Front Page Titles (by Subject) HIPPOCRATES ON THE HUMOURS. a - The Writings of Hippocrates and Galen
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HIPPOCRATES ON THE HUMOURS. a - 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).
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HIPPOCRATES ON THE HUMOURS.a
In his preface to this treatise, Haller tells us that Galen appears to have thought it genuine, since he wrote a commentary upon it, or else upon another that has been lost. Mercurialis considered it doubtful, since ancient critics mostly repudiated it. To me, says Haller, it seems genuine, and the production of the writer of the treatise, “De Locis,” for we find in it the same alternating superiority of bile and pituita, that is there depicted. It also contains some things that are to be found in the first Epidemics, a book that is undoubtedly genuine; as well as some aphorisms, the same to a word, as in the book under that title. It possesses, moreover, the brevity of Hippocrates; for we find the names of things alone, without the slightest comment. It commences with a theory of the humours, and of their various tendencies. It briefly rehearses the signs of diseases, and the common rules of practice; notices the critical days, and the power of different ages, years, and winds, and affords examples of metastases from the Epidemics.
In its general character it consists, according to Haller, of medical precepts, relating both to the sick, and to the diseases themselves, their different sources in atmospheric changes and constitution; how to foretell those different constitutions from the existing diseases, and of the preventive powers of hemorrhoidal affections.
According to Gardeil, if this treatise is compared with a commentary on it, by Galen, it will be found to be mutilated in several places. Haller has conveniently divided this treatise under eight short chapters, in which I follow him, with the heading to each one.—Ed.
The collection of humours is to be conveyed away by appropriate channels at proper times, or must be resolved by derivation, revulsion, and other means.
The colour of the humours, unless deep-seated, is perceived, like an efflorescence on the skin. When they tend at any time to break forth, they should be directed through their appropriate excretories, with the exception of such as require time for maturation,a observing carefully, whether their tendency is outwards or internally, and taking every due precaution, by attention to the rise of symptoms, and to any difficulty they may present. The state of the hair, of the viscera, the fulness of the lower parts, and the good state of the superior; what has a tendency of its own accord, either upwards or downwards, and what appears injurious or beneficial; what is in conformity with custom, region, age; the state of the season, and nature of the disease; what is deficient, or in excess, or altogether wanting. The discharges, remedies, variation or decline of disease, or its tendency to the head or sides, or downward by revulsion from the upper parts,—or upwards, from the inferior. All these particulars require attention; so also as to what parts require desiccation, or moistening, or other means of relief. Effused fluids are to be prevented returning, and their passages are to be dried up. Disturbance in the bowels, how to cleanse them; if abscess threatens in the fundament, and if to be remedied by medicine or by suppuration; if there is a congestion, or appearance of pustules,b a discharge of flatus, or food, or worms, or great heat, or any other disease.
What is to be regarded by the physician—Activity essential in the art of medicine—Considerations respecting irregularity of humours—Of infra-umbilical pains.
Notice is to be taken of what terminates spontaneously; if the pustular eruptions arise from heat, and if they are injurious or beneficial. So too, we are to observe the form, mobility, elevation, and depression of tumours, sleep, insomnia, anxiety, jactitation; and thus foresee what we are to do, and what to avoid. Attention is required as to vomiting, purging, expectoration, nasal mucus, cough, flatulence both up and down, singultus, sneezing, urine, tears, itching, excoriation, palpitation, thirst, hunger, repletion, dreams, facility or inaptitude to work. We are to attend to the state of the mind, as developed by its ideas, by memory, speech, and taciturnity.
In female affections, regard is to be paid to the uterine discharges; if upwards, inducing tormina; if sebaceous, uniform, unmixed, frothy, hot, acrimonious, eruginous, of different colours, feculent, bloody, not flatulent, crude, concocted, dry, and also the discharges of the parts adjoining. How all these are sustained, and when and how they are to be checked; which tend to maturation, and to be evacuated downwards; the fluctuation of such as are seated above, or are discharged from the uterus; the sordes from the ears; the maturation, rupture, discharge, heat or coldness, both internally and externally. Intestinal tormina below the umbilicus are less intense and frequent than when above.
Alvine evacuations considered.
We are to notice the character and appearance of the alvine discharges, if, or not frothy,—whether crude or concocted, cold, fetid, dry, moist, or very offensive. Does thirst arise without great heat, or other apparent cause? Examine the urine, and nasal moisture; is there great jactitation and heat of the body, and difficulty in respiration? How are the præcordia and extremities, the eyes, the countenance, the pulse? Is there palpitation, rough cuticle? How is the state of the tendons and joints, of the voice, mind, person, hair, and nails? and how does the patient bear his sickness? All these are so many symptoms for our attention.
Other symptoms are derived from the odour of the body, or of the mouth, the stools, the ears, flatus, urine, ulcers, sweat, sputum, tears, &c. Are any of these humours saline? All these signs may be under particular circumstances good, or bad. Insomnia also affords us information, as likewise what occurs in sleep. We must ascertain if the patient hears well, and is obedient to directions, and if the majority of symptoms, and the strongest, are favourable. If the patient is perfect in his senses, and readily accommodates himself to every thing around, as odours, conversation, clothes, figures, and if he seems benefited by any of them. All these, if natural, are advantageous, especially towards a crisis. Eructations, and the urine deserve attention also, the last especially, if it is at proper times and in due amount; if the signs are adverse, we must direct our care to restrain the evil.
Those parts that are nearest to the organ affected, or which are alike in function, are the first to become influenced by it, and in a higher degree. Its nature is judged of by the primary symptoms; the crisis is estimated by the urine and all other concurrent signs, such as the change of colour of the skin, difficulty of breathing, and others associated. We must examine whether or no the excretions are natural, whether of the urine, from the uterus, the sputa, by the nostrils. Examine the eyes, and if any exudation occurs from tubercles, wounds, or pustules, compare what may be natural, and what the effect of art; what connexion exists between all these about the crisis, whether for good or evil, that you may as much as possible avert the bad, and aid those that are of a favourable nature.
We must also attend to the skin, the extremities, and joints, the præcordia, the eyes, mouth, tongue, manner of decubitus, and sleep; from all which indications are derived as to the crisis, and the measures to pursue; they aid in estimating the formation of abscesses;—we must not omit to judge of the effects produced from the different foods and drinks, and odours; from seeing, hearing, ideas, thinking; from heat and cold, moisture and aridity; and with respect to remedies, we must attend to their effects, whether they be unctions, liniments, cataplasms, plasters, or aspersions, singly or conjointly.
We must consider if the patient be accustomed to work, or inactivity; notice his sleep and watchfulness; if easily excited or depressed, and if such influence is partial or universal, or the result of the measures adopted. Also, if at or near the increase of the disease, or at its decline, and if the feet are cold. In periodic complaints, during the access, we must not give food or force it upon him. At the crisis, and even a short time before, nothing should be done, but leave all to nature. After concoction has taken place, then we may act; never whilst the humours are crude, or at the beginning, unless by their force they tend to discharge themselves, which is rarely the case. When necessary to evacuate, effect this through those channels to which a tendency is evident. The utility of evacuations is not to be estimated by their quantity, but by their fitness, and by the relief they afford. When it is necessary to induce debility and faintness, this may be effected by derivation, or by drying up, or moistening, as the case may be, that is, if the patient can bear it. This is known by parts naturally dry, becoming hot, and those that are moist, becoming cold. Alvine discharges are here generally to be restrained. If the disease is periodic, and well marked by exacerbation on uneven days, emetics are given,—and purgatives on even days; for we find spontaneous evacuations useful, unless the exacerbation occurs on even days,—in which case the treatment is to be reversed. Such, however, seldom occur, and with difficulty is a crisis produced. If such a type continues for any time, as for instance if the increase is well marked on the thirteenth or fourteenth day, then we should purge on the thirteenth, and vomit on the fourteenth, by which a crisis is assisted. In such as extend to twenty days, besides the regular stools, copious purgation should be employed before the crisis.
In acute diseases, much purgation is unnecessary in those who are worn down by them. In fevers, abscesses of the joints or parotid tumours take place near where pain has been felt, which is commonly in the superior parts. If the disease be slow, and tends downwards, the abscess will be in the inferior parts. Hot feet generally indicate its location below; and cold feet, in the upper parts. In convalescence, if the patient experiences sudden pains in his hands and feet, there the abscess will form; or if, previous to falling sick, he had pains in any part, there will the deposit take place. Such was the case in those with coughs and anginas at Perinthus, for they as well as the fevers ended in abscess. Such, too, occurs in those surcharged with humours, or by a wasting away of the body or mind. Hence it is necessary to know at what season the humours are most turgid, and to what diseases they give rise, with their appropriate symptoms. We should be acquainted likewise with the disease to which a patient may be most liable in any part,—as to an indurated spleen. And as regards other parts, what is it that produces an unhealthy colour of the skin, or shrivels up the body?—and so of the rest.
Of the uneasiness of the mind and body—The sudden sight of a serpent induces a pallid countenance—The earth assimilated to the stomach.
We are also to consider what are the effects of intemperance in food or drink; of too much or too little sleep; or of the passions, as of gaming; of great fatigue, whether of body or mind, and if or not of an accustomed character. The changes which take place are to be investigated, together with their causes and effects. Thus, as to what are the effects of mental labour, in deep research, thought, seeing, converse; or from sorrow, anger, avarice, and all that can exert an influence on the mind and body, through vision or hearing. The noise of a grindstone sets the teeth on edge; the sight of a precipice near to which we pass, makes the legs tremble; as do our hands, when any thing is suddenly snatched from them that we wish to retain; the unexpected sight of a snake induces paleness. Fear, modesty, pain, pleasure, anger, &c., all produce some change in some part of the body, as sweat, palpitation, and similar effects.
External agents are beneficial or hurtful, according to circumstances; as anointing, shower baths, liniments, plasters, cataplasms, bandages, and such like. They produce effects internally, just as internal remedies produce external effects; sleeping on unclean woollen fleeces, smelling the cumin called royal. We observe the effects of catarrh on the voice and speech,—the influence of age on the mammæ, the uterus, the testicles, and their secretion, inducing hysteria, cough, and difficulty of breathing. As the earth is to vegetables, so is the stomach to animals, in the production of nutrition, warmth, and cold; warmth when it is full, and cold when empty. As the ground well manured is warm in winter, so is the stomach. Trees have a dry and thin bark, but if their interior is dry and pulpy, they are healthy, lively, and not apt to decay. It is the same with animals, such as tortoises and the like, under similar ages, seasons, and years. The actions of life are all benefited by moderation. As a new cask leaks, and an old one retains its contents, so the stomach transmits its nourishment, but retains the recrements.
Of the modes of diseases—Diseases dependent on the seasons—Seasons judged of by diseases.
The forms of disease are various. Some are congenital, and are detected by inquiry. Some are endemic, peculiar to certain regions, and attacking numbers. Others originate from a peculiar constitution, regimen, locality, or season. Unhealthy situations produce diseases corresponding to the constitution of the atmosphere that is dependent on their locality. Sudden changes of temperature bring on complaints analogous to those of autumn, and so of other changes. Some diseases arise from marsh and other exhalations; or from the nature of the water, producing calculus or affections of the spleen. The winds are also of a beneficial or hurtful character. As are the constitutions of the year, so are the diseases. If mild and not tempestuous, the diseases are not difficult to manage. Diseases peculiar to certain seasons, indicate by their appearance the approach of those seasons. According to the variation of the seasons in their constitution, diseases of a regular or irregular type appear. If the season is natural, they are of a common kind; in autumn, repeated variation in heat and cold induces jaundice. If heat predominates, the diseases are bilious, and should it be extreme, the spleen becomes affected. If similar variations take place in spring, jaundice is likewise seen. If summer has the character of spring, the fevers are accompanied by sweats; they are mild, and not very acute, and the tongue is moist; but if spring resembles winter, and the cold is long continued, the diseases resemble those of winter, and coughs, pleurisies, and sore throat are common. Again, in autumn, if the cold is tardy in appearance, the usual seasonable complaints are wanting; and when they appear, they are of anomalous character; for seasons, like diseases, have their irregularities, whether of too early, late, or sudden approach. Generally, however, the seasons and their diseases are sufficiently uniform, and it is proper to pay some attention to the state of the system at these different seasons of the year.
Irregularity of the seasons are productive of difficulty in crises; and also induce relapses.
A south wind affects the sight and hearing, induces headache and lassitude; if of long continuance, the discharge from wounds and ulcers is augmented, particularly those of the mouth, pudenda, &c. If the north wind prevails—coughs and sore throats ensue, with costiveness and paucity of urine, and pains in the side and breast. These are all more likely to appear as the wind predominates—and should it still continue, accompanied by drought, fevers will follow, equally as after rains, or other extremes of the atmospheric constitution, according to the state of the body during such successive constitutions, and the humour that predominates in it. The aridity of the north and south winds differs in many respects, as to the degree of dryness at different seasons of the year, and in different countries. In summer, bile is produced, and blood in spring—and thus of the other humours. All vicissitudes induce disease, and those, proportioned to such changes which occur in different seasons. The change is sometimes insensible, and the seasons are then less sickly. So with food, cold, and heat; they ought to be slowly diversified as the ages of life pass into each other. The constitution differs in relation to the season; some are improved by winter, others by the summer. They vary likewise in respect to climate, age, food, and even to disease—some constitutions are less influenced by these than others. Some readily adapt themselves to seasons, climate, diet, and disease. There are food and drinks, and regimen peculiarly adapted to the different seasons. Winter is a season of relaxation, and requires light nourishment and of easy digestion; this is of importance. The autumn is that of labour and exposure, and demands much drink, different sorts of aliment, wine, and fruit.
The character of diseases may be conjectured from that of the seasons; and from the character of diseases we may predict the nature of the subsequent season—Foretelling of dropsical complaints—Variation of complexion according to the seasons.
As we are capable of conjecturing the various complaints of the different seasons, so also, by the diseases that ensue, are we enabled to foretell the occurrence of drought, of rain, and the direction of the winds. Attention will confirm this remark. We observe, for example, some cutaneous affections and pains in the joints, that are affected with much itching on the approach of rain—and so in other cases. Rain occurs at times periodically, viz.: daily, every third day, or continued, or at other intervals. Certain winds likewise blow for successive days, others in opposition to them; some continue for a brief period—others, at fixed and settled times, having an apparent connexion with the constitution of the seasons, but of less duration. If a peculiar constitution of the air continues throughout a great portion of the year, the diseases to which it gives rise will also continue; and the more violent they are, so will they be more extended, and of longer duration. Humidity after extreme drought is promotive of dropsies on the coming on of rain, or when slight changes of the wind are apparent. We may hence form an idea of what diseases may be expected from the state of the winds and moisture; and endeavour to ascertain what kind of spring or summer will succeed to such or such a winter.
The complexion is not uniform, either in the seasons, or in the constitutions of the air, induced by the north or south winds; nor at the different periods of life, whether by comparison of individuals with themselves, or with others. This must be referred to causes which we know to be productive of such irregularity; age itself acting in a measure like the seasons, both as to complexion and existence.
To what diseases those affected with hemorrhoids are not subjected.
Those who have hemorrhoids are not subject to pleurisy, inflammation of the lungs, to phagedenic ulcers, furunculi or tubercles; perhaps not to lepra, nor to vitiligo: but if the hemorrhoids are unseasonably healed up, they are not unfrequently attacked by some of those complaints, and sink under them. Besides hemorrhoids, other abscesses are occasionally preventive of diseases, and sometimes cure them when supervening during their actual existence; but where they are concomitants of the disease, they cannot be regarded in this salutary point of view. Parts, of which we have apprehension of danger, are at times preserved by the accession of pain and uneasiness in the parts already diseased, or elsewhere, or by some sympathetic connexion: blood, if not then any longer discharged, may be expected as near at hand from the lungs. And here, in some cases, bleeding is found proper; in others, its omission is most correct: the season, pain of side, bile, &c., will help to determine its propriety. If swellings about the ears do not suppurate at the crisis, the disease will return on the subsidence of those tumours; and if at the crisis of this relapse they are again elevated, and continue so to imitate the periodic type of the fever, it may be expected that the disease will be transferred to the joints. The urine sometimes becomes thick and white (as in the case of Archigenes), in fevers attended with great lassitude, on the fourth day, with advantage, especially if aided by copious bleeding from the nose,—by which means suppuration is prevented. A person who was afflicted with the gout, was attacked with pain of the bowels, which assuaged that of the joints; but when the pain of the bowels ceased, that of the gout returned with redoubled force.
[a ]χυμος, succus, humor,—in a general way, may be considered as embracing all the various fluids of the body, chyle, blood, bile, &c.
[a ]“Ducere oportet quam in partem momento feruntur, per loca accommodata, nisi quorum maturationes progressu temporis contingunt, quæ vel foras, vel intro, vel alio quo expedit tendunt.”—Fœs., p. 47. It might be supposed without difficulty, that what is marked above in italics has reference to some of the exanthematous eruptions, as measles or small pox.
[b ]βλαστϰμα; pullulatio, Fœs.; pustulosa eruptio, Hal.