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Discovering Diverse Content Through
Random Scribd Documents
 [590] In reference to this practice Horace says:

“Si noles sanus curres hydropicus.” (Serm. I., 1.)

[591] Galen finds many things in this section also carelessly

and confusedly written, and therefore unworthy of Hippocrates.
For example, the list of cases in which purging is inapplicable,
Galen holds to be incomplete; and even in some of the cases
specified by Hippocrates he demurs to admit his views to be
correct; for example, in diseases of the spleen he contends that
melanogogues are strongly indicated. Many more of the rules he
considers to be vaguely and inaccurately stated. Altogether, then,
he holds that it is a loss of time to devote much attention to
writings of such a stamp; but, he shrewdly remarks, there is no
persuading many people to study only such writings as are clear,
and to leave such as are not so to the writers themselves; for it is
just that, as they have paid no regard that we should understand
what they have written, we should not be very anxious to find out
and learn what they say.
[592] Galen correctly remarks that this rule is applicable in
certain cases, but not in all.
[593] As Galen remarks in his Commentary, something
appears to be wanting here in order to indicate the disease to
which these directions apply. Perhaps, as he suggests afterwards,
they are meant to apply to general pains.
[594] The Cantharis of the ancients was indisputably the
Mylabris cichorii, or M. Fusselini. It continued to be used in
ancient times as a diuretic, (see Paulus Ægineta, Vol. III., p. 153;)
and is well known in the East at the present day.
[595] All the remaining part of this work evidently consists of
fragments put together, without any method or arrangement.
Though not devoid of interest, they decidedly have no connection
with the treatise On Regimen in Acute Diseases. Indeed an
impartial examination of the whole Appendix must satisfy any one
that there are but too good grounds for holding with Galen, that
the whole work is a disorderly compilation, which, although it
may have been made up of notes written or dictated by
Hippocrates, had certainly not been published by him.
[596] It most probably is the Reseda mediterranea. See Paulus
Ægineta, Vol. III., p. 331.
 [597] This description has always been regarded as very
obscure. According to Galen it is the operation which was
afterwards named anabrochismus. See Paulus Ægineta, Vol. III.,
pp. 262, 269. M. Littré gives the following interesting observations
on this passage by M. Malgaigne: “Quoiqu’il semble que l’auteur
emploie deux fils, cependant il n’est fait mention que d’une
aiguille. Il paraît bien indiqué que l’aiguille traverse deux plis
transverseaux en marchant de haut en bas. Voici comment je
traduirais le passage en question: pour le trichiasis, avec une
aiguille armée d’un fil, traversé de haut en bas le point le plus
élevé (ou la base); de la paupière supérieure, après lui avoir fait
former un pli, et repasser l’aiguille de la même manière un peu
plus bas (ou près du bord libre); rapprochez les extrémités du fil,
et fixez-les par un nœud: puis laissez-les tomber d’eux-mêmes. Si
cela réussit, c’est bien: si non, it faudra recommencer.” (Op.
Hippocrat., tom. iii., p. xliv). In my Commentary on Paulus
Ægineta, (Vol. II., p. 163.) I have in so far fallen into the mistake
of supposing this description to apply to the lower eyelid, and M.
Ermerins would appear to have done the same. See Littré, l. c.
The operation by the ligature on hemorrhoids will be found more
circumstantially described in the treatise on that subject, of which
a translation is given in this volume.
[598] For the weights and measures mentioned here, and in
other parts of our author’s works, see the Comment. on the last
section of Paulus Ægineta, Syd. Soc. edit.
[599] A mineral, consisting principally of sulphate of copper.
See Paulus Ægineta, Vol. III., pp. 400–2.
–
[600] The μηκώνιον was applied to three totally distinct
substances; 1st, To a sort of opium, that is to say, the expressed
juice of the poppy (see Paulus Ægineta, Vol. III., p. 280); 2d, to
the Euphorbia peplus, L., (see Appendix to Dunbar’s Greek
Lexicon, under the name): and, 3d, to the excrement of new-born
children. It is singular that the learned Foës, in his Œconomia
Hippocratica, should apply it in this place to the last of these; for
if Hippocrates had used such a substance medicinally, we may be
well assured that it would not have been overlooked by
Dioscorides and Galen. There is every reason, however, to
suppose that it is the same as the πέπλος of Dioscorides and
Galen, that is to say, the Euphorbia peplus, which was
recommended as a drastic purgative by all the ancient authorities
on the Materia Medica, and consequently would be a medicine
very applicable either in coma or dropsy.
[601] All the commentators admit that the last section is
obscure. It would appear to me that Galen understands the
expression τὸ ἀπὸ τῶν κοπρἰων as applying ἑδρικοῖς, that is to
say, to affections of the anus. I have followed Littré in giving the
passage a very different interpretation, but I am by no means
sure that Galen may not be right.
[602] De Diebus Decretoriis, i.
[603] See the Argument of the Prognostics.
[604] Μηδὲν εἰκῆ, μηδὲν ὑπερορῇν. (Epid. vi., 2, 12). Νούσων
φύσιες ἰητροί· ἀνεθρίσκει ἡ φύσις αὐτὴ ἐωυτῇ τὰς ἐφόδους·
ἀπαίδευτος ἡ φύσις ἐοῦσα καὶ οὐ μαθοῦσα τὰ δέοντα ποίει. (Ibid.
vi., 5, 1.)
[605] Galen, De Venesect. adv. Erasist., c. iii.
[606] One cannot help being struck with the resemblance
between this description and a passage in Aretæus’s chapter on
Causus: Ψυχῆς κατάστασις, ἄισθησις σύμπασα καθαρὴ, διάνοια
λεπτὴ, γνώμη μαντικὴ, κ. τ. λ. In the yellow fever of the West
Indies, which would certainly appear to me to be a variety of the
causus, the mind is said to be wonderfully entire to the last. Dr.
Fergusson gives a very striking instance of this in describing the
case of Sir James Leith, the British Governor of Guadaloupe.
[607] Traité des Fièvres ou Irritations Cérébro-spinales
intermittentes, d’après des Observations recueillies en France, en
Corse et en Afrique. Paris, 1836.
[608] Œuvres d’Hippocrate, etc., tom. ii., p. 565.
[609] Prax. Med. nova Idea, i., 31.
[610] Tom. ii., p. 565.
[611] On the Influence of Tropical Climates.
[612] Tom. vii., p. 290; ed. Kühn.
[613] Copland’s Dictionary of Practical Medicine, P. iv., p. 974.
[614] Clinical Observations on the more important Diseases of
Bengal. Calcutta, 1835.
[615] Epidém. d’Hippocrate.
 [616] See Ægineta. The narrative contains the most distinct
and unequivocal traces of the belief in the contagiousness of
consumption.
[617] Thasus is an island in the Ægean sea, off the coast of
Thrace, which bears the modern name of Thaso or Tasso. It was
in a flourishing condition in the time of Hippocrates, and a
tributary to Athens, but revolted from that power after its
disasters in Sicily during the Peloponnesian war. See Herodot., vi.,
47; Thucydid., i., 101; viii., 66. Galen states that it is cold, with a
northerly exposure.
[618] According to Galen, in his Commentary on this passage,
the setting of the Pleiades takes place fifty days after the
autumnal equinox. See the Argument to the treatise On Airs, etc.
[619] We have already stated that the ardent fevers or causi,
of which repeated mention is made in the Hippocratic treatises,
were fevers of the remittent type, in short that they were the
same as the bilious remittent fevers of Pringle and Monro.
[620] I need scarcely say that the disease here described is
cynanche parotidæa or parotitis. It is a remarkable proof of our
author’s talent for observation, that he has pointed out the
tendency of the disease to be complicated with swelling and
inflammation of the testicles. Altogether the description of the
disease here given is quite applicable to the mumps of modern
times. As stated by him, the swelling of the testicles is generally
painful. See the Commentary of Galen.
[621] On reference to Galen’s Commentary it will be seen that
anciently the reading of this passage was reckoned equivocal.
According to one of the readings, the meaning is that those who
were sick did not require to come to the Iatrium for advice. See
also Littré’s annotations on this passage.
[622] Galen thinks our author expresses himself confusedly in
this place, but Littré justly defends him from this charge.
According to Littré, Hippocrates means that those who had been
long affected with consumption (the term used, ὑποφθειρομένων,
rather signifies had obscure symptoms of consumption), then
betook themselves to bed; but those who were in a doubtful
state, then first manifested signs of confirmed phthisis; and,
finally, that there were some who then for the first time felt the
attack of phthisis, and that these were persons who were
predisposed to it. According to Galen, the phthisical constitution is
marked by a narrow and shallow chest, with the scapulæ
protuberant behind like wings; and hence he says chests of this
construction have been named alar. He further states that there
are two forms of consumption, the one originating in a defluxion
from the head, and the other being connected with the rupture of
a vessel in the lungs. I may be allowed to mention in this place,
in confirmation of our author’s accuracy of observation with
regard to the connection of hemoptysis with phthisis, that Louis
found hemoptysis to a greater or less extent in two thirds of his
cases. (Researches on Phthisis, p. 166, Sydenham Society
edition.) The same author relates several cases in which death
occurred suddenly and unexpectedly, as Hippocrates states to
have happened to some of his patients. (Ibid.)
[623] I am of opinion that the species of phthisis noticed in
the latter part of this section was the acute form of phthisis
described by Louis (p. 351). Our author, it will be remarked,
states that his patients were mostly delirious when near death.
Louis, in like manner, mentions delirium in, I believe, every one of
the cases of acute phthisis which he relates. Galen justly remarks,
that, in the ordinary forms of phthisis, delirium is not a common
symptom. I would also call attention to our author’s observation
regarding the inflamed state of the fauces, which is also amply
confirmed by the observation of Louis in this form of phthisis.
 [624] The nature of the continual fevers of the ancients is fully
explained in the Commentary on the twenty-seventh section of
the Second Book of Paulus Ægineta. Galen, in his Commentary on
this passage, marks their nature very distinctly in few words. He
says that such fevers as have an exacerbation of fever ending in
complete apyrexia are called intermittents, whereas such as do
not end in a complete remission of the fever are called continual.
See further De Diff. Febr., ii., 2. In a word, the continual fevers
were decidedly of the remittent type. See further Donald Monro’s
work on Army Diseases, in the beginning of the chapter on the
Bilious Remittent Fever.
[625] The introduction of phthisis in this place has created
some difficulty in the interpretation, as may be seen on reference
to Galen and Littré. Galen gives a very interesting account of the
way in which interpolations often took place. (Opera, tom. v., p.
356.)
[626] The text of this last sentence is in an unsettled state.
The following would be a translation of it as it stands in the Basle
edition of Galen’s Works: “Of all the cases described under this
constitution, those alone which were of a phthisical character
proved fatal. But they (the phthisical affections?) did not
supervene upon the other fevers.” Provided this be the true
meaning of the passage, it would merit great attention, as
seeming to contain a declaration that intermittent fevers
superinduced an immunity to phthisis. I need not say that this
supposed fact has been exciting a great deal of interest lately in
the profession, more especially in France.
[627] It is to be borne in mind that the autumn began with
the rising of Arcturus, and ended with the setting of the Pleiades.
The setting of the Pleiades then indicated the commencement of
winter. The classical reader will find the different seasons,
strikingly defined by the rising and setting of the stars, in Virgil’s
Georgics. See in particular Georg. i., 221.
[628] Galen thus explains the origin of the ophthalmies. He
says, the constitution of the air being not only cold and humid,
but attended also with hurricanes. The eyes were thus injured,
and consequently were the first part of the body to show
symptoms of disease. The dysenteric and other alvine complaints
which followed, he ascribes to the constriction of the skin induced
by the cold, and to the humoursæ of the system aggravated and
increased by the humid state of the season. These humours being
thus shut up by the occlusion of the pores of the skin, part of
them were determined to the intestines, occasioning diarrhœa,
tenesmus, dysentery, etc.; some to the bladder, inducing
strangury; and some to the mouth of the stomach, occasioning
vomiting.
[629] Galen states in his Commentary that the phrenitis is
connected with inflammation of the parts about the brain. We
have mentioned before that the phrenitis of the ancients was a
febrile affection, and not idiopathic inflammation of the brain, as
is generally supposed.
[630] According to Galen, the causi or ardent fevers are
occasioned by yellow bile collected about the vessels of the liver
and stomach, and the tertians by the same diffused over the
whole body.
[631] Galen states in his Commentary that children are
peculiarly subject to convulsions owing to the weakness of their
nervous system. He adds, that in their case convulsions are not
attended with so much danger as in other cases. See the
Hippocratic treatise On Dentition.
[632] The fever here described is evidently the semitertian.
See Paulus Ægineta, Book II., 34. “The true semitertian,” says M.
Bartels, as quoted by M. Littré, “is a real complication of an
intermittent fever with another fever of a continual type. It does
not show itself but rarely in our countries; but it is more frequent
in the hotter countries of Europe, although the false semitertian
has oftener than once been confounded with the true. In the
true, the intermittent fever is tertian; the non-intermittent is
quotidian.” See also Galen, Opera, tom. v., p. 362; ed. Basil.
[633] The text here is in an unsatisfactory state, and, as usual
in such cases, no ingenuity nor pains can do much to mend it.
See Foës and Littré. I have translated the disputed words “not
resolved,” which seems to me to agree best with the sense. Every
practical physician knows that swellings of the glands, which
continue long and do not suppurate, are unfavorable in fevers.
[634] The modern physician will not fail to be struck with this
observation as to the termination of certain cases of fever in
determination to the kidneys. Galen remarks in his Commentary
on this passage, that as the general system is often purged by
the bowels, so is it also sometimes by the kidneys and bladder.
This, he adds, is a protracted and painful mode of resolution in
fevers. The reader will remark the characters of the urine as
stated below by our author. One cannot help being struck with his
statement, that all these cases recovered. I am not aware of any
modern observations bearing on this point.
[635] There is considerable difficulty here in determining the
reading. See Littré, whom I have followed.
[636] I need scarcely remark that this passage is of classical
celebrity. Galen, in his Commentary, remarks that the first time he
read it he thought it unworthy of Hippocrates to lay it down as a
rule of practice, that “the physician should do good to his patient,
or at least no harm;” but that, after having seen a good deal of
the practice of other physicians, and observed how often they
were justly exposed to censure for having bled, or applied the
bath, or given medicines, or wine unseasonably, he came to
recognize the propriety and importance of the rule laid down by
Hippocrates. The practice of certain physicians, Galen remarks, is
like playing at the dice, when what turns up may occasion the
greatest mischief to their patients. The last clause of this passage
is very forcibly put. Galen, however, informs us that in some of
the MSS. instead of “art” he found “nature;” that is to say, that
the physician is “the minister (or servant) of nature.” Either of the
readings, he remarks, will agree very well with the meaning of
the passage.
[637] The reader will find it interesting to refer here to the
Prognostics. See also the Commentary of Galen. Let me here
impress upon the reader the necessity of making frequent
comparisons of the Prognostics with this work, if he would wish
rightly to apprehend the bearing and meaning of the latter. That
the Epidemics are entirely founded upon the principles of
prognosis there can be no doubt.
[638] It is to be recollected that the rising of Arcturus marked
the beginning of autumn, and the setting of the Pleiades the end
of it. See above.
[639] The season of the Dog-star was immediately after the
summer solstice, namely, when the sun enters the constellation
Leo. The classical reader will readily bring to his recollection the
lines of Horace, which are descriptive of this season:
 “Jam Procyon furit;
Et stella vesani Leonis,
Sole dies referente siccos.”

[640] Galen, in his Commentary, remarks that the attacks of

paraplegia (that is to say, of apoplexy) were brought on by the
cold winds of the winter succeeding to a humid autumn.
[641] The causi or ardent fevers, it is worthy of remark, began
this season in spring, but were not of a fatal character until
autumn. In modern times the bilious remittent fever has
uniformly been found to be most aggravated in autumn, and
hence it has been named by some authorities the autumnal
remittent fever. See the works of Sydenham, Pringle, Monro, and
Cleghorn. Monro mentions that he seldom saw it in spring, but
that it is common in the neighborhood of London towards the end
of summer and beginning of autumn. All these authorities are
agreed that it is of a highly bilious nature.
[642] Monro mentions epistaxis as occurring in the autumnal
remittent fever; he says it did not prove a crisis in any case.
[643] The complication of the autumnal remittent fever with
jaundice is noticed by Sir John Pringle (Obs. iii., 4), and by Monro
(On Army Diseases, p. 161). Galen, in his Commentary, remarks
that when nature is unable to evacuate the bile, it is collected in
the skin, and occasions jaundice. He adds, that the occurrence of
the jaundice in this case was unfavorable, owing to its taking
place before the seventh day. When occurring on the seventh
day, jaundice was reckoned a favorable symptom. See On Crises,
3; Aphorism, iv., 62, 64.
[644] The reader may feel interested to learn Galen’s
hypothesis by which he accounts for the hemorrhage in this case.
He says it is produced by the redundancy of yellow bile, which,
being mixed up with the blood and heating it, is carried up to the
head, where it produces rupture of the vessels and hemorrhage.
[645] Modern observations have confirmed this account of the
generally fatal issue of febrile diseases after parturition. In the
Hippocratic work On Diseases, fever after delivery in a woman is
reckoned among the cases which generally prove fatal.
[646] I would again request the attention of my
contemporaries to the characters of the urine before a crisis, as
given by Hippocrates; and, in confirmation of them I will venture
to introduce here an extract from Donald Monro’s admirable
account of the autumnal remittent fever: “The urine in the
beginning was commonly of a high color, though sometimes it
was pale and limpid; but when the fever came to remit, there was
often a small sediment after each paroxysm; and as the fever was
going off, it let fall a sediment in all.” (Army Diseases, etc., p.
159.) The absence of the sediment in the urine before the crisis is
an important fact in the history of febrile diseases, which I have
reason to think is not now sufficiently adverted to.
[647] Galen does not hesitate to give it as his opinion that the
dysentery was owing to the bile not being properly purged off by
the urine.
[648] The reader will find it interesting here to mark the
alliance between the causus and phrenitis, to which we formerly
adverted. Galen remarks that both arise from the same humour,
that is to say, bile, which when it collects in the veins of the lower
part of the body gives rise to causus; but from the beginning of
autumn to the equinox, produces phrenitis by being determined
to the brain.
[649] This is perhaps the most striking account of an
aggravated form of causus which is anywhere to be found.
Although less finished than the celebrated picture of the disease
given by Aretæus, it is evidently more original. In fact, any
human production which is very original cannot well be finished,
and consequently a very finished work can scarcely be expected
to be very original.
[650] It is impossible to overrate the importance of these
observations on crises in fevers, provided they be correct and
confirmed by general experience. Monro, without appearing to
have our author in view, seems to give an ample confirmation of
his doctrines on crises as here laid down.
[651] From Galen’s Commentary it appears that the text here
is in a doubtful state. See also Littré.
[652] Allusion is here made to the symptoms of delirium as
described in the fourth paragraph of the Prognostics. See Galen’s
Commentary on this passage.
[653] What an admirable and comprehensive enumeration of
all the circumstances upon which the prognosis and diagnosis of
diseases are to be founded! Here we find nothing either wanting
or redundant; and with what conciseness and precision the whole
is stated! Galen gives an elaborate and, upon the whole, a very
interesting Commentary on this section, but does not supply any
new views, and there are few terms in it requiring explanation.
[654] Having already stated in this work, as well as in the
Commentary on Paulus Ægineta, Book II., 27, my opinion
respecting the nature of the continual fevers, I need not enlarge
on the subject in this place. Whoever wishes for more information
may find much to interest him in the Commentary of Galen.
Respecting the septans and nonans, he remarks, that, although
conversant with fevers from his youth, he had never met with any
cases of these.
[655] Galen, in illustration, states that epilepsy is sometimes
carried off by an attack of quartan fever.
[656] The semitertian was always looked upon as a very
formidable form of fever. See Paulus Ægineta, Book II., 34. Galen
gives a prolix, but not a very distinct account of it.
[657] Galen, in his Commentary, states that he had often seen
persons in consumption attacked with tertian and quotidian
intermittents, but admits that he had no more experience of
quintans than he had of septans and nonans. Avicenna. however,
is not so sceptical as to the occurrence of these rare forms of
intermittents. Indeed he says, he had often met with quintans,
and that a trustworthy physician of great experience had assured
him that he had met with nonans. (iii., 1, 3, 67.) Rhazes also
would appear to acknowledge the occurrence of all these varieties
of intermittent fever. (Contin., xxx., 10, 1, 409.)
[658] The text is much improved in Littré’s edition, so that the
meaning is pretty intelligible without any commentary. Galen
states in explanation, that the three varieties of fever are thus
marked and distinguished from one another: in the first, the fever
attains its height at the commencement, and gradually diminishes
until the crisis; in the second, it begins mild, and gradually
reaches its height at the crisis; in the third, the fever begins mild,
gradually attains its height, and then gradually subsides until the
crisis.
[659] These are all febrile diseases, and for the most part of
the ardent type. In order to enter properly into the spirit of them,
the reader will find it necessary to revert frequently to the
Prognostics, and compare the parallel passages. See also the
Argument.
 [660] Galen, in his Commentary, remarks that the fatal issue
of this case might have been anticipated after the return of the
fever on the third day, with a complication of bad symptoms, such
as great thirst, dry tongue, black urine, delirium, coldness of the
extremities, and so forth. The modern reader will be struck with
the description of the respiration, namely, that the patient
seemed like a person who forgot for a time the besoin de
respirer, and then, as it were, suddenly recollected himself. Such
is the meaning of the expression as explained by Galen in his
Commentary, and in his work On Difficulty of Breathing. By “rare”
is always meant “few in number.” The reader will remark that this
is a striking case of a fever having regular exacerbations on the
even days, and slight remissions on the uneven.
[661] This, it will be remarked, is a case of fever induced from
obvious causes, namely, excessive fatigue and dissipation. We
must take into account, however, the febrile constitution of the
season. According to Galen, the fatal result could have been
confidently foreseen from the seventh day. The distention in the
hypochondriac region here described would appear to have been
meteorism. The throbbing in this region was no doubt owing no
the same cause. The rash was most probable miliary. It is
described as resembling vari (ἴονθοι), by which was probably
meant acne. See Paulus Ægineta, Vol. I., p. 454. Upon reference to
the Prognostics, it will be remarked that the characters of the
urine are all bad, that is to say, it was either suppressed, or the
sediment was either wanting or black and farinaceous. See
Prognost. 12. By “black,” as applied to the urine, is to be
understood “a dark-red color,” like that of wine.
[662] There is nothing in this case very remarkable, or which
stands in need of elucidation; but yet the reader may feel
interested in Galen’s reflections upon it. The recovery he holds to
have been unexpected, as a different result might have been
anticipated from the characters of the alvine discharge, and of the
urine at the commencement. The favorable change he attributes
to the swelling of the spleen, whereby the peccant humors were
attracted to it; and he further remarks, that as the swelling of the
spleen diminished, the humors are described as having passed
down to the extremities, after having first affected the groin of
the side on which the spleen is situated. He further calls attention
to the improved characters of the urine when the swelling of the
spleen and pains of the limbs supervened. Still, however, he adds,
there was a remnant of the cacochymy in the system which gave
rise to the relapse on the fourteenth day, so that the complete
crisis did not take place until the seventeenth day.
[663] This is evidently a well-marked case of puerperal fever,
or of fever complicated with the puerperal state. There is nothing
particularly interesting in Galen’s commentary on it. He states
that the application made in order to remove the suppression of
the lochial discharge may either have been a pessary or a
suppository. It seems most likely to have been the former. On the
composition of the ancient pessaries, see Paulus Ægineta, Book
VII., 24. He remarks that the symptoms first stated are
unfavorable, but not necessarily fatal, until we come to the
coldness of the extremities, which is an extremely mortal
symptom in the beginning of a disease when combined with a
very violent fever. The modern reader will be struck with the
expression that “the attendants seldom put her in mind” to make
water; it is very descriptive, however, of the state of stupor the
patient was in when she was so insensible that she did not attend
to the calls of nature.
[664] Galen remarks that it was reckoned very extraordinary
for a rigor not to be followed by febrile heat. See Comment. et de
Rigore; de Diff. Febr., ii.; and Foës’s long annotations on this
passage.
[665] It will be remarked that the characters of the urine
throughout are favorable. Though darkish at first, this was
reckoned not unfavorable, as being connected with the lochial
discharge. (See Galen. Comment. 2, Epid. iii.) The sediments
afterwards are all of good omen; but, as Galen remarks, its first
characters indicated a prolonged fever.
[666] On the Critical Days, see Paulus Ægineta Book II., 7.
[667] On comparing the symptoms here enumerated with the
Prognostics, it will be remarked that none of them are of fatal
omen. But the white sediment, and afterwards the reddish color
of the urine, while they indicated recovery, at the same time
prognosticated a protracted attack of fever. See Prognost., 12.
The reader will further remark that there is an absence of all the
decidedly fatal symptoms, such as delirium, coldness of the
extremities at the commencement, and so forth.
[668] The rapid recovery in this case would seem to be partly
attributable to the decided plan of treatment, namely, the copious
affusion of hot water on the head. Hippocrates probably had it in
view when he wrote the forty-second Aphorism of the Seventh
Book: “In fever not connected with bile, if a large quantity of hot
water be poured over the head, it proves a resolution of the
fever.” Galen points it out as a remarkable circumstance, that in
this case the crisis took place without concoction of the urine, in
consequence of the hemorrhage from the nose, and the
sweating.
[669] In this case, as Galen remarks, the continued sweats,
unfavorable condition of the hypochondriac region, and the black
urine, precluded all hopes of recovery. He thinks our author
related the case as an instance of sudden death in fever, this
patient having died on the fourth day after the attack (the first
not being counted). See his Commentary. He also makes
reflections upon this case in his work On Difficulty of Breathing,
where he points out the danger of meteorism of the
hypochondriac region as being necessarily accompanied with
dyspnœa, and connected with inflammation (2).
[670] This case, as Galen remarks, is interesting from the
suddenness of the fatal result. We should not hesitate nowadays
to set it down as a case of malignant erysipelas; the pain,
swelling, and bullæ of the foot and ankle must have been of this
nature. By the way, these bullæ, when not followed by
suppuration, are represented in the Coacæ Prænotiones, as a
fatal symptom. Galen thinks it strange that this patient was not
bled, but accounts for it by supposing that Hippocrates had been
called in too late. He remarks on this case in the Second Book of
his work On Difficulty of Breathing.
[671] Galen looks upon this patient as an example or
paradigm of general principles in Prognostics. Thus, with regard
to the characters of the urine, it is stated that on the eleventh
day the urine was thin, of a good color, and having many
substances floating about in it, but without sediment. Thus
matters remained until the sixteenth, when the urine became
somewhat thicker, and had a slight sediment. Now Galen remarks
(as the reader will find on turning to the Book of Prognostics) that
these characters of the urine are indicative of recovery after a
protracted disease. Galen further points out that no one of the
fatal symptoms are mentioned, and that swellings of the parotid
glands and the dysenteric affections of the bowels indicated that
the crisis would be distant. He also calls attention to the case as
confirmatory of the doctrines of Critical Days. In the Second Book
of his work On Difficulty of Breathing, he makes some remarks, of
no great importance however, on the meteorism of the
hypochondriac region, as noticed in this case.
[672] In this case, as Galen remarks, the characters of the
urine from the first were such as to indicate a fatal and speedy
result. On the second day the urine was turbid, and without any
sediment; on the third day the same, and consequently
confirming the anticipation of the disease proving mortal; on the
fourth, oily urine, with epistaxis, so that it was not to be
wondered at that the patient died on the sixth. Indeed, when we
further take into account the state of the breathing, the coldness
of the extremities, the meteorism of the hypochondriac region,
and the subsultus tendinum, it is difficult to imagine a more
hopeless case of fever. Having mentioned “oily urine,” it may be
well to state its characters, as fully given by one of the later
authorities on urology, namely Theophilus. He says, when the
urine in fevers assumes the color of oil, it indicates that the fat of
the body is melting down; when the appearance of the urine still
more resembles oil, it shows a still greater melting; and when the
urine in consistence and color exactly resembles oil of a dark
color, it prognosticates a fatal collapse. (De Urinis, 17; ed. Ideler.)
On this subject, see further some very interesting observations by
Foës, in his annotations on this passage (p. 988). With regard to
the respiration in this case, see also the remarks of Galen in the
Third Book of his work On Difficulty of Breathing (tom. vii., p.
932; ed. Kühn). As Galen here remarks, Hippocrates explains the
meaning of this passage in one of his Aphorisms, where he writes
thus: “In fevers, when the respiration stops, it is a bad symptom,
for it prognosticates convulsion.”
[673] According to Galen, this case is an instructive example
of the danger of neglecting the diet at the commencement of
complaints which appear unimportant. This man, having taken
supper at the beginning of a fever which appeared slight, suffered
therefrom as the result showed; that is to say, vomiting ensued,
followed by serious symptoms, among which Galen particularizes,
as indicating a fatal result, urine at first thick and without
sediment, and afterwards oily. So much importance did the
ancient physicians attach to observations on the urine in fevers!
Galen further calls attention to the fact, that the patient died on a
critical day, that is to say, on the eleventh.
 [674] Galen, in the commentary, makes a remark regarding
this report, which appears more important to him than it will do
to most modern readers, namely, that he wonders Hippocrates
did not state the age of this patient. He adds, that it is very rare
for a pregnant woman to have such a serious fever without
parting with her child. He thinks the patient, in the present
instance, owed her recovery to the strength of her constitution,
as “urine white, and not of a good color,” in combination with the
other bad symptoms, indicated an unfavorable result. By the way,
upon reference to the Basle edition of Galen, and to Foës’s
annotations on this case, it will be seen that there is a difference
of reading in the words descriptive of the urine, that is to say,
some read ἀχρόων, some εὑχρόων. Certainly it appears to me
that Foës is right in preferring the latter. The decided crisis, it will
be remarked, took place on a critical day, that is to say, the
fourteenth, by a sweat.
[675] Here again Galen calls attention principally to the
characters of the urine, which is first described as being “of a
good color, but thin.” Now, by a good color of the urine, Galen
observes, was meant of a slightly yellow color. In this case, as
usual, the crisis was marked by a sediment in the urine.
[676] Œuvres d’Hippocrate, tom. iii., Arg., pp. xxxvi.-xlii. tom.
v., pp. 57–70.
[677] There is some doubt, however, even on this head;
indeed Riolanus does not scruple to affirm, with a considerable
degree of plausibility, that Ruffus must have lived after Galen,
since he is nowhere mentioned by the latter. (Anthropographia, i.,
5.)
[678] In illustration, consult Plutarch (Placit. Philosoph., v.,
29).
[679] De Differ. Feb., i., 7; tom. vii., p. 296, ed. Kühn.
[680] Commentary on Paulus Ægineta, Book II., 16, 36; IV., 25,
Syd. Soc. edition.
[681] Disquisitio Historico-Medica de Natura Morbi
Atheniensium. Stuttgart, 1831.
[682] On this case Galen has left very lengthy and elaborate
commentaries, containing much important and amusing matter,
but not a little verbose trifling, to say the least. Our limits, as well
as our tastes, dispose us to be very sparing in our extracts from
them. Passing over his remarks on the solecism in syntax, with
which the Report commences, and his observations on the
absence of all mention of the exciting causes, as is the usual
practice of our author, I shall proceed to state what Galen says on
the apparent neglect of venesection in a case where it would
certainly appear to have been clearly indicated. In this case, as
Galen remarks, one or other of these suppositions may be made:
either that bleeding was not practiced, or that the author did not
think of mentioning the practice here, as supposing that it would
be taken for granted that it was applied. Now, he adds, the
former supposition is very improbable, considering how partial
our author shows himself to this practice in his works which are
unquestionably genuine, such as On the Regimen in Acute
Diseases, the Aphorisms, the work On the Articulations, and even
in this very book, where in one place he mentions that he
abstracted blood copiously on the eighth day. If, then, he bled so
late in febrile diseases, Galen contends that he was not likely to
neglect the operation in an earlier stage, when so much more
demanded. He argues further, that in many of the other reports
of cases he neglects to mention that the usual routine of practice
was followed: and therefore he inclines to the opinion that it is
omitted to be mentioned here, because the author supposed
there could be no question on this point, more especially as it
was his universal rule to bleed in all great complaints, when not
prevented by the age or powers of the patient. He afterwards
insists strongly on venesection having been indicated in this case,
in order to procure revulsion from the brain. As usual with the
commentator, he calls attention to the characters of the urine,
and explains the meaning of the term “cloudy,” as applied to the
eneorema, or substances floating in the urine, by which he
contends is to be understood a color intermediate between white
and black. What follows in this very lengthy Commentary is very
interesting in a general point of view as regards the views of
some of the older commentators, but is not directly applicable to
the present case. His observations on the characters affixed to
this and many of the subsequent cases have been noticed in the
Argument. The reader will further remark of this case that it is an
instance of fever passing into a deposit (or abscess), and the
latter into strangury, of which our author had made mention in
the First Book of the Epidemics. I may further mention that the
reader will find much interesting matter in Galen’s work On
Trembling, in illustration of the nature of the attack under which
the patient labored.
 [683] Galen, in his Commentary, communicates a singular
notion which one of the earlier commentators maintained
respecting the name of the place where this patient was laid, that
is to say, that this new wall, having been recently washed with
quicklime, had been the cause of this patient’s illness. Galen,
however, rejects this paltry conceit. He says on his own authority,
that there being three distinct classes of fever, namely, the
ephemeral, the hectic, and those connected with putrid humors,
the present case belongs to the last of these.
[684] Galen compares the characters of the urine with their
indications as given in the Prognostics. None of them are
favorable, although not decidedly fatal.
[685] This complication cannot fail to attract attention, from
its resemblance to an epidemic which prevailed in Scotland in the
year 1843. In this epidemic, as in the present case, the fever was
very subject to relapses and to jaundice at an early stage.
Hippocrates, in one of his Aphorisms, pronounces jaundice in
fevers before the seventh day to be a fatal symptom. (iv., 62, 64.)
Galen justly thinks it somewhat singular that no further mention
of the jaundice is made in the course of the report; but he
inclines from this to draw the conclusion that it remained in the
same state throughout. As there was no crisis by the stomach,
the bowels, the urine, or sweat, he concludes that the jaundice
could not have been carried off. From all that has been said, he
adds, it is clear that the organ primarily affected was the liver.
Galen, then, decidedly opposes the view taken in the Explanation
of the Characters respecting the cause of this man’s death, which
he contends was not connected with any suppression of the
alvine discharges, but with the affection of the liver. On the
Scotch Epidemic, see Ed. and Lond. Med. Journal, March, 1844.
[686] Most of the ancient authorities regarded deafness as an
unfavorable symptom in fevers. See Paulus Ægineta, Book II., 4.
The modern are divided in opinion on this point. Pringle and
Huxham regard it as a favorable symptom, but Home looks upon
it as unfavorable.
[687] Here again Galen mentions the absurd notion of Sabinus
the commentator, that this man’s disease was occasioned by the
locality in which he was laid. Galen, on the other hand, thinks it
likely that the patient was conveyed to the garden as being a
favorable situation for a person ill of fever. He further alludes to
this case in the Second Book of his work On Critical Days.
 [688] Galen remarks, that as there is no mention of a single
favorable symptom up to this date, the patient would certainly
have died if he had not been of a vigorous constitution.
[689] Thus, as Galen remarks, after two ineffectual attempts,
Nature accomplished a cure on the fortieth day.
[690] There is not much to remark in this case. A modern
reader will suspect that there had been cerebral disease before
the attack of the fever, and that matters had been brought to a
crisis by the drinking of wine. Indeed Galen, in his Commentary,
remarks that the precursory symptoms indicate a congestion of
humors in the brain, which of course would be much aggravated
by the wine, the brain then being, as he says, in a bad state; and
the patient having inflicted an additional injury to the organ, by
means of the drink, brought on the acute attack, which proved
fatal in five days. The deafness, delirium, spasms, and bilious
vomitings all indicate a cerebral affection. The state of the
hypochondria, as described in the report, Galen would seem to
attribute to a spasmodic affection of the diaphragm, from
sympathy with the brain. Retraction of the hypochondrium is
pronounced to be a bad symptom in the First Book of the
Prorrhetics. Galen justly contends that there is no reason in this
case to suspect any inflammation in that region.
[691] Galen’s remarks on this case are unusually brief; he
attributes the fever to a bilious plethora, and states that the
result was such as might have been anticipated from a knowledge
of the critical days, and of the characters of the urine. Indeed the
latter appear to me well deserving of attention.
[692] This is in many respects an interesting case, and more
especially, from its being stated that the disease was complicated
with hereditary consumption. Galen, in his Commentary, remarks
that some authorities denied that any disease is congenital, but
this opinion he decidedly rejects. The phthisical affection,
however, as he justly remarks, would not have occasioned so
sudden an issue if it had not been complicated with a complete
prostration of the natural powers. He insists strongly on the
striking description here given of the total loss of the natural
appetite, both in regard to food and drink. Of course, no worse
state of the system can be imagined than that in which it is totally
insensible to its own wants, nay, that it loathes the very articles
which it stands most in need of. Galen properly remarks in
another place (Comment. I., in Epid. i.), that it is an extremely
unfavorable symptom when in an ardent fever there is no thirst.
The small abscess about the nates would seem to have been an
incidental complication. It would appear to be now settled by the
best pathological authorities that there is no natural alliance
between phthisis and fistula in ano, as was at one time
suspected. See Andral (Cliniq. Médicale, tom. iv., p. 308), and
Louis (On Phthisis, p. 89, Sydenham Society’s edition). The
affection of the fauces and throat, which is described as having
attacked the patient at “the commencement of the disease,”
would appear to have been a common complication of that
epidemic. It is noticed in the First Book of the Epidemics. Foës
remarks, however, that some had referred it to that redness of
the fauces to which persons laboring under consumption are
liable. Compare Louis, l. c. p. ii., § 12. Galen makes mention of a
difference of reading in the MSS. he used in reference to the
Critical Days.
[693] On this brief case Galen has left a lengthy and elaborate
Commentary, abounding in most interesting matters on a variety
of subjects; as, for example, the different readings and opinions
of the more ancient commentators on the characters at the end
of this and the other reports; on the formation of the Hippocratic
Collection, and the extraordinary zeal of the Ptolemies in
procuring books for their great Library at Alexandria, and so forth.
There is not much in it, however, which bears directly on the
present case, and therefore we shall give but a very brief abstract
of it. It appears from Galen that there was a considerable
diversity of readings in the latter part of it, more especially in
regard to the number of days the patient lived; some of the old
authorities having placed the death on the fifth, some on the
seventh, and others on the eighth. Galen inclines to hold by the
text as we now have it, and maintains, apparently with good
reason, that under such a combination of fatal symptoms it was
not likely that the patient’s strength should have stood out longer
than the fourth day. Another curious subject connected with this
case which Galen slightly touches upon, but without throwing any
light upon it, is the omission of the treatment. He justly remarks,
that if Hippocrates treated the patient himself, or superintended
the treatment as managed by another, it is singular that there is
no mention of a clyster having been administered, nor of a
cataplasm having been applied, nor of venesection having been
practiced. I shall not attempt to solve the question here
propounded by Galen. See the Argument. His Commentary also
contains an interesting discussion on the meaning of the
expression “respiration elevated.” To give the sum of what has
been advanced on this subject in a few words, it may signify
laborious breathing so as to move the labia of the nose; or it may
mean simply orthopnœa, or it may signify laborious respiration,
attended with elevation of the chest. By the way, this is evidently
the “sublimis anhelitus” of Horace, in his famous ode entitled
“Nireus.” I have often wondered that such a learned physician as
Julius Cæsar Scaliger, in his celebrated critique on Horace in his
Poetics, should have remarked on this expression: “Ex toto
Galeno non intelligo quid sit sublimis anhelitus.” Galen, in fact,
treats fully of the “sublimis anhelitus” in various parts of his
works. See in particular On Difficulty of Breathing.
[694] Galen has given us a lengthy Commentary on this case,
but a great part of it relates to the characters and to other
matters not of any very great importance in this place. As he
remarks, it is a striking example of an acute fever induced by
immoderate fatigue. It appears from his Commentary, moreover,
that some of the older authorities had added “drinking” to the
excesses which induced his affection; that is to say, they
proposed to read πότων instead of πόνων. The symptoms, upon
reference to the Prognostics, are all such as indicated a fatal
result, namely, the blackish and thin urine, “the fumbling with the
bedclothes,” the coldness and lividity of the extremities, the
meteorism, and so forth.
[695] In Galen’s Commentary on this case there is not much
of any great interest to the professional reader of the present
day. He animadverts again on the omission of all mention of the
treatment, although, as he states, venesection and the other
usual means had no doubt been tried; indeed the report implies
as much. Hippocrates, he repeats, never thinks of mentioning the
usual routine of practice, as he takes it for granted that the
reader will understand that it was not neglected. It is only on
special occasions, then, that he thinks of making any particular
reference to the treatment. Galen remarks, that ileus being an
inflammation of the upper intestines, is a particularly dangerous
affection.
[696] As remarked by Galen in his Commentary, this was no
doubt a case of ardent fever or caucus, complicated with an
incidental miscarriage. There is no reason for looking upon it as
being a case of puerperal fever. Galen thinks that the last word
(caucus) is an addition made by the copyists, having been
transferred from the Glossarium to the text in the course of
transcription. Galen, as usual, directs attention to the characters
of the urine, which in this case are particularly unfavorable, being
defective both in quantity and quality.
[697] Galen’s remarks on the circumstances of this case are
sufficiently to the purpose, but there is nothing very striking in
them. He states that the abortion may have been occasioned
either by external causes—such as the application of pessaries for
this purpose, and the like—or internal, such as hemorrhage from
the neck of the uterus. and so forth. As in the former case, he
pronounces the last word (phrenitis) to be an addition to the text,
as Hippocrates never enters upon the diagnosis of diseases, as is
done in the work On Diseases. I suppose he means that our
author’s real works are all founded on Prognosis; whereas the
other, being derived from the Cnidian school, is founded on
Diagnosis. See our observations on this subject in the Preliminary
Discourse, and the Argument to the Prognostics.
[698] Galen remarks, that with such a combination of fatal
symptoms, namely, coldness of the extremities, fetid vomiting,
etc., it is wonderful that this patient stood out until the fourteenth
day. He thinks, however, that this is to be explained from her age
and constitution. He justly remarks that the occurrence of the
epistaxis could not be supposed sufficient to carry of such a
combination of unfavorable symptoms. He once more protests
against the last word of the report (causus) being admitted as
genuine. He confesses himself unable to determine whether “The
Liars’ Market” was in Athens or elsewhere.
[699] This is entitled the pestilential constitution by Galen. By
constitution, he explains, is meant not only the preternatural state
of the atmosphere, but also of everything else which influences
the state of the general health.
[700] Galen remarks, that in the First Book of the Epidemics
three constitutions of the year are described and also that others
are described in the Second Book; but that these are not carefully
drawn out for publication like those of the First and Third. He
further remarks on this head, that the constitution of the season
might prepare us for the putrid diseases, which are described
below, as heat is the active, and humidity the material, cause of
all putrefaction.
 [701] Galen remarks that erysipelas is occasioned by a bilious
defluxion, but that it is not always of a malignant and putrid
nature; on the contrary, when the defluxion is mild, and the bile
which produces it is natural, it is not attended with any
considerable injury to the body, if properly managed; but that the
humor which produced the erysipelas about to be described was
not such, but of a malignant, corrosive, and septic nature, being
engendered by the humid and calm state of the weather in such
persons as were of a choleric constitution.
[702] According to Galen, aphthæ in general are superficial
ulcerations in the mouth, produced by the acrimony of the nurse’s
milk, and which are easily removed by an astringent application.
But in the present instance the aphthæ were of a malignant
nature.
[703] The carbuncle (anthrax), Galen says, is always
dangerous, and the product of bad humors. See Paulus Ægineta,
Vol. II., pp. 78, 79. Galen, in his excellent work On the Difference
of Fevers, writes thus: “In constitutions of the year, similar to
those which Hippocrates describes as taking place in Cranon (See
Ep. ii.). I have known cases of anthrax prevailing epidemically in
no few numbers, the formation and other symptoms of which
were exactly as described by him.” (Tom. vii., p. 293; ed. Kühn.)
[704] Galen explains under this head that the term epidemic is
not applied to any one disease, but that when many cases of any
disease occur at the same time in a place, the disease is called an
epidemic; and that when it is remarkably fatal it is called a
plague.
[705] The history of the epidemical erysipelas here described
cannot fail to prove interesting to the modern reader. I need
scarcely remark that epidemics of a similar nature are
occasionally met with in Great Britain at the present day. I myself
have encountered two such epidemics in the locality where I am
now writing, the one in 1823, and the other in 1846. As described
by Hippocrates, the disease sometimes supervened upon a slight
injury, and generally terminated in gangrene. On epidemical
erysipelas, see De Haen (Ratio Medendi), Bartholinus (Hist.
Anatom. Rat. Hist., 56), Wells (Transactions of a Society for the
Improvement of Medical and Chirurgical Knowledge), Cooper’s
Surgical Dictionary; and Cyclopædia of Practical Medicine, under
Erysipelas.
 [706] Galen amply confirms this statement, that when
erysipelas fixes on a particular part of the body it is more
formidable in appearance than in reality, and that the disease is
attended with most danger when it leaves an external member,
and is determined inwardly.
[707] The classical reader will here call to his recollection a
striking passage in the celebrated description of the Plague of
Athens, as given by Thucydides: “For the mischief, being at first
seated in the head, spread over the whole body, and if one
survived the most formidable symptoms, an attack on the
extremities manifested itself; for it was determined to the genital
organs and to the hands and feet, and many escaped with losing
them, and some with the loss of their eyes.” (ii., 49.) The passage
is thus rendered by Lucretius:

“tamen in nervos huic morbus et artus

Ibat et in partes genitales corporis ipsas;
Et graviter partim metuentes limina lethi
Vivebant ferro privati parte virili:
Et manibus sine nonnulli pedibusque manebant
In vita tamen et perdebant lumina partim.”
(vi., 1203.)

Lucretius, it will be remarked, understands the historian to

mean that the mortified parts were amputated; and this opinion,
although rejected by most of our non-professional editors of
Thucydides, is confirmed by what Galen says in his Commentary
on this passage, namely, that in erysipelas of the genital organs
“we (meaning the physicians of his own time) are often obliged to
excise the putrid parts, and apply the cautery to them.” I would
here further point out a singular mistake into which Dr. Bloomfield
falls in his note on this passage of Thucydides; he says that the
words of the original (ἄκρας χεῑρας καὶ πόδας) “can only signify
the ends of or lower joints of the fingers and toes.” No one who is
acquainted with the language of our author will require to be told
that this is an entire misconception. In the works of Hippocrates
χεῖρες is often put for the arms, and χεῖρες ἄκραι are always
applied to the hands.
[708] Upon reference to the Glossary of Erotian, the
Commentary of Galen, and the Annotations of Foës and Littré, the
reader will see that there is great difficulty in determining the text
in this place. After examining all that has been written on the
subject, one cannot come to any satisfactory conclusion as to the
true reading. I have adopted the meaning which seems to suit
best with the passage. The professional reader will scarcely
require to be reminded that in cases of phthisis there is often a
notable impairment of the voice.
[709] Galen makes the important remark on this word, that, in
febrile diseases, epistaxis is always a bad symptom.
[710] This obliviousness is a feature of the plague, as
described by Thucydides: “And some, when they first left their
beds, were seized with an utter forgetfulness of all things, and
knew not themselves nor their relatives.” (l. c.)
[711] Our author alludes to the affection called coma vigil by
the later authorities. In this affection, as Galen remarks, the
patient lies with his eyes shut, but can get no sound sleep. This,
of course, is so much more the case provided pain be present, as
it necessarily will prevent the occurrence of sleep. See Galen’s
tract On Coma.
[712] The low muttering delirium of typhoid fevers is here
evidently alluded to. Galen, in his Commentary, guards the reader
against supposing that the fever passed into lethargus.
[713] This description apparently can refer to nothing but
pestilential buboes.
[714] It is impossible not to recognize this as a description of
purulent ophthalmia. Celsus thus describes the ficus: “Est etiam
ulcus quod a fici similitudine σύκωσις Græcis nominatur, ubi caro
excrescit; et id quidem generale est. Sub eo vero duæ species
aunt. Alterum ulcus durum et rotundum est: alterum humidum et
inæquale. Ex duro exiguum quoddam et glutinosum exit: ex
humido plus, et mali odoris.” See the Lexicons of Hesychius and
Phavorinus, and also Paulus Ægineta, Book III., 3. It will be
remarked that Hippocrates also makes mention of fungous
excrescences about the pudenda. Were they syphilitic? In other
words, did they derive their origin from elephantiasis? See the
Annotations on Paulus Ægineta, Book IV., 1, Sydenham Society’s
edition.
[715] The meaning of this term is not precisely determined.
Galen’s account of it may apply both to exanthemata, and
pustulæ. The description of the eruption in the Plague of Athens
is likewise vague and indeterminate. (Thucyd, ii., 49.)
 [716] These intestinal complaints are all mentioned in the
description of the Plague at Athens. (l. c.) Upon reference to the
Commentary of Galen, the reader will remark that there is a
question here respecting the reading.
[717] Galen, in his Commentary, makes the remark that he
observed the same symptom in the plague which raged in his
time.
[718] It will readily be understood that a colliquative diabetes
would prove a very unfavorable complication of these complaints.
[719] By nocturnal fevers, according to Galen, was meant
quotidians, which had their paroxysms during the night. Foës
inclines to think that diurnal should also be inserted in this place.
These nocturnal fevers are thus described by D. Monro: “The sick
were restless and uneasy at night; but commonly felt themselves
cooler and lighter in the daytime: and although they had no cold
fit, as the fever came on at nights, and many of them no
breathing sweat, as they became cooler and freer from the fever
in the morning; yet the fits were so remarkable, that many of the
patients used to say that they had a regular fit of an ague every
night, and some few that they had the fit every second night.”
(Army Diseases, etc., p. 158.)
[720] The account of the origin and progress of consumption
here given is, upon the whole, wonderfully correct. Common
experience seems to have decided that spring and autumn are
the most fatal seasons to phthisical patients. Avicenna makes the
remark, which is very important, and deserves to be kept in mind,
that by phthisis, in this place, Hippocrates most probably meant
hectic fever, connected with disease of the internal viscera, which
had been in an inflamed state during the acute attack of the
fever. (iii., 1, 3, 67.)
[721] I shall not enter into a discussion of the different
readings of this interesting passage. I may mention that our great
pathological authority on phthisis, Dr. Louis, agrees with
Hippocrates in deciding that the lymphatic temperament
constitutes a more or less marked predisposition to the
development of phthisis. (p. 483.) Galen describes the phlegmatic
temperament as being attended with a soft and slightly tumid
skin. He attributes the disease in their case to a cacochymy, that
is to say, to cachexia. I need scarcely remark that this opinion is
strongly advocated by one of the highest authorities of the day, I
mean Sir James Clark. See his treatise on Tubercular Phthisis.
Galen gives a discussion on the color of the eyes, about which
there is some difficulty, as the ancient terms which relate to
colors are not very well defined. The term here used (χαροπὸς)
may signify either blue or gray. Galen considers this color of the
eyes as a symptom of a cold and humid temperament.
[722] There is an ambiguity in the part of the sentence which
relates to women, as Galen states in his Commentary. Galen does
not hesitate to declare that women are more subject to phthisis
than men, an opinion upon which modern authorities are not at
all agreed. See the recent publications of Louis and Clark on
Phthisis.
[723] The last paragraph, and the latter clause of the
preceding one, were at first attached to the end of the
subsequent cases, and were transferred to their present position
by Dioscorides the commentator a short time before Galen. They
evidently embody a most distinct and admirable enumeration of
the general facts with which the practical physician ought to make
himself acquainted.
[724] We learn from the Commentary of Galen that some of
the older critics supposed that the sixteen cases about to be
related had been selected by Hippocrates in illustration of his
doctrines, as laid down in the preceding description of what is
generally entitled the Pestilential Season. Galen, however, does
not incline to this opinion.
[725] This is an example of one of those protracted fevers of
an intermittent type, which, as I have been informed by an
intelligent physician who practiced for several years in the Ionian
Islands, are so common in the climate of Greece. There is not
much of any particular value in Galen’s Commentary on this case.
He informs us that one of the older commentators absurdly
maintained the opinion that the country of this patient was given
because, according to Asclepiades, the inhabitants of Paros were
most especially benefited by bleeding. But, as Galen says, this
remark is particularly out of place here, since no mention of
venesection occurs in the report. Galen, and after him Foës, have
given very lengthy and elaborate disquisitions on the nature of
oily urine. The result is, that it is an unfavorable, but not
necessarily a fatal, character. It is minutely described by the later
authorities on urology, namely, Theophilus and Actuarius. See
also the Commentary on Paulus Ægineta, Book II., 14, Sydenham
Society’s edition.
 [726] This appears clearly to be a case of fever, complicated
with, but not produced by parturition. Galen, however, seems to
ascribe the fever and its fatal results to the retention of the
lochial discharge. The characters of the urine, he properly
remarks, are unfavorable, being copious, thin, and black. He also
calls attention to the want of proper concoction in the sputa, to
which he attributes the fatal relapse.
[727] Galen’s Commentary on this case is written in his usual
light and diffuse style, but contains very little which is calculated
to throw light on the text, or on the nature of the disease which
is here described. If any one find difficulty in comprehending the
characters of the respiration, as given in this narrative, he can
turn to Galen’s work, On Difficulty of Breathing, where they are
explained very fully. I may just mention that by shortness of
breath (βραχύπνοος) was understood, by Hippocrates and Galen,
frequency of the act of respiration.
[728] This case, as Galen remarks, is an instance of the most
acute form of phrenitis. He states that he himself had met with
cases of phrenitis in which the patients had died on the fourth
and fifth day, but that he had never seen a case which proved so
suddenly fatal as the present one. He further makes some very
interesting reflections on the suddenness of the attack in such
cases, which is the more wonderful, as the exciting cause of them
must be gradually collecting in the system, and acquiring strength
and intensity, and it is singular that it should then be developed
all at once, and cut off the patient in a very short time, as if he
had swallowed poison, or had been stung by a venomous animal.
He compares the latency of the febrile humor in the system to
that of the mad dog, which will remain for a long time in the body
of a person who had been bitten, and then all at once will
manifest its effects, by inducing the rage. For the ancient views
on the subject of Hydrophobia, see Paulus Ægineta, Book V., 4,
Sydenham Society’s edition.
[729] Galen, in his Commentary on this case, enters into a
train of reflections how a physician ought to proceed when called
in to a patient so circumstanced. He ought, in the first place, as
the Commentator properly remarks, to make careful inquiry, in
order to find out whether the pain in the limb be occasioned by
any external cause, as persons often meet with local injuries by
sudden twisting and movements of their limbs, or even by laying
a limb uncomfortably in bed, without being aware of it. When no
such cause of the complaint can be discovered, Galen says the
physician should try to ascertain whether or not it be connected
with the regimen or temperament of the patient. If it shall turn
out that the body is in a plethoric state, general bleeding must be
had recourse to, before any local applications are made to the
part. It is then to be fomented, and liquid and heating medicines
applied to it. Whether or not this was the mode of treatment
which Hippocrates adopted in this case, Galen cannot take upon
himself to affirm, as no mention is made in the report of
venesection, nor of the particular remedies which were used. I
am of opinion that this is one of the most interesting cases in the
whole Collection, for I believe it to be a faithful report of a
disease which on three several occasions I have met with during
an active professional practice of thirty years, and which I have
not seen described elsewhere. In all my cases, indeed, the
patients were from twelve to sixteen years old, but in other
respects the symptoms were the same as here described by
Hippocrates. In every one of the cases the patient was seized
with pain and swelling of the thigh, attended with high fever,
great jactitation, and partial delirium. They all proved fatal in the
course of three or four days. Whether the disease be connected
with diffuse inflammation of the areolar substance, or with
inflammation of the veins, or whether it be a general fever
complicated with a local affection of the limb, or what may be the
exact nature of the affection, I have not been able to determine.
From what is stated above, it will be clearly seen how justly
Hippocrates deserves the compliment paid to him by Galen, of
having been, of all medical authorities, the most careful in
observing the phenomena of disease. (Opera Galeni, tom. vii., p.
829, ed. Kühn.)
[730] Galen remarks, that this is one of those cases which
appear formidable to the inexperienced, but which those who are
practiced in the art judge of as being likely to come to a speedy
crisis. He adverts to the slight swelling of the spleen and the
characters of the urine, which soon showed a proper sediment, as
being particularly favorable symptoms. The more that we study
Hippocratic medicine, we shall be the more convinced that too
little attention has been paid of late years to the physical
characters of the urine in all febrile complaints.
[731] Galen’s Commentary on this case is unusually brief. He
holds it to be a case connected with general plethora, as
indicated by the good color of the urine. He once more makes the
remark that a favorable issue of the case might have been
anticipated, from the characters of the urine.
[732] Galen remarks in his Commentary, that of all the cases
related in the First and Third Books of the Epidemics, this is the
only one in which Hippocrates says that the patient was bled, not,
he adds, that this was the only case in which venesection was
adopted, but because, although the general rule was not to bleed
after the fourth day, the patient, in the present instance, was bled
on the eighth. Many others, he says, were no doubt bled on the
second, third, and fourth days, but of these bleedings, and the
other means used, Hippocrates in general takes no notice, except
that he sometimes states, in order to render the malignity of the
disease more apparent, that it was nowise benefited by the
remedies applied. In other cases he adds, he would appear, from
the words he uses (such as “as far as I am aware”), not to have
attended the patient at the commencement. Galen further directs
attention to the characters of the expectoration, the concoction of
which he looks upon as having proved the means of carrying off
this fever. Galen has reviewed the symptoms of this case very
fully, and in a most interesting manner, in the Second Book of his
work, On Difficulty of Breathing, see ed. Kühn, tom. vii., p. 854,
etc. That it was a case of fever complicated with pleurisy seems
clear, as Galen remarks. Galen further treats of the characters of
the sputa in this case, in the First Book of his work, On Crises.
Upon reference to the edition of Littré, it will be seen that
unfortunately there is considerable variation in the readings of
this passage.
[733] On this case Galen makes the remark that this patient
must have had a strong constitution, otherwise it could not have
withstood such an affection. He adds that, moreover, his pulse
must have possessed strength, but that, as formerly said by him,
this department of prognostics is altogether omitted by
Hippocrates, in his reports of febrile cases. He further remarks
that the respiration and appetite were not to complain of, and the
only bad symptom was the thinness and blackness of the urine,
which therefore required a long time for nature to overcome, by
occasioning hemorrhage, pain of the hip-joint, and determination
downwards. He adds, that great diseases require decided crises,
and that even with those now mentioned, the disease was not
entirely removed in this case, until concoction in the urine took
place.