Front Page Titles (by Subject) OF THE PHYSICIAN. - The Writings of Hippocrates and Galen
The Online Library of Liberty
A project of Liberty Fund, Inc.
Search this Title:
Also in the Library:
OF THE PHYSICIAN. - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
About Liberty Fund:
Liberty Fund, Inc. is a private, educational foundation established to encourage the study of the ideal of a society of free and responsible individuals.
The text is in the public domain.
Fair use statement:
This material is put online to further the educational goals of Liberty Fund, Inc. Unless otherwise stated in the Copyright Information section above, this material may be used freely for educational and academic purposes. It may not be used in any way for profit.
OF THE PHYSICIAN.
SECTION I.—TREATISE V.
Haller, in his preface to this treatise, says, a more appropriate title for it would have been, “Of the Shop or Office of the Physician or Surgeon,” which is minutely described;—nothing is stated as to plants or medicines. It might be supposed to be written after the subdivision of the art, and during a period of peace, since the author recommends attendance on foreign campaigns, in order to attain a knowledge of the treatment of wounds. The treatise is intended to point out what a physician ought to be, both in respect to body and mind. It then describes the plan of his office or shop, in regard to situation, light, the various instruments and appurtenances required, and speaks of several operations, as cupping, scarification, bleeding, &c., of the extraction of darts, &c., of ulcers, and of tubercles.—Ed.
This treatise is intended to point out some short precepts and advice, as to what is essential to the physician; and first, as to his exterior; he ought to have a healthy appearance, and be of proportionate size to his particular constitution: for should he be otherwise, the public will believe him unqualified to attend to the health of others.—His dress should be neat, and his person clean and unperfumed, lest it might be supposed he employed perfumes to conceal some disagreeable emanation, that might be unpleasant to the sick.
As to internal qualifications, he should possess much prudence; not that merely which prevents indiscreet or untimely conversation, but in all his concerns. His mode of life should be perfectly correct; for good manners and modesty contribute greatly to his reputation. He ought to possess circumspection and humanity: haste and assurance will be followed by contempt, although they may occasionally benefit him, for it is not always possible to avoid his services. They are at times useful, but rarely to be employed by the physician who desires to secure esteem.
In regard to manners, he should be grave, without austerity, lest he should be considered proud or misanthropical; and he should avoid perpetual laughter and hilarity, for they are not at all times acceptable.—In his moral character, justice should predominate. It is at all times of infinite importance, and especially in that intercourse that exists between the physician and his patients. These place themselves entirely in his hands; at all times, wives, daughters, and goods are placed at his discretion. Well then does it behoove the physician to be continually on his guard.—And thus much in regard to his mind and body.
We will now take notice of what is requisite in the study and practice of his profession. In order to excel, it is essential to be careful in the choice of a teacher. Those who give instruction, usually have every thing requisite about them. They ought to be careful in the location of their dwelling, that it should not be incommoded by the wind or sun, to the injury of the sick. Too strong a light, though not felt by the physician, is painful to the sick, and detrimental to the sight; the meridian sun ought to be carefully guarded against, and the light should rather be admitted from the opposite side.* The seats of the patients should be of proper dimensions. No ornaments of brass about them; such are only adapted for the instruments; in any other respect they should be considered inappropriate. Good and pure water for drink should be provided for the sick, and the towels should be clean and soft. For the eyes, soft linen is employed, and sponges for wounds; the property they possess of swelling up, renders them very useful. All the instruments ought to be well made for use, as respects size, weight, and finish. In regard to external applications, such as compresses, bandages, plasters, and cataplasms, the greatest attention should be paid to their accurate adjustment, especially when they are to be of long continuance. The removal of dressings, and their renewal after washing and cleansing wounds, is soon done; the thing to be chiefly attended to, is as to the frequency of this, for much depends on acting correctly herein. As to bandaging, two things are essential, that the pressure should be on the appropriate part, and not be unduly tight. Attend also to the temperature, for the impression of the air is at times to be guarded against. He must also be acquainted with those weak parts, that will not bear too strong a pressure. Pay no regard to those intricate bandages that are more ostentatious than useful; they are superfluous, and often injurious. It is not ornament, but utility that is required. With respect to operations, either by the knife or by cautery, they demand both promptitude and caution, for both at times are proper. When a single incision is required, do it quickly; for, as cutting is attended with great pain, we must make it as short as possible; but when accurate dissection is necessary, it must be slowly accomplished, since, if too hastily effected, the pain is continual and severe, whilst some intermission of it is experienced by the former proceeding. Of instruments, it may be stated, that large or small knives are not to be indiscriminately employed. In the body are parts from whence the blood flows largely, and is not readily arrested, as from varices, &c. Small incisions here are proper, and give us the means of more ready restraint, whenever it may be necessary to allow its discharge, but in parts not dangerous, nor attended with hæmorrhage, large knives may be made use of, and the blood will be evacuated, which would not otherwise be the case. It is disgraceful in the surgeon not to effect properly the intention he had in view.
Cups are employed in two ways. If the fluxion is deep-seated, the neck and belly should be narrow, and the handle long, but light. Cups of this description draw in a direct line, and attract towards the surface the deep-seated humours. But if the affection is more external and diffused, the cups, in other respects similar to the above, should have a wide orifice, which adapts it to draw from a more extensive surface what is to be evacuated. If they are at the same time heavy, by their greater pressure, they act more deeply, and less superficially, thus perhaps leaving behind a part of the external humours. So likewise, if the fluxion is profound, should the orifice of the cups be large; they then act upon the surface, which thereby, from the moisture thus attracted, prevents that of the deeper-seated humours, thus leaving behind what was injurious, and drawing off that which did no harm. The size of the cups must depend on the parts to which they are applied. If scarification is necessary, make the incisions perpendicular to the surface, which affords a greater discharge from the tumid part, in which the blood has accumulated. The bistouries for this purpose should be rounded, and of a moderate size, for sometimes the serous and bloody fluid evacuated, is thick and tenacious, and would be left, should the incisions be too small.
The vessels in bleeding must be sustained by ligatures, for in some cases, they readily move under the skin, from not being sufficiently adherent to the parts beneath, and hence the skin is pierced without touching the vessel. If only slightly penetrated, the parts swell, the discharge of blood is impeded, and suppuration may ensue. Two evils hence follow, pain for the patient, and disgrace for the operator. And this remark holds good in all similar cases.
Besides the instruments mentioned as essential, others are also required, such as forceps for drawing the teeth, and for taking hold of the uvula; these are in common use and extremely simple.
Tumours and ulcers are diseases of more importance, and deserve attention. The principal point as to the former, is to disperse them, and prevent their enlargement. Should this take place, we must endeavour to reduce them as much as possible, and equably; otherwise they may chance to become excoriated, and form ulcers of difficult cure. They are not to be rashly removed, nor should they be opened, until their contents are fully concocted. The means for promoting this are elsewhere described. As to wounds and ulcers, four kinds are observed. 1. Characterized from depth: these are fistulous, cicatrizing above, but hollow and filled with sanies. 2d. Characterized by elevated carnosities. 3d. By their breadth or extent of surface, and denominated creeping. 4th, and most natural, is attended with suppuration;—all these are seated in fleshy parts, and have a common relationship. We have elsewhere detailed their respective symptoms and method of treatment; viz., to resolve congestions, to fill up cavities, destroy excrescences, and restrain their enlargement. We must particularly attend to the due adaptation of poultices, dressings, and bandages. The first, correctly placed, are of immense utility, and help to sustain the dressings. Their composition assists in the cure, by their action on the surrounding parts. Time and circumstances must determine their composition; this cannot be noticed at present, but it requires both knowledge and experience.
We have only further to take notice of battle wounds from javelins, &c., of which few examples occur in towns, though frequent in hostile encounters. Whoever wishes to excel in such cases, must follow the camp, and quit his home, as the only means of pursuing this the most laborious and yet useful branch of his profession. A knowledge of the symptoms of a concealed weapon in the body, by which its presence is denoted, is a high degree of surgery; its continuance detects the ignorant, for science only is capable of undertaking those cases. Of this we have elsewhere treated.
[* ]It would appear as if a dispensary or hospital is here described. It seems scarcely allied to the private domicile of the practitioner.