperature of the body moderate, and when there is no wasting of the extremities. It is favorable when there is no cough, thirst, nor dryness of the tongue, when the bowels are easily moved by medicine, and when, at other times, the dejections are consistent. Dropsy, supervening, along with fever, upon a great discharge of blood, is of a most intractable nature, and the physician should intimate the danger to some other person beforehand. When great swellings suddenly subside and rise again, there is more hope in such a case than in dropsies connected with a discharge of blood. He concludes his observations on dropsies with the remark, that they are apt to deceive the patients, so that they desert their physicians and thus perish.

With regard to consumptive patients, he says, he has the same observations to make with regard to the sputa and cough as he had written with regard to empyema.[522] If the patient is to recover, the sputa should be white, equable, of one color, without phlegm; the defluxion from the head should be determined to the nose; there should be no fever, nor anorexia, nor thirst; the alvine discharges firm, proportionate to the ingesta, and the patient should not get thin. The best form of the chest is when it is quadrangular and hairy, and when the cartilage is small, and covered with flesh. Young persons, who become affected with empyema from determination (metastasis?), or fistula, or from any other similar cause, or from the retrocession of an abscess, do not recover unless many of the favorable symptoms combine in the case. They die, most commonly, in autumn, which proves peculiarly fatal in protracted diseases. Of all others, virgins, and women suffering from amenorrhœa, seldomest recover; and in their cases there is no hope unless menstruation be restored. All sexes, he seems to say (but the meaning appears to me rather ambiguous), have a better chance of recovery, when there is a discharge of blood, especially in those cases in which there are pains in the back and chest, connected with black bile; and if, after the evacuation, there be a remission of the pain; if the cough and fever do not set in; and if the thirst be tolerable. He seems to state (but the text is in an unsatisfactory condition), that relapses take place unless there be deposits in the place, the best of which are those which contain most blood; and that in those cases in which there are pains in the chest, if the patients get emaciated, and cough, and a dyspnœa supervenes, without fever or empyema, they should be asked whether, when they cough, and have difficulty of breathing, the sputa be compact, and attended with little smell.

With regard to persons affected with the gout, those who are aged, have tofi in their joints, who have led a hard life, and whose bowels are constipated, are beyond the power of medicine to cure. But, the best natural remedy for them is an attack of dysentery, or other determination to the bowels. Persons, under opposite circumstances, may be cured by a skilful physician.

The prognosis in epilepsy is unfavorable when the disease is congenital, and when it endures to manhood, and when it occurs to a grown person, and without any obvious cause. When connected with the head it is particularly to be apprehended, but least so when it seems to be derived from the hands or feet. The cure may be attempted in young persons, but not in old.

In the case of children, he mentions various complaints, such as distortion of the eyes, tubercles about the neck, pain in the bowels, omental hernia, etc., which, upon inquiry, will be found to be the consequences of an attack of epilepsy.

The judgment to be formed in the case of ulcers is to be founded on the age of the patient, the situation of the sore, and its appearance.

Strumous tubercles, which end in suppuration, occur most frequently in young persons. Adults are subject to bad favi, internal cancers, and herpetic sores, after epinyetis, until they pass sixty. Old persons are subject to cancers, both deep-seated and superficial, which never leave them. They are particularly intractable when seated in the armpits, the loins, and the thighs.

Of affections of the joints, the most dangerous are those seated in the thumb and great toe. When there is a chronic sore on the side of the tongue the surgeon should examine whether it be not occasioned by the sharp edge of a tooth.[523]

The most dangerous wounds are those which implicate the large veins (blood-vessels), in the neck and groin; then those of the brain and liver; next, those of the bowels and bladder. These cases are all dangerous, but not uniformly fatal, as some suppose. Much depends upon constitution, as to liability to fever and inflammation after a wound. Sometimes, also, the wounds of smaller vessels prove fatal by inducing hemorrhage, fever, or delirium. In all recent wounds, however, the physician should endeavor to afford assistance.

Of spreading ulcers, the most fatal are such mortifications as are very deep, black, and dry; and those are bad and dangerous which are accompanied with a black ichorous discharge. Those which are white and mucous are less dangerous, but are more subject to relapse, and become inveterate. Herpes is the least dangerous of the spreading sores, but is most difficult to remove about deep-seated cancers.[524] An ephemeral fever, with very white and thick pus, is beneficial in such a case; also, sphacelus of a nerve, of a bone, or of both, in deep-seated and black mortifications. For a free discharge of pus takes place and carries off the mortification.

The prognostics in wounds of the head are given in nearly the same terms as laid down in the treatise on that subject, and therefore I need not enter minutely into an exposition of what is stated regarding them here. Those in the upper part of the head, more especially if they implicate a suture, are said to be particularly dangerous. The author directs the surgeon to inquire whether, at the time of the accident, the patient fell down or became comatose, as in this case greater danger is to be apprehended.

Large wounds of the joints, if they involve the connecting nerves, necessarily leave the limb maimed. Several other observations connected with these injuries are added, of which one of the most important is the direction to practice flexion and extension of the limb, frequently, with the view, no doubt, of preventing rigidity of the joint.

Large excisions in the arm becoming inflamed end in suppurations, which require to be evacuated by the knife or cautery. Injuries of the spinal marrow, whether from disease or accident, are attended with loss of motion and sensibility, retention of the alvine and urinary discharges; but, after a time, involuntary evacuations take place, which are soon followed by death. When the throat is frequently filled with blood, and there is no headache or cough, nor any other morbid symptoms, the physician should examine whether there be not an ulcer or a leech in the part.

With regard to the eyes, the prognostics are given with so much prolixity of detail that I must be content with a brief abstract of them. Much attention is paid to the characters of the discharge from the eyes in diseases of them, namely, of the glutinous matter and tears; thus, if the gum be white and soft, the tears mixed with it not very hot, and the swelling light and loose, under these circumstances the eyelids are glued up during the night, so that the eye is free of pain, and thus the disease is without danger, and of short duration. The other appearances of the eye, and the discharges, are also minutely given. When the discharge is green or livid, the tears copious and hot, a burning heat in the head, and pains darting through the head to the eye, there must necessarily be ulceration in the eye; and there is much reason to apprehend that it will burst. If, when one can get a sight of the eye, it should be found burst, and the pupil projecting above the rupture, it is bad and difficult to restore; and, if there be sloughing, the eye will be wholly useless. According to the form and depth of the ulcers must be the subsequent cicatrices. These are minutely described according to their different varieties. Mention is also made of the prognostics from the eyes in fevers, as described by the author in another work. It is most likely that allusion is here made to the first book of “Prorrhetics.” In conclusion, the surgeon is directed to pay great attention to the state of the urine in diseases of the eyes.

Dysenteries, when they set in with fever, alvine discharges of a mixed character, or with inflammation of the liver, or of the hypochondrium, or of the stomach, such as are painful, with retention of the food and thirst, all these are bad; and the more of these symptoms there are, the greater the danger; and the fewer, the more hope is there of recovery. Children from five to ten years of age are the most apt to die of this complaint; the other ages less so. Such dysenteries as are of a beneficial nature, and are attended with blood and scrapings of the bowels, cease on the seventh, or fourteenth, or twentieth, or thirtieth day, or within that period. In such cases even a pregnant woman may recover and not suffer abortion.

All cases of lientery are said to be of a bad character when they are continued and protracted, both day and night, and when the dejections are either very crude, or black, soft, and fetid; for they occasion thirst and determine the fluids otherwise than to the bladder, give rise to ulcerations (aphthæ?) in the mouth, redness and ephelis[525] of all colors, and at the same time the belly is in a state of ferment, and has a foul, wrinkled appearance externally. This disease is most to be dreaded by old persons; it is formidable to men of middle age, but less so in the other ages. The indications of cure, it is acutely stated, are to determine the fluids to the urine, to relieve the body from its atrophy, and change the color of the skin.

All the other varieties of diarrhœa without fever are of short duration and mild; for they will all cease when washed out, or of their own accord. The discharge may be predicted as about to cease when, upon touching the belly, there is no movement, and flatulence passes with the discharge. Eversion of the gut takes place in the case of middle-aged persons having piles, of children affected with the stone, and in protracted and intense discharges from the bowels, and of old persons having mucous concretions (scybalæ?).

Women may be judged of whether they are in a fit state for conception or not by attending to the following circumstances:--In the first place to their shapes. Women of smaller stature more readily conceive than taller persons; the thin than the fat; the white than the ruddy; the dark than the pale; those who have prominent veins than the contrary. In oldish women it is bad to have much flesh, but a good thing to have swelled and large breasts. In addition, inquiry should be made whether or not the menstruation be regular as to time and quantity. And it should be ascertained whether the uterus be healthy, of a dry temperament, and soft; neither in a state of retraction nor prolapsus; and its mouth neither turned aside, nor too close, nor too open. When any of these obstructions come in the way, it is impossible that conception can take place.

Such women as cannot conceive, but appear green, without fever, and the viscera are not in fault; these will say that the head is pained, and that the menstrual discharge is vitiated and irregular. But such of these as have the proper color, are of a fat habit of body, the veins are inconspicuous, they have no pains, and the menses either never appear at all, or are scanty and intense, and this is one of the most difficult states of sterility to remove. In other cases the health is not to blame, but the fault lies in the position of the womb. The other contingencies in this place are attended with pains, discoloration, and wasting.

Ulceration in the womb from parturition, an abscess of a chronic nature, or from any other cause, is necessarily accompanied with fevers, buboes, and pains in the place; and if the lochial discharge be also suppressed, all these evils are more intense and inveterate, along with pains of the hypochondrium and head. And when the ulcer heals, the part necessarily is smoother and harder, and the woman is less adapted for conception. If, however, the ulceration be in the right side only, the woman may conceive of a female child, or if in the left, of a male. When a woman cannot conceive, and fever comes on with a slight cough, inquiry should be made whether she has any ulcer about the uterus, or any other of the complaints I have described; for if she has no complaint in that region to account for her loss of flesh and sterility, it may be expected that she will have vomiting of blood, and the catamenia will necessarily be suppressed. But if the fever be carried off by the evacuation of blood, and if the catamenia appear, she will then prove with child. But if looseness of the bowels having a bad character take place before there is an evacuation of blood, there is danger lest the woman perish before a vomiting of blood can take place.

In cases of false conception, in which women are deceived by the non-appearance of the menses, and by the increase of the belly and movement in it, they will be found to have had headache and pains about the neck and hypochondria, and there is no milk in the breasts except a little of a watery character. But when the swelling of the womb passes away they will conceive, unless there be any other impediment. For this affection is beneficial in so far as it produces a change in the uterus, so that afterwards the woman may prove with child. Women with child have not these pains unless the headache be habitual to them, and in addition they have milk in their breasts. Women affected with chronic discharges are to be asked whether they have pains in the head and loins, and in the lower part of the belly, and whether their teeth be set on edge, and if they have dimness of sight, and noises in their ears. Such women as vomit bile for several days while in a fasting state, though they are not with child nor have fever, are to be asked whether they have vomited up round lumbrici, and if they say not, they should be warned that this will happen to them. This affection happens principally to married women, then to virgins, and less seldom to other people.

Pains without fever are not deadly, but mostly prove protracted, and have many changes and relapses. Several varieties of headache are described, and the prognosis in each laid down. The natural cure of them is a coryza, a discharge of mucus from the nose, or sneezing. Pains spreading from the head to the neck and back, are relieved by abscesses, expectoration of pus, hemorrhoids, exanthemata on the body, or pityriasis on the head.

Heaviness and pruritus in the head, either in a part or through the whole of it, if, on inquiry, they extend to the tip of the tongue, indicate a confirmed disease, and one difficult to remove. They are best removed by the occurrence of an abscess. But those cases which are accompanied with vertigo are difficult to cure, and are apt to pass into mania. Other diseases in the head, of a very strong and protracted character, occur to both men and women, but especially to young persons, and virgins at the season of manhood, and especially at the catamenial period. Women, however, are less subject to pruritus and melancholic affections than the men, unless the menses have disappeared.

Both men and women who have long had a bad color, but not in the form of jaundice, are subject to headaches, eat stones and earth, and have piles. Those who have green colors, without decided jaundice, are affected in like manner, only instead of eating stones and earth, they are more subject to pains in the hypochondriac region. Persons who are pale for a length of time, and have the face tumid, will be found to have headache, or pains about the viscera, or some disease in the anus; and in most cases, not one, but many, or all these evils make their appearance.

Nyctalopia is most apt to attack young persons, either males or females, and to pass off spontaneously on the fortieth day or in seven months, and in some cases it endures for a whole year. Its duration may be estimated from the strength of the disease and the age of the patient. They are relieved by deposits which determine downwards, but these rarely occur in youth. Married women and virgins that have the menstrual discharge regular are not subject to the complaint. Persons having protracted defluxions of tears who are attacked with nyctalopia, are to be questioned whether they had any previous complaint in the head.

Such persons as have frequent pains in the vertex and temples, without fever or loss of color, unless they have some other obvious deposit in the face, or speak in a rough tone, or have pain in the teeth, may be expected to have a hemorrhage from the nose. Those who have bleeding at the nose, although they may appear to be otherwise in good health, will be found to have enlarged spleen, or pain in the head, or flashes of light before their eyes. Most of these patients have both headache and affection of the spleen.

The gums are diseased and the mouth fetid in persons who have enlarged spleens. But persons who, although they have enlarged spleens, are exempt from hemorrhages and fœtor of the mouth have malignant ulcers on the legs and black cicatrices. But if they have any obvious deposit in the countenance, or if their speech be rough, or if they have toothache, a hemorrhage from the nose may be expected. Those who have great swellings below the eyes will be found to have enlarged spleens. And if there come on swellings in the feet, and if they appear to be dropsical, the belly and loins must be attended to.

Distortions of the countenance, if not sympathetic with some other part of the body, quickly pass off either spontaneously or by remedial means. The others are of an apoplectic nature. In other cases, when the diseased part wastes from want of motion, there can be no relief afforded. But when wasting does not take place there may be recovery. With regard to the time when this may occur, it is to be prognosticated by attending to the severity of the disease, to its duration, to the age of the patient, and to the season, it being known that of all cases the inveterate, and such as are the consequences of repeated attacks, are the worst, and the most difficult to remove, and those in aged persons. Autumn and winter are more unfavorable seasons for such complaints than spring and summer.

Pains in the shoulder, which, passing down the arms, occasion torpor and pains, do not usually terminate in deposits, but the patients get better by vomiting black bile. But when the pains remain in the shoulders, or extend to the back, the patients are relieved by vomiting pus or black bile. They are to be judged of thus:--If their breathing be free, and if they be slender, it is rather to be expected that they will vomit black bile. But if they have more difficulty of breathing, and if there is any unusual color on the countenance, whether reddish or black, it is to be expected that they will rather spit blood. It should also be attended to whether there be swellings on the feet. This disease attacks men most violently from forty to sixty years of age. At this period of life ischiatic diseases are most troublesome.

Ischiatic diseases are to be thus judged of:--In the case of old persons, when the torpor and coldness of the loins and legs are very strong, and when they lose the power of erections, and the bowels are not moved, or with difficulty, and the fæces are passed with much mucus, the disease will be very protracted, and it should be announced beforehand that the disease will not last shorter time than a year from its commencement; and amendment is to be looked for in spring and summer. Ischiatic diseases are no less painful in young men, but are of shorter duration, for they pass off in forty days; and neither is the torpor great, nor is there coldness of the legs and loins. In those cases in which the disease is seated in the loins and leg, but the patient does not suffer so much as to be confined to bed, examine whether any concretions have taken place in the hip-joint, and make inquiry whether the pain extends to the groin; for if both these symptoms be present, the disease will be of long duration. And the physician should also inquire whether there be torpor in the thigh, and if it extend to the ham; and if he says so, he is to be again asked if it spreads along the leg to the ankle of the foot. Those who confess to the most of these symptoms are to be told that the limb will be sometimes hot and sometimes cold; but those persons in whom the pain leaves the loins, and is turned downwards, are to be encouraged; but when the disease does not leave the hip and loins, such persons are to be warned that it is to be dreaded. In those cases in which there are pains and swellings about the joints, and they do not pass off, after the manner of gout, you will find the bowels enlarged, and a white sediment in the urine; and, if you inquire, the patient will admit that the temples are often pained, and he will say that he has nightly sweats. If the urine have not this sediment, nor do the sweats take place, there is danger either that the joints will become lame, or that the tumor called meliceris will form in it. This disease forms in those persons who in their youth had epistaxis, and in whom it had ceased afterwards. They are to be interrogated whether they had discharges of blood in their youth, and if they have pruritus in the breast and back. And the same thing happens to those who have severe pains in the bowels, without disorder of them, or who have hemorrhoids. This is the origin of these complaints. But if the patients have a bad color, they are to be interrogated whether their head be pained, for they will say that it is. In those cases in which the bowels are pained on the right side, the pains are stronger, and especially when the pain terminates in the hypochondrium at the liver. Such pains are immediately relieved if borborygmi take place in the belly. But when the pain ceases, they pass thick and green urine. The disease is not deadly, but very protracted. But when the disease is already of long standing, the patients have dimness of sight in consequence of it. But they are to be interrogated whether, when young, they had a flow of blood, and regarding the dimness of vision, the greenness of the urinary discharge, and regarding the borborygmi, if they took place and gave relief; for they will confess to all these symptoms.

Lichen, leprosy, and leucè, when they occur in young children and infants, or when they appear at first small, and gradually increase in the course of a long time--in these cases the eruption is not to be regarded as a deposit, but as a disease; but when they set in rank and suddenly, this case is a deposit. Leucè also arises from the most fatal diseases, such as the disease called phthisis;[526] but leprosy and lichen are connected with black bile. These complaints are the more easily cured the more recent they are, and the younger the patients, and the more soft and fleshy the parts of the body in which they occur.

ON REGIMEN IN ACUTE DISEASES.

THE ARGUMENT.

In this treatise two very important questions are discussed: first, a nosological question, regarding the proper distinction of diseases from one another; and secondly, a therapeutical, respecting the rules by which the regimen in acute diseases ought to be regulated. The former of these is of a polemical nature, being an attack directed against the physicians of the Cnidian school of medicine, who distinguished diseases from one another in an arbitrary manner, from incidental varieties in their constitution, and without proper attention to their true constitution and identity. As will be seen in the annotations, the Cnidians pretended to recognize several varieties of disease connected with bile,--several fanciful divisions of diseases of the bladder, and so forth; to which mode of distinguishing diseases there would obviously be no end, since of incidental varieties in any case there can be no limit. The other question discussed in this treatise relates to what may justly be pronounced to be one of the most important points connected with the practice of medicine, namely, the proper regimen in acute diseases; that is to say, in idiopathic fevers and febrile diseases, comprising most of those diseases now classed under the head of _Zymotic_, and which constitute by far the highest item in our bills of mortality at the present day. Our author distinguishes them by the names of pleurisy, pneumonia, phrenitis, lethargy, causus, and their cognate diseases, including fever of the continual type. Now it is to be borne in mind, that the phrenitis,[527] lethargy, and causus of Hippocrates, were all epidemic fevers, so that, with the exception of pleurisy and pneumonia, all the diseases here treated of are fevers of the country in which Hippocrates resided. One, then, cannot well imagine a question which from the commencement of the medical Art must have been felt of higher importance than this,--how so numerous and formidable a class of diseases ought to be treated. In the attempt to solve it, every imaginable mode of treatment, as might have been expected beforehand, was tried, and its effects determined by experience. Herodicus, the master of Hippocrates in gymnastics, applied his panacea in the treatment of febrile diseases, and, as we are informed, with the most disastrous results. “Herodicus,” says the author of the sixth Book of Epidemics, “killed persons in fever by promenading, much wrestling, and fomentations.” (§ iii., 18.) It may _now_ appear wonderful that so extraordinary a mode of practice should have ever been attempted in this case; but while men of all ranks continue to resort for the cure of all sorts of diseases to any individual who has got a single hobby with which he constantly works to his own profit, whether it be _gymnastics_, or _shampooing_, or the _wet sheet_, we may expect to hear that such rash experiments have been repeated. Truly mankind pay as dearly for their tame submission to the insane practices of professional chiefs, as the Greeks are represented by the poet to have suffered from the follies of their princes:

“Quicquid delirant Reges, plectuntur Achivi.”[528]

And surely it is much to be desired that men would learn a lesson from the Past, and not allow every new page in the history of society and of the profession to furnish a repetition of the oft-told tale of supine credulity on the one side, and of audacious folly on the other. From what has been stated, it will readily be understood that it was soon settled that active exercise is inadmissible in febrile diseases.[529] It would next come to be determined, what rule was to be followed with regard to the administration of food in fevers. On this point, as will be seen below in our annotations, the most diametrically opposite plans of treatment were essayed. One authority administered the most highly nutritious articles of food, namely, fleshes, to his patients, while, on the other hand, some wasted them by enforcing a total abstinence for several days. Experience, we may be well assured, was not long in deciding against both the starving and the glutting system: the palled appetite would soon refuse to accept of solids, and the parched tongue would speedily crave some allowance of liquids. Even before the days of Hippocrates, there is every reason to suppose that these extreme modes of treatment had been abandoned; but still he complains that in his time many important points in the treatment of acute diseases were wholly undetermined, such as the following: whether plain drink, that is to say water, was to be administered;--or, water seasoned by the admixture of something farinaceous, such as the decoction of barley;--whether the same should be given so thick as to constitute a nutritious gruel, or strained so as to form merely a drink;--whether wine should be given in small quantity, or more copiously;--whether any of these things should be given from the commencement of the disease, or not until after an interval of certain days. Hippocrates informs us that the most discordant opinions prevailed upon these points, and his professed object, in this treatise, is to reduce the rules of practice to certain fixed principles. How our author performs this task, the reader is left to judge for himself; it may be interesting, however, to know, that Galen with all his devoted admiration of Hippocrates, is not disposed to admit that his solution of the question at issue is quite lucid and satisfactory. This opinion Galen pronounces on two separate occasions; in his commentary on this treatise, and in his great Work “On the Tenets of Hippocrates and Plato.” As I look upon his observations contained in the latter Work to be of great importance toward understanding the bearing of this treatise, I shall not scruple to introduce a translation of the greater part of them in this place.

The ninth book of the Work we have mentioned opens with an elaborate disquisition on the logical principles which ought to guide us in deciding with regard to identity and difference, both in Philosophy and Medicine: on the former of these subjects he quotes freely from Plato, and on the other from Hippocrates. Coming, then, to the question in hand, he says:--“And thus Hippocrates proceeded in the work ‘On the Regimen of Acute Diseases,’ finding fault with the Cnidian physicians, as being ignorant of the differences of diseases with regard to genus and species; and he himself points out the definitions according to which that which appears to be one, being divided becomes many, not only in the case of diseases, but also in that of all other things; in which we find that many of the most celebrated physicians fall into mistakes, even with regard to the remedies. For some, coming to the particular use of them, have established a most immethodical method of instruction; whilst others, stating a very general precept, lay down a rule which at first sight appears very methodical, but in truth is very bad, and hence they disagree among themselves; some, as for example those treating of the remedy for a certain affection, such as pleurisy, declaring it to be venesection, others purging, some fomentations by means of sponges, and others of bags, or something of the like kind. And they differ, in the same manner, with regard to the use and disuse of the bath, of oxymel, of hydromel, and of water, of wine, and of ptisan, either giving of the strained juice only, or of the barley portion only; and some, with regard to food, giving discordant decisions as to the differences of the sick, and the indications which a pleuritic affection requires. And that he, as being the first discoverer, has handled these subjects in rather a confused manner, I have shown in my Commentary on the treatise which has been improperly entitled, ‘Against the Cnidian Sentences,’ and ‘On the Ptisan.’ But in order that those who are desirous of learning, may have a clear exposition of this question in a brief form, I shall not scruple to give here a summary of it. In the commencement of pleuritic attacks, when the side is just beginning to be pained, inasmuch as the nature of the disease is not yet obvious, he directs fomentations, otherwise called heating applications, to be tried, and he explains the materials of which they consist. And then, if the complaint is not removed, it is to be ascertained whether the patient took food recently, and whether the bowels have been moved, and he gives instructions what should be done in these cases. But if the disease does not yield to these means, he gives definitions of those cases which require venesection and purging, and those in which one should use hydromel for drink, or oxymel, or water until the crisis, without giving any food; and those in which the juice of ptisan is to be used, or the barley along with it, and when food is to be administered. In like manner, with regard to the administration of wine, it is determined in what cases it is to be given, and in what not, and when, and of what quality. And in like manner respecting baths, and other matters of the like kind. And as a twofold mistake is committed with regard to the divisions (of diseases), some doing it in a deficient manner, and others carrying this process to excess, Hippocrates, finding fault with both, expresses himself thus, in the beginning of the book: ‘Some of them, indeed, were not ignorant of the many varieties of each complaint, and their manifold division, but when they wish to tell clearly the members (species?) of each disease, they do not write correctly; for the species would be almost innumerable if every symptom experienced by the patients were held to constitute a disease, and receive a different name.’ And again, respecting the remedies, as being deficient, he writes thus: ‘And not only do I not give them credit on this account, but also because those they use are few in number.’ Afterwards, assuming what is of great importance to the question, he does not give a clear solution of it, and therefore the whole bearing of the question is misunderstood by many physicians. I have, therefore, given an exposition of the whole subject, in my first Commentary ‘On the Regimen of Acute Diseases;’ and it is necessary to show the import of it briefly. The question is given by Hippocrates in the following terms: ‘But it appears to me that those things are more especially deserving of being consigned to writing, which are undetermined by physicians, notwithstanding that they are of vital importance, and either do much good or much harm. By undetermined, I mean such as those: wherefore certain physicians, during their whole lives, are constantly administering untrained ptisans, and fancy they thus accomplish the cure properly, whereas others take great pains that the patient may not swallow a particle of the barley (thinking it would do much harm), but strain the juice through a cloth before giving it: others, again, will neither give thick ptisan nor the juice, some until the seventh day of the disease, and some until after the crisis. Physicians are not in the practice of mooting such questions, nor perhaps, if mooted, would a solution of them be readily found, although the whole Art is thereby exposed to much censure from the vulgar, who fancy that really there is no such science as Medicine, since, in acute diseases, practitioners differ so much among themselves, that those things which one administers, as thinking it the best that can be given, another holds to be bad.’ And a little afterwards: ‘I say, then, that this question is a most excellent one, and allied to very many others, and some of the most vital importance in the Art: for, that it can contribute much to the recovery of the sick, and to the preservation of health in the case of those who use it well, and that it promotes the strength of those who take gymnastic exercises, and is useful to whatever one may wish to apply it.’ The inquiry regarding the differences of opinion among practitioners, he says, is of the greatest consequence, not only to the sick, for the recovery of health, but also to those in health, for the preservation of it, and to those who practise it for the recovery and preservation of deportment. And he afterwards adds, ‘to whatever one may wish;’ as indicating that the solution of this inquiry is applicable not only to medicine but to all the other arts to which one may choose to apply it. For it is wonderful that physicians practising an art, in which the remedies applied may be determined by experience whether they are beneficial or hurtful, should yet make the most conflicting statements respecting those things which are beneficial and those which are prejudicial. For, in philosophy, it is not to be wondered at that there should be no end to most disputes, since these things cannot be clearly determined by experience; and therefore some hold that the world is uncreated, some that it was created, some that there is nothing beyond its boundary, some that there is, and some declaring what that which is contained is, and some pronouncing it to be a vacuum, having no substance in it, and some holding that worlds in inconceivable numbers, and infinite, exist. For such discrepancy of opinion cannot be set at rest by any clear appeal to the senses. But it is not so with respect to the benefit or injury derived from remedies administered to the body, since the differences among physicians, in this case, may be decided by experience, as to which of them are beneficial and which injurious. Wherefore the solution of this question is not very clearly stated by Hippocrates, and on that account it has excited the observation of almost all the commentators on this book. It is this: some of the sick require abstinence from food, until the disease come to a crisis, and some require food, and of these some require the unstrained ptisan, and some the strained, as also some require still more substantial food, and, moreover, some require oxmyel, or hydromel, and some water, or wine. Wherefore to those physicians who have cultivated the Art upon experience alone, that only appears beneficial which perchance has seemed useful in most cases. Neither do they venture to try the opposite mode of regimen, for fear of failure. He alone, then, who knows the constitution of the sick, and the nature of the disease, and the powers of the remedy which is administered, and the time in which it ought to be used, will be able rationally to devise the remedy to be applied, and confirm his expectation of it by experience.”

Galen gives other remarks, not devoid of interest, on the same subject, but these want of room obliges me to pass by. I may mention, however, that after giving, in the form of extract, the passage on wine (§ 12), he makes the remark, that if the question be put whether wine should be given to persons in fever, the proper answer to it would be, that it is to be given in some certain cases, and in others not. (See tom. v., p. 773, ed. Kühn.) Thus far Galen.

Before quitting this subject, I would beg leave to make a few remarks on some points of medical practice which are here treated of, and which appear to me to be either overlooked, or not satisfactorily determined at the present day; and also upon some modern innovations on the practice of the ancients. As far as I have observed, it is quite a common practice now to administer food, such as farinaceous gruels, or animal broths, without much reserve, after evacuation of the system either by purging or bleeding. Now it will be seen that Hippocrates forbids food to be administered at such a season, as the body, being weakened by the depletion, is unable to digest it properly, and consequently what is given as a support to the frame proves a load to it. To the reason here assigned for this practice, might be added that the vascular system, having been emptied, greedily absorbs the food before it is properly digested. I am not sure that this physiological principle is stated in any of the works of Hippocrates, but it is frequently to be met with in the works of Galen, and in those of the toxicologists, from Nicander to Actuarius. See PAULUS ÆGINETA,