Chapter VI: Section II (4)

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. Perhaps, then, it must be admitted that there is some inconsistency in allowing the one a place among the genuine works of Hippocrates, and refusing the similar claims of the other. That the work in question contains a most interesting summary of what were regarded, in ancient times, as great medical truths, cannot be doubted. From the condensed form in which the subject matters of it are presented, it will readily be apprehended that they do not well admit of being given in the form of an abstract, and that any specimens of its contents will afford but a very imperfect idea of its value as a whole. I would remark, at the outset, that the title of the work, “On the Humors,” appears not very applicable, since very few of the paragraphs relate to the humors; in fact, as already hinted, the treatise may be said to be a _recueil_ of various observations gathered out of other works. I also feel at a loss to account for M. Littré’s disposition to rank it as the eighth book of the Epidemics, as it bears no resemblance either in form or matter to that work; the one consisting of isolated observations and of particular facts, and the other of general principles; and the style of the one being comparatively full, whereas the other is remarkably succinct, so as to be nearly unintelligible in many places. Take the following as a specimen of it: “The earth is to trees what the stomach is to animals; it nourishes, heats, and cools; cools when emptied, heats when filled, as the earth when manured is hot in winter, so is it with the stomach.” This important observation, that the earth, in connection with the vegetable productions, is analogous to the stomach in animals, is repeated by Aristotle and other of the ancient philosophers.[237] The author makes the important remark, (§ 14,) that we ought to study the condition of the body previous to the season in which the disease broke out; in confirmation of which M. Littré, in his arguments, gives some very interesting observations by M. Forster.[238] In the paragraph on deposits, the author remarks, that in fevers attended with a feeling of lassitude, the deposits generally take place to the joints and jaws. It is afterwards stated--and if confirmed by experience, as I think I have observed it to be in many cases, it is an important remark--that “when the feet are hot, the depositions point downwards, but when cold, upwards.” § 7. In § 12 diseases are thus classified: “with regard to the modes of diseases, some are congenital, as may be learned upon inquiry; some are connected with the nature of the locality, (for many are affected, and therefore many are acquainted with them); some with the condition of the body and the diet, the constitution of the disease, and the seasons. The localities which are ill situated in respect to the seasons engender diseases similar to the season; in like manner, irregularities as to heat and cold in the same day when it has such effects, produce autumnal diseases in the locality, and in the other seasons likewise. The diseases which are engendered by fetid and marshy waters are calculus and splenic diseases, and such are influenced by good or bad winds.” Altogether, as will be readily seen, it is a work of great ability, and will amply repay a diligent perusal. Galen esteemed it very much, and did not hesitate to declare that, not only Plato, Aristotle, and Theophrastus, but also several of the most distinguished medical authors had copied freely from it.[239]

XXXV. Περὶ χρήσιος ὑγρῶν--_On the Use of Liquids_.

This would seem to be the work which appears in Erotian’s list under the title of “On Waters” (περὶ ὑδατῶν); and, contrary to what is stated by Foës and Gruner, it is quoted by Galen in two places;[240] and it is further referred to by Athenæus, under the same title as that given to it by Erotian.[241] Foës pronounces it to be a mutilated work, and one which is wanting in many of the MSS. of the Hippocratic treatises; and all the modern critics, from Lemos and Mercuriali down to Littré and Greenhill, regard it as spurious. Gruner speaks of it as being a work of little importance, and Ackerman as being a mere compilation from the Aphorisms.[242] Gruner further remarks, that the title does not suit well with its contents, and this is in so far correct, for undoubtedly the title given to it by Erotian is more suitable, as it treats almost exclusively of the medicinal properties of waters; and this it certainly does in a fuller and more interesting manner than they are treated of in any other ancient, and, I may almost venture to add, any modern work with which I am acquainted. I look upon its contents, then, as being extremely valuable, even as the work has come down to us, but it is to be regretted that the text is in a very unsatisfactory state. Water the author of the treatise recommends as a fomentation to the eyes, when applied with a sponge; and further, as a general or local fomentation, for producing relaxation of any part when contracted. When poured over the head, and other parts, it is said to induce sleep, is useful in convulsions, and relieves pains of the eyes and ears. Cold water inflames ulcers, except such as have a tendency to hemorrhage, and also fractures, luxations, etc. In applying water to the body, the author recommends the feelings of the patient to be consulted, unless he be in a state of paralysis or of stupor, or be suffering from exposure to great cold, or be in great pain. In these cases, he adds, the patient may be insensible, and instances have occurred of persons having their feet congealed by cold, which have dropped off upon the affusion of hot water. The immoderate use of hot water induces relaxation of the fleshy parts (muscles?), weakness of the nerves, torpor of the understanding, hemorrhage, and deliquum animi, so as even to prove fatal; and much cold water will occasion spasms, tetanus, lividity, and febrile rigors. The parts of the body which are usually covered endure the cold water worst, and are most refreshed by hot. Cold water disagrees with the brain and its processes, the bones, the teeth, and the nerves; and hence, it is added, convulsions, distentions, and febrile rigors, which are induced by cold, are relieved by hot water. Hot water occasions delight and determination (to the skin?); cold, on the other hand, pain and determination inwardly: wherefore the loins, the breast, the back, and the hypochondriac region, are injured by cold applications, but delight in warm. Cold water, thrown on the extremities, relieves lipothymia, the reason of which he states, but the text is so corrupt that I dare not undertake to translate the passage. Ulcers, excoriated parts of the body, and burns, bear cold ill. The extremities, the bladder, and the organs of generation, delight in warm water. Salt water is proper to itchy parts, and to parts affected with pungent humors, but disagrees with burns, and abraded surfaces. Vinegar is said to have much the same properties as salt water in the cure of these complaints. Warm water, in which salt has been melted, is beneficial in lichen, leprosy, alphos, and other complaints of a like nature. The lees of vinegar (_caustic potass_?) also answer in these cases. The astringency of cold water is increased by having beet leaves, ivy, bramble, sumach, sage, etc. boiled in it. Red pustules, like lentils, are benefited by cold things, but eruptions arising from cold, and resembling millet, are improved by hot. There are certain cases in which both hot and cold are applicable, such as gouty affections, and most sprains: in these, cold applications deaden the pain, and warm soothe it. Indurations and ankyloses of a joint are to be removed by pouring warm water out of a vessel upon it. Rheums of the eyes are relieved by rubbing them with some fatty substance, to obtund the acrimony of the tears. In pains, suppurations, pungent tears, and deep ulcers of the eyes, hot water is most expedient; when the eyes are merely red, and free of pain, cold is to be preferred. Cold does not agree with complaints of the rectum and uterus, nor with cases of bloody urine. Cold raises pain when it is applied to ulcers, hardens the skin, renders it painful, suppresses suppuration, renders parts livid and black, is injurious in febrile rigors, spasms, and tetanus. But he adds, sometimes in a robust young man, in the middle of summer, when laboring under tetanus not connected with a wound, the affusion of cold water brings back the heat. (See Aphor. v., 21, and PAULUS ÆGINETA, B. III., 20). Hot water does the same. It promotes ulceration in all cases, softens the skin, attenuates it, is anodyne, and soothes rigors, spasms, and tetanus, and removes heaviness of the head. It is most particularly applicable in fractures, when the bone is laid bare, and especially in injuries of the head. Hot water agrees with all ulcerations, whether innate or produced by artificial means, in herpes exedens, in blackened parts, and in diseases of the ears, anus, and womb. But cold water is inimical in all these cases, except when hemorrhage is apprehended.

The above is a brief summary of the matters contained in this little treatise. That they are highly important, and evince an extraordinary talent for apprehending the true bearing of practical points in medicine, will hardly be denied by any person who is a competent judge. Many of the rules and observations contained in it are, no doubt, the same as those found in the Aphorisms (see Section v.), but there is also no lack of valuable matter in it, which is not to be found elsewhere. Though I am disposed, then, to agree with the authorities who exclude it from the list of genuine works, I do not hesitate to declare it as my decided opinion, that it is not unworthy of the reputation of the great Hippocrates, and that, if not written by him, it must be the production of some person who thoroughly apprehended his high principles and discriminating views. How much, then, is it to be regretted, that this treatise should have come down to us in so mutilated a state that the meaning, in many places, can only be guessed at with considerable hesitation!

XXXVI. Περὶ γονῆς--_On Semen_.

XXXVII. Περὶ φύσιος παιδίου--_On the Nature of the Infant_.

That these two treatises originally constituted one work, has been remarked by Foës, Gruner, Ackerman, Littré, and others. Indeed, this will be made sufficiently obvious, upon comparing the conclusion of the one with the beginning of the other. Galen, in one place,[243] quotes the former of these as if he held it to be a genuine work of Hippocrates, but elsewhere he mentions that it had been referred to Polybus.[244] Erotian mentions, among the works of Hippocrates, a treatise bearing the title of the latter, under which he probably comprehended both treatises. It is also noticed as a Hippocratic treatise by Palladius,[245] and by Macrobius.[246] Both are rejected by Haller, Gruner, Ackerman, Kühn, Littré, and Greenhill. Indeed the story of the female musician, whom the author gravely admits that he taught the way how to get rid of a conception,[247] is so alien to the morals of Hippocrates, as declared in “The Oath,” that it is impossible for a moment to suppose him guilty of such an act of flagitiousness. Moreover the treatise so abounds in little subtleties and conceits, especially in reference to the Pythagorean doctrine of numbers, that no competent judge will hesitate for a moment in pronouncing it not to be the production of the Great Hippocrates.[248] Without doubt, however, these treatises are of great antiquity, and are valuable as containing the hypotheses with regard to the origin of the fœtus which prevailed in the schools down to the days of Harvey; that is to say, that the embryo is formed from the male semen, into which the uterine vessels enter, and form the cotyledones (_or_ placenta). It contains, moreover, an hypothesis adopted by Aristotle in several of his physiological works regarding the semen, namely, that it is collected from all parts of the body; and hence, if any part be mutilated in the parent, it is so likewise in the fœtus.[249] The author moreover holds, that the fœtus breathes, and is nourished by the umbilicus,[250] which may be looked upon as an anticipation of the modern doctrine, that the placenta performs the function both of a lung and of an intestine. It contains a statement regarding the incubation of the egg, which has been often repeated in modern times, but which, from personal observation, I can affirm not to be true; namely, that the hen chips the shell to let out the chick.[251] Presentations in delivery are divided into those by the head, the feet, and crossways. I would mention, in conclusion, that these works abound in repetitions, and are written in a diffuse style, very unlike that of Hippocrates. Altogether, then, I can have no hesitation in pronouncing both treatises to be spurious. From what has been stated of them above, it must be obvious, however, that to the student of ancient anatomy and physiology they are very interesting, and will repay a careful perusal. Although, probably, later productions than the age of Hippocrates, there can be no doubt that they are anterior to the memorable epoch of Herophilus and Erasistratus.

XXXVIII. Περὶ γυναικείων--_On the Diseases of Women_.

We have already stated in our critical remarks on the fourth book, “On Diseases,” that it and the present treatise are evidently the productions of the same author. Although Erotian and Galen[252] make reference to it as if acknowledging it to be the production of Hippocrates, its claim is rejected by Foës, Schulze, Gruner, and Ackerman, and all the modern authorities of any note. Its connection with the treatises “De Genitura” and “De Natura Pueri,” is pointed out by Foës and Gruner; and Littré does not hesitate to refer to the same author the whole of the following treatises, “De Genitum,” “De Natura Pueri,” “De Morbis,” iv., “De Morbis Mulierum,” “De Morbis Virginum,” “De Sterilibus.” Although not the composition of Hippocrates, all these treatises are, without doubt, of high antiquity, and were anterior to the age of Aristotle.

The work now under consideration contains much valuable matter, and deserves a careful perusal. I feel rather at a loss what selections to make from it, as a specimen of its contents, but shall be brief on the present occasion, more especially as I have no difficulty in establishing the point, that the treatise in question is not one of the genuine works of Hippocrates.

The observations contained in the first part of it, on menstruation and the causes of sterility, are ingenious. For the cure of sterility, fumigation of the uterus is recommended, and a minute description is given of the mode of performing this process, by means of a tube introduced into the os uteri, and connected with a vessel which emits aromatic fumes. When sterility is connected with the shutting up of the os uteri, the author gives directions for expanding it by means of a wooden or leaden pipe. We need scarcely remark, that this practice has been revived of late years. A minute description is given of a malformation of the vagina, in which the passage is nearly obliterated by a membrane. Allusion is probably made here to a preternatural rigidity of the hymen. The author directs the membrane to be fairly torn, and the part dressed with wine and myrrh. In transverse and footling presentations of the child it will be best, he says, to bring it down by the head. Both cases are said to be dangerous, so that either the mother or child is lost, and sometimes both. Treating of retention of the placenta, the author remarks, that if it is not cast off it becomes putrid, and thus comes away on the sixth or seventh day, or later. To promote its expulsion, he recommends southernwood, dittany, the flowers of the white violet, and asafœtida. The process of abortion, and the unpleasant circumstances connected with retention of the placenta in this case, are given with much accuracy. Hydrops uteri is described at considerable length. For an account of it, see PAULUS ÆGINETA, Vol I., p. 573, Syd. Soc. edition, and the modern authorities there referred to. For ulcers of the womb, he recommends applications consisting of many stimulating ingredients, such as the flos argenti, etc. The subject of difficult delivery is resumed; when the arm or leg of a living child is protruding, it is directed to be pushed back, and the child turned to the head; and if the fœtus be dead, either the same thing may be done, or the projecting part may be cut off, and the head opened with a sharp knife, and the bones thereof extracted, and the body brought along. The chest also may be opened, if there be any difficulty in extracting the body. The author expresses himself strongly in regard to the danger of abortions. All abortions, he says, are attended with more danger than deliveries at the full time. Artificial abortion never takes place without violence, whether produced by medicine, a draught, or food, or a suppository, or any other means.

The second book commences with a description of fluor albus, an affection to which the old are stated to be more subject than the young. It arises from suppression of the menses, from parturition, or a fever. Among other means which he speaks of for the cure of it, he mentions the application of cupping-instruments to the mammæ. Astringents from the vegetable kingdom are to be administered, such as sumach boiled in vinegar, mulberries, or the like. A full account of the red fluor, _or_ uterine hemorrhage, is also given. It is said to be connected principally with parturition. The treatment which is recommended can scarcely be improved upon, even after the lapse of two thousand years: a sponge is to be wetted and applied to the pudenda; soft garments are to be moistened with cold water, and laid on the belly; and _the foot of the bed is to be raised_. When the hemorrhage is connected with putridity many women thus perish, indeed few recover. A long description is given of hysterical convulsions which is said principally to attack antiquated maids and widows. It is remarked that hysterical complaints bring on cough, and other pectoral complaints. A very striking and accurate description is given of procidentia uteri. Inflation of the womb is also described. On it see PAULUS ÆGINETA, Vol. I., p. 632, Syd. Soc. edition. There is also a curious description of the mole. The clitoris is described under the name of columna.[253]

From the extracts now given, it will be seen that these Books contain a great variety of most important matter. Indeed, there are few treatises in the Collection more deserving of an attentive perusal. They furnish the most indubitable proofs that the obstetrical art had been cultivated with most extraordinary ability at an early period. Beyond all doubts the complaints of women, and the accidents attending parturition, must at that time have come under the jurisdiction of the male practitioner. But, considering the wandering life which Hippocrates led, and that during the best part of it he must have been what is now called a consulting physician, it is not at all likely that he could have acquired that acquaintance with the minutiæ of obstetrical practice which this work displays. It is not, then, at all probable that he can be the author of it.

XXXIX. Περὶ ἀφόρων--_On Sterile Women_.

This treatise is closely connected with the preceding one, both in matter and style. It relates to a subject which, as we have shown, is also treated of in the other work, I mean sterility, the most common cause of which is held to be the state of the os uteri, when it is oblique to the passages of the vagina, constricted from cicatrices, or otherwise diseased. Distinct directions are given for opening the mouth of the womb, after which a cleansing application, composed of cantharides and myrrh, is to be made to it. The mole, and procidentia uteri, are described in nearly the same terms as in the preceding treatise. Though it bears a great resemblance, then, to the work “On the Diseases of Women,” it is not likely, as suggested by Albertus Fabricius,[254] that it is an appendix to it, for why should an author treat twice of the same subject in the same work?

XL. Περὶ παρθενίων--_On the Complaints of Young Women._

Foës looks upon this little tract as being the prelude to the greater work “On the Diseases of Women.” It is destitute of all claims to be held as genuine, and accordingly no critic, ancient or modern, stands up for it. Gruner is inclined to ascribe it to the author of the treatise “On the Sacred Disease,” but I see no grounds for this opinion, except it be that, in the two treatises, there is a certain similarity of views with regard to the nature of the hysterical convulsion. This, however, is not a sufficient reason for deciding that they both must have come from the same source, for all the ancient authorities, from Hippocrates to Actuarius, held pretty much the same ideas regarding the nature of “Uterine suffocation.” See PAULUS ÆGINETA, III., 71. The author of this little fragment gives very naïve advice to virgins who are subject to hysterics; instead of making costly oblations of garments and the like to Diana, as recommended by the prophets, he gravely advises them ὡς ταχίστα συνοικῆσαι ἀνδρασι.

XLI. Περὶ ἐπικυήσιος--_On Superfœtation._

This treatise, I believe, is not mentioned by any one of the ancient authorities, and it is almost universally rejected by the modern.

I need scarcely remark that it relates to a very curious subject, and that great doubts are now entertained whether or not superfœtation in women ever actually takes place. I can state, however, that two trustworthy persons, the one a surgeon and the other a _sage femme_, informed me, some years ago, that they once attended together a case in which a woman was first delivered of a fœtus about four months old, and, about thirty-six hours afterwards, of a fully grown child. The ancient _savants_ all believed in the occurrence of superfœtation. See in particular Aristotle (Hist. Anim. vii., 5); and Pliny, (H. N., vii., 11.)

The following are a few of the most interesting observations which I have remarked in perusing this treatise. When the secundines are evacuated before the child, they cause difficult parturition, and the case is dangerous unless the head present. Presentations of the hand and foot are directed to be replaced. When the placenta is retained after the expulsion of the child, the child is to be laid upon wool, or upon two bladders, filled with water, either of which is to be pricked, so that the water may run off gradually, and thus draw down the placenta. When there is a copious discharge of blood before labor, there is a risk that the child may be dead, or at least not viable. When women with child long for coals, the appearance of these things is to be seen on the child’s head. (For the opinions of the ancients on the effect of imagination on the fœtus in utero, see the commentary on B. I., § 1, of PAULUS ÆGINETA, Syd. Soc. edition.) Some ridiculous things are contained in this work, such as the following; when a man wishes to beget a male child let his left testicle be tied, and when a female the right.[255] The composition of suppositories for cleansing the uterus is described at considerable length towards the end of the treatise. Altogether, the work is by no means devoid of interest, but, as I have already said, it is certainly not the composition of Hippocrates. Littré, on the authority of the passage quoted from Aristotle on this head, refers the treatise to Leophanes. From the account which we have given of its contents, it will be remarked that the title and contents of it do not well accord together. This remark, however, applies to other of the Hippocratic treatises besides the one we are now treating of.

XLII. Περὶ γυναικείης--_On the Female Nature_.

As Foës remarks, this work is mostly made up of excerpts from the treatise “De Muliebribus.” I need not, therefore, occupy time in discussing its claims to be regarded as genuine, nor in giving an outline of its contents.

XLIII. Περὶ καρδίης--_On the Heart_.

Galen, in one place, appears to cite a passage in this treatise, but without naming it.[256] It is not found in Erotian’s list, and all the modern authorities, including even Foës, who is more disposed than most of the others to deal leniently with the claims of the treatises which bear the name of Hippocrates, concur in refusing to admit it as genuine. Still, however, there can be no question as to its being a work of very high antiquity. It is to be regretted, then, that the text is in a very unsatisfactory state. It contains, upon the whole, a wonderfully accurate description of all the parts about the heart--of its substance, which is said to be a strong muscle; of its pericardium, which is described as being a smooth tunic, containing a little fluid resembling urine; of its ventricles (γαστέρες); of its auricles (ὄυατα); of the origin of the veins from it; of its sigmoid valves; of its office, to be, as it were, the fountain head, from which all parts of the body are irrigated, and the seat of the understanding, which is said to be in the left ventricle. The understanding, it is added, is not nourished by the blood, but by a pure and luminous (φωτοειδὴς) superfluity from it. Altogether, this little treatise bespeaks much practical acquaintance with human anatomy, and, considering the age in which it was written, must be the production of a very superior mind. It contains an account of an experiment which has been much animadverted upon, both by ancient and modern authorities. The writer says, if a colored fluid be given to an animal, such as a sow, to drink, and if its throat be cut while it is in the act of swallowing, it will be found that part of the fluid has passed down by the gullet to the lungs. See in particular Aulus Gellius (Noctes Atticæ, xvii., 11); Macrobius (Saturnal. vii., 15); and Plutarch (Sympos. vii., 1.) Aulus Gellius says decidedly that Plato had adopted this opinion from Hippocrates. Aulus Gellius and Macrobius also quote Plutarch as having stated, in his ‘Symposiacon,’ that Hippocrates is the author of this opinion; but the text of Plutarch (l.c.) is in an unsatisfactory state. See Schulze (Hist. Med. i., iii., vi., 12.)

XLIV. Περὶ τροφῆς--_On Aliment_.

It must be admitted that this treatise has very high authorities in favor of its authenticity, such as Erotian, Galen,[257] Aulus Gellius,[258] Palladius,[259] Stephanus;[260] and, in modern times, Mercuriali, Foës, Haller, and Le Clerc.[261] It is rejected by Casper Hoffman,[262] Gruner, Ackerman, Kühn, Littré, and Greenhill, though, by the last two, not in decided terms. Considering the respectability of the external evidence in its favor, I should certainly not have hesitated in admitting it as genuine, had not a careful examination of its contents led me to form the unbiassed decision that it must be the production of some metaphysician, rather than of a medical practitioner, such as we know Hippocrates to have been. The physiological dogmata with which it abounds are announced in so antithetical, not to say paradoxical, a manner, that I can conceive nothing more foreign to the style and character of the true writings of Hippocrates. I shall give a few specimens:--“The species of aliment is one and many; all these (kinds of aliment?) are one nature and not one. Purging is upwards and downwards, and neither upwards nor downwards. Purging in aliment is excellent, purging in aliment is bad. Aliment not aliment, unless it conveys nourishment; it is aliment in name but not in deed; aliment in deed and no longer in name only. Sweet and not sweet; sweet potentially, as water, sweet to the taste, as honey. Things not animals are animated; animals are animated, the parts of animals are animated. It (the embryo) is and is not.” Now, I must say, that all this appears to me to savour more of the taste of Democritus than of Hippocrates himself. It may be said, indeed, that the very circumstance of Galen’s having admitted the work as genuine, and having composed an elaborate commentary on it, is a most presumptive proof of its authenticity; for where shall we find so excellent a judge of the doctrines of Hippocrates as his great commentator? But then it must be taken into account that Galen himself had a great _penchant_ towards metaphysical subtleties, and this would lead him to believe that what was in accordance with his own tastes must have been in accordance with those of his great professional hero. But, notwithstanding the doubts which hang over the question of its authorship, it may be confidently affirmed regarding this treatise that, illustrated as it is by Galen’s commentary (even although it has come down to us in a mutilated state), few works in the Collection are more suggestive than the present one. I shall merely give a few more specimens of it:--“The root of the veins is the liver, and the root of the arteries is the heart; and from them blood and spirits are carried to all parts, and heat passes to the same.” This passage is frequently quoted and commented upon by ancient authors; as by Galen,[263] and Aretæus.[264] We have seen it stated in the preceding treatise that the heart is the place from which both veins and arteries originate. This seems a presumptive proof that these two treatises must have had a distinct authorship. “The aliment reaches to the hairs, the nails, and the outer surfaces from within; and aliment from without passes from the most external to the most internal parts, there is one conflux and one conspiration (ξύρροια μία, ξύμπνοια μία). All parts sympathize throughout the whole frame, but in so far every part has its own peculiar action.” This passage, also, is very celebrated and frequently quoted.[265] I need scarcely remark that it embraces a grand and most important view of the animal economy. “Milk is food to some with whom it agrees, and to others not. To some wine is food, and to others not; and so with flesh and many other kinds of aliment. We must look to situation and habit. Humidity is the vehicle of food. The natures (instincts?) of all things are untaught. Persons who perspire freely are weak, more healthy, and have easier recoveries than others. Those who perspire ill are stronger than others before they become indisposed, but being indisposed have more difficult recoveries. These remarks apply to the whole and to the parts.”

From these specimens it will be readily seen that the work abounds in curious matters, but of a very different stamp from those which the true Hippocratic treatises contain. Contrary, then, to my general rule, I certainly feel disposed in the present instance to reject, upon internal evidence, a treatise which has the most unexceptionable external evidence in its favor.

XLV. Περὶ σαρκῶν, ἤ ἀρχῶν--_On Fleshes, or Principles_.

This treatise does not appear in Erotian’s list of the Hippocratic works, and it is rejected by all the modern authorities, from Mercuriali downwards. Galen is inconsistent in his notice of it.[266] Some of the philosophical dogmata which it contains are curious, such as the following specimen: “It appears to me that what we call heat is immortal, and that it knows all, sees, hears, and perceives all things that are and will be.[267] When things, then, were thrown into confusion the greater part of this passed off to the highest circle, and this it is which the ancients called ether.” The following extract is held by Gruner, but probably without any good reason, to evince a degree of anatomical knowledge in advance of the age of Hippocrates: “There are two hollow veins from the heart, the one called the artery, and the other the vena cava. The artery has more heat than the vein.” The other veins are also described with considerable accuracy. It is stated that the fœtus in utero sucks in fluid (liquor amnii?) by its lips, and in proof of this the author remarks that the child voids fæces soon after delivery, which, it is argued, must be derived from food. The opinion thus stated has been often maintained in modern times, but does not appear to be well founded. The author mentions correctly that persons in attempting to commit suicide open the trachea, in which case, he adds, the patient lives, but loses his voice until the opening be closed. Conringius and Haller, with considerable plausibility, but yet without any direct proof, attribute this treatise to Democritus.

XLVI. Περὶ ἑβδομάδων--_On Hebdomads_.

This treatise exists now only in the Latin translation, which M. Littré has discovered in the Royal (_National_, it is now called!) Library in Paris, and will be published in his edition of the works of Hippocrates. M. Littré gives an elaborate and most interesting disquisition on it, and seems to make out clearly that it is the production of the same author as the treatise “On Fleshes,” which we last noticed. It is cited by Philo Judæus,[268] and several other writers of antiquity. Galen, however, held it not to be the production of Hippocrates. A considerable extract from it is contained in the tract “On Critical Days,” and the eighth section of the Aphorisms, which has always been looked upon as spurious, is said by M. Littré to be mostly taken from this treatise.

XLVII. Περὶ ἀδένων--_On the Glands_.

Erotian makes no mention of this treatise, and Galen pronounces it to be the work of the recent Hippocratists.[269] M. Littré remarks, and with great truth, that it is difficult to find out the grounds upon which the ancient critics have rejected this work. Certain it is that it contains a goodly store of interesting matters, none of which, as far as I can discover, are inconsistent with the true doctrines of Hippocrates. In it a pretty correct description is given of the glands, including those of the mesentery. The brain itself is said to be of glandular nature, and also the kidneys. An ingenious account is also given of the origin of scrofula, which is said to be produced by the lodgment of humors in the glands of the neck, which get into a state of slow inflammation. Glands, the author says, are seated mostly in parts of the body which most abound in humidities, such as the armpits and groins, and hence such parts produce hairs. In the case of the mesentery, however, no hairs are produced, because the humidities here are excessive, and choke up, as it were, the seeds of the hairs; in like manner as seeds sown in marshy grounds perish. A very ingenious account is given of the origin of phthisis, which is said to spring from tubercles in the lungs and matter (pus), which corrodes the lungs when “the patients do not readily recover.” A curious description is next given of the tabes dorsalis, “in which disease the patient does not wish to live.” How expressive this language is of the state of mind in the case of the unfortunates who are subject to spermatorrhœa! The treatise concludes with some striking remarks on the sympathy between the mammæ and uterus, and on the influence which both exercise on the development of the female character. Altogether the contents of this treatise are most valuable, and may suggest important views to the medical practitioner and physiologist, even at the present day. We need have no hesitation in pronouncing, with regard to it, that it reflects infinite credit on the school from which it emanated, and that it is not unworthy of Hippocrates, although we have reason to believe that he was not actually the author of it.

XLVIII. Περὶ φλεβῶν--_On the Veins_.

This is merely an excerpt from the treatise “On the Nature of the Bones.”

XLIX. Περὶ ἰητροῦ--_On the Physician_.

I may mention in this place, generally, that the treatises which follow have no ancient authority in support of them, and that, with very few exceptions, they are also rejected by all the modern critics. Their contents, moreover, are not of much practical importance, and therefore I shall be very brief in my analysis of them.

The treatise in question is held to be genuine by no one critic, as far as I know, with the exception of Foës, who appears, in part, to sanction its claims. The object of the author is announced to be in order to instruct the physician how to conduct matters connected with the iatrium, that is to say, with his establishment or surgery. Mercuriali, I may mention, is unjustly severe in his animadversions on the exordium. (See Conringius, Introd. p. 120.) The physician should have a healthy look himself, for the writer says, people fancy that a person who does not keep himself in good health is not qualified to take charge of the health of others. He should be of a prudent disposition and a gentleman in morals.[270] Minute directions are given respecting the site and other circumstances connected with the iatrium: clean and soft towels are to be at hand, linen is to be used for the eyes, and sponges for the sores. In supplying bandages, attention is to be paid to utility rather than to display. The surgeon should pay great attention to all matters connected with this operation: for it is attended with much disgrace when any manual operation does not succeed. Minute directions are given about the performance of venesection at the arm, and mention is made of several untoward accidents connected with it, such as the blowing up of the vein, whereby the flow of blood is stopped; and suppuration following as a consequence of the operation. In order to acquire dexterity in the treatment of accidents, the author recommends the young physician to attach himself to some foreign army; and from this Gruner infers, that the work cannot belong to Hippocrates, as domestic wars were but too common in his time; and there could have been no necessity for the surgeon’s seeking foreign service in order to gain experience. It does not occur to me, however, that there is much force in this argument; for intervals of peace were just as common during the long life of Hippocrates, as during the interval between his death and the time when the Collection was made. But, in fact, there is no necessity to seek recondite reasons for rejecting a treatise which has no proper authority in support of it.

L. Περὶ εὐσχημοσύνης--_On Decorum_.

This work, like the last, has not the slightest claim to be looked upon as genuine. Moreover, it has come down to us in a very unsatisfactory state as regards the text, so that the meaning is often very dark and uncertain; and I must confess that, as a general rule, I have little inclination to spend much time in searching out a meaning, in obscure writings, when, after it is discovered, it is not likely to repay the exertions made in discovering it. I am always disposed to remember the advice which Galen repeatedly gives to the student of medicine, “to concern himself more about things than about words.”[271] The object of the author seems to be to give general directions with regard to decorum in the physician’s communication with the sick. It is evidently the production of some sophist, according to Bernard, of some one belonging to the Stoical sect. I shall be brief in my abstract of it. A philosophical physician is equal to a god. In the practice of medicine all the virtues relating to wisdom are exercised; namely, contempt of money, decency, modesty, simplicity in dress, character, judgment, quietness, accessibility, purity of life, sententious maxims, knowledge of the purifications which are proper and necessary in life, abstinence from lucre, freedom from superstition, divine excellence. The physician should keep himself aloof, and not hold much converse with the common people, unless when necessary. The surgeon should be well provided with all the means required in the practice of his profession, such as dressings, medicines, instruments, and so forth, as any deficiency in these might produce serious results. Minute directions are given for the regulation of the physician’s address in entering the chamber of the sick, and his conduct while there.

LI. Παραγγέλιαι--_Precepts_.

This little tract stands altogether in much the same circumstances as the preceding one, that is to say, it is wholly destitute of all good authority in its favor, and the nature of its contents is what might rather be expected from a sophist than a practical physician. The text, moreover, is in a most unsatisfactory state. I shall dismiss it then with a very brief notice. It opens with an advice to the physician not to trust to speculation but to rational experience. He ought to learn remedies from all quarters, even from the vulgar, and not be avaricious in his dealings with the sick, more especially if strangers and needy. The author alludes, as Schulze thinks, to the practice then followed by the physicians of migrating from one city to another, and of making a public declaration of their pretensions at their first entry into any place. These physicians were called _periodeutæ_. The author of this tract advises the physician, in such a case, not to make any vainglorious or inflated profession of his abilities. He also enjoins the medical practitioner to look to the health of those who are free from disease, as well as those who was indisposed.

LII. Περὶ ἀνατομῆς--_On Dissection_.

This small fragment of ancient anatomical science has no claim to be regarded as the work of Hippocrates. Neither Erotian nor Galen, nor any other ancient critic, holds it as such, and the modern authorities are unanimous in rejecting it. That it may have been the composition of Democritus, as suggested by Gruner, seems not unlikely. It abounds in harsh and obsolete terms, which have never been satisfactorily explained. Some parts of the anatomical description are difficult to determine, as for example, “the large bronchia which extend from the heart to the liver;” “the vena scalena, which extends from the liver to the kidneys.” The latter passage, however, may be supposed to refer to the emulgent vein.

LIII. Περὶ ὀδοντοφυίης--_On Dentition_.

This little tract is destitute of any competent evidence of its authenticity. Some of the observations contained in it bespeak a familiar acquaintance with the diseases of infancy. Thus it is said, that when the bowels are loose at the term of dentition, if the digestion be good, the children thrive, and are not subject to convulsions. When children at the breast vomit up their food, the bowels are constipated. When there is fever accompanying dentition, children are seldom attacked with convulsions. But when there is heavy sleep along with dentition, there is danger of convulsions. All the children that are seized with convulsions at the time of dentition do not die. Children that take food during dentition bear vomiting best. Ulcers on the tonsils are attended with danger.

LIV. Περὶ ἐγκατοτὸμης άμβρύου--_On Excision of the Fœtus_.

No one stands up for the genuineness of this treatise,[272] which, however, is not wanting in interesting matter relative to the extraction of the fœtus in cross-presentations. For an abstract of the practice there recommended, see PAULUS ÆGINETA, Vol. II., p. 389, Syd. Soc. edition. A circumstantial description is also given of the process of _succussion_, the dangerous effects of which, in certain cases, are related in the Epidemics.

LV. Περὶ ὄψιος--_On Vision_.

This little fragment is admitted by all the authorities to be spurious. It contains a description of glaucoma, for which purging of the head and the application of the actual cautery are recommended, and also in certain cases venesection. In epidemic ophthalmy, purging both of the head and bowels is recommended.

LVI. Περὶ ὀστέων φύσιος--_On the Nature of the Bones_.

M. Littré has very ingeniously shown that this work is a compilation made up of fragments of other works, and thus he has announced his intention of excluding it altogether from the Hippocratic Collection. Certain it is, beyond all dispute, that the treatise is not the production of Hippocrates himself. The following are a few of the most notable things which I have observed in it. “It appears to me that what we call heat is immortal, and that it understands, sees, hears, and perceives all things that are and will be.” The heat, it is further said, is the origin of all movement in animals. This will be recognized as the original of the doctrine of the _Calidum innatum_, which figures in the works of our earlier physiologists in modern times. See the works of Harvey and the other physiologists of the seventeenth century; also what is said on this subject in the next section. The aorta and vena cava are correctly described, the one as an artery, the other as a vein; and their origin from the ventricles of the heart is noticed. The author states (p. 440, ed. Kühn), that he had known cases of attempted suicide in which the windpipe had been opened, and yet death did not ensue; only while the opening remained the person lost the power of speaking. See No. XLV.

LVII. Περὶ κρισίων--_On the Crises_.

This tract has no ancient authority whatever in support of it, and Foës, Gruner, and Littré concur in holding it to be a compilation from other Hippocratic treatises, more especially the Aphorisms and Prognostics. This, indeed, must be obvious to every person who reads it with any attention.

LVIII. Περὶ κρισίμων--_On Critical Days_.

This treatise stands in the same predicament as the preceding one, that is to say, it has no ancient authority in support of it; indeed Galen declares against it when he says that Hippocrates had not given any work on the Critical Days. (Tom. iii., p. 440; ed. Basil.) It is manifestly a compilation from the other treatises, more especially from those “On Internal Diseases” and “On Diseases.” Still it appears to me to be an interesting and well-written compilation. For example, it would be difficult to point out in any other work, ancient or modern, a better description of pneumonia than is given towards the conclusion of it. Tetanus also is accurately described. To be sure, Gruner infers, from the circumstance that three varieties of this disease are described, that the work in question must have emanated from the Cnidian school. But Aretæus, and, indeed, all the ancient authorities that treat of tetanus, describe three varieties of this disease; and therefore this is no good reason for excluding it from the Coan school.

LIX. Περὶ φαρμάκων--_On Purgative Medicines_.