Front Page Titles (by Subject) SECTION IV.: ON A HEALTHY DIET. - The Writings of Hippocrates and Galen
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SECTION IV.: ON A HEALTHY DIET. - 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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ON A HEALTHY DIET.
The ancients, says Haller, united this with the treatise “De Natura Hominis.” To me, it appears more connected with the third book of the treatise on diet, from which much is transcribed here and there, and other matter more extensively treated of; as, for example, the reasons for dietetic vomition.
The argument of the book is the pointing out the proper use of food, as instituted from the various circumstances of time, habit of body, age, affections, sex, and custom. It is divided into three chapters by Haller.
Chap. I. Of the rules of diet in respect to different seasons of the year and age of life. Of exercise, and bathing, &c.
Chap. II. Of the measures to induce corpulency or leanness. How and when to administer vomits.
Chap. III. Of various exercises; which, when, and for what reasons, best.
Gardeil considers the next treatise on regimen as a continuation of the present, although it is probable they are the production of two different authors. He divides this under fourteen paragraphs.
Sec. I. to IV. Of the diet or regimen for winter, spring, summer, and autumn.
Sec. V. Of diet in respect to age and temperament.
Sec. VI. General principles respecting diet.
Sec. VII. On the use of emetics, glysters, &c.; when to be employed.
Sec. VIII., IX. General principles of regimen for children; for women.
Sec. X. Of gymnastic exercises, and of a fit regimen therefor.
Sec. XI., XII., XIII. Regimen required in some particular cases.
Sec. XIV. General maxim concerning dietetics.
Haller says, that Galen and Mercurialis considered this treatise as unworthy of Hippocrates. It is, adds he, certainly of great antiquity, for it contains the precepts of Heraclitus. It is wonderfully concise, obscure,a and so far Hippocratic. All things are made to consist of fire and water, and these are deemed adequate for every purpose. The first giving motion, the latter nourishment; the life or soul (anima) is even produced by them. Eight temperaments are produced by the varied proportions and powers of each; and the difference of disposition is ascribed to the different temperies of these elements,—to each of which appropriate remedial plans are adopted. Thus in the choleric, cold and humid nourishment and baths are prescribed. No mention is made of bleeding. A theory of temperaments is presented, very different from that given in the treatise “De Carnibus.” A twofold semen is here advocated, as in the tract “De Genitura,” and the dispositions are attributed to the predominance of the one or the other. The uterus is stated as being double. Exercise and emetics are important aids in practice. Between this and the third book there is not much difference.
In the subsequent portions much obscurity exists, which the great sagacity of Gesner has elucidated in the germs of animals and plants; which, if unputrefied, alternately become apparent, vegetate, and grow, and then return to an inconspicuous state. Much is interspersed, the sense and scope of which are not very readily perceived.
The argument of this first book is, that it points out the pre-requisites for instituting a healthy regimen; treats of the constituents of the animal body; of the connexion of art and nature; the union of the sexes in establishing the strength, increase, and nutrition of the body; of the temperaments as influenced by sex and age; and of various affections of the mind.—Ed.
Chap. I. The proëmium of the whole, as founded on attention, docility, and kindness. What previous information is necessary to the dietetic physician. Of the power or property of food and drink.
Chap. II. Propositions as to diet, both general and particular. As to the knowledge of the powers of food, drink, labour, the heavens, and climates, &c., in its employment.
Chap. III. Continued; discusses the principles of nature; asserts them to be two, viz., fire and water, which are endowed with four qualities, viz., hot, and dry, and cold, and moist, &c.
Chap. IV. Of the resulting compounds of the principles; nothing perishes; but, by their modification, alteration, increase and decrease ensue.
Chap. V. Further progress in the view of natural objects; and its basis laid down; treats generally of life and death, and of a divine necessity in the various changes.
Chap. VI. Of the origin, growth, and food of man; and of the wonderful harmony in the intermixture produced, &c.
Chap. VII. Of the origin and increase of the fœtus; demonstrated and explained.
Chap. VIII. A comparison of some of the actions and affections of human beings, whether derived from nature or art; confirming and illustrating the doctrine of birth and of growth.
Chap. IX. The preceding theory of the general origin and growth of man, illustrated and confirmed by induction.
Chap. X. The difference of origin and of growth in the male and female, pointed out.
Chap. XI. The difference shown further, in the diversity of numbers of fœtuses, twins, sex, &c.
Chap. XII. Further shown in the different constitutions of the human body, and the different diet necessary for different periods of life.
Chap. XIII. The same further demonstrated in the powers of the mind; its difference in strength, intellectual and sensitive.
Chap. XIV. The subject continued; the passions, &c.—Haller.
This treatise, says Gardeil, “consists of three books, in which we find prescribed, that mode of living which is best calculated to avoid disease. Although not unanimously regarded as the work of Hippocrates, and although Haller has removed it from that class, it appears to me in many respects worthy of the Father of Medicine, and I believe it is really his work. This opinion will perhaps be thought to be well-founded, by attending to what is said at No. iii. of this book, and No. viii. of the third book. We are occasionally dissatisfied by finding the author strangely deviating from his subject in the first book, and in a large part of the second. At the same time we are gratified extremely, after perusing the third. And we find, if I am not mistaken, that the subject of regimen is admirably treated in all the books united.”
Sec. I. Preamble, in regard to preceding writers on regimen; praise and blame awarded; the writer’s own views on the subject.
Sec. II. Of the preliminary information essential to the writer on regimen; the subject of gymnastics and astronomy touched upon.
Sec. III. Further necessary considerations on the subject.
Sec. IV. Of the nature of man, as constituted of two opposite principles, viz., water and fire; neither of which predominate absolutely, but differ only as to the greater or less amount.
Sec. V. The preceding principle applicable to all things, animal or others; none of which are ever entirely destroyed; nothing new is created, nor is any thing lost; life and death are merely mixtures and separations.
Sec. VI. Death, diminution, and separation are synonymous; all are under the operation of laws provided by nature; and the control of a divine necessity, involving the doctrine of a metempsychosis, or change of matter as to form, &c. The animal soul is under the same influence; that of man is a mixture of fire and water, constituting a part of himself; sundry speculations and analogies on this subject.
Sec. VII. Of what takes place in the early period of fœtation; the motions induced are owing to fire; in what manner bones, ligaments, vessels, &c., are produced; of the mixture of the male and female seed; three great hollow vessels, the vena cava, vena porta, and aorta, with their ramifications, &c.
Sec. VIII. Medicine is but an imitation of nature, as are likewise all other arts.—(Here follows a long and curious digression, respecting the greater part of the arts cultivated by man, in order to demonstrate that all are reducible to the principle of plus and minus, and continued in sections ix., x., xi., &c., to xxii., embracing divination, workers in iron, medical gymnastics, fulling, shoemaking, carpentry, architecture, cookery, tanning, sculpture, music, goldsmiths, potters, writing, public schools, merchants, and actors.)
Sec. XXIII. The author returns to the formation of man, (in whose nature all the arts participate,) in being a mixture of fire and water. The soul is expanded throughout whilst life exists, and augments with the growth of the body. Organization of the fœtus; perfect in some at forty-three days, in others in three months; the former are born at seven, the latter at nine months, bringing with them the temperament which continues through life.
Sec. XXIV. Of the formation of males and females. Twins. Superfœtation. The subject continued to sec. xxviii.
Sec. XXVIII. Of temperaments. What constitutes them. General views on regimen. The first species of temperament. The 2d, 3d, 4th, 5th, and 6th species, extending to sec. xxxiii.
Sec. XXXIV. Of the phenomena proper to the temperaments; derived from—first, the age, second, sex.
Sec. XXXV. Of different constitutions in regard to the soul; with views as to the regimen best adapted as the medicina mentis. Continued to the end, and embracing the diseases to which the mind is subjected.
This book, says Haller, is not unworthy of the Hippocratic name by its good construction; in which those things, called non-naturals by the schools, are considered, together with their powers in relation to the human body. The author derives those powers from simple qualities, viz., sweet, acrid, watery, fat; from which arise those called attenuants, calefaciants, refrigerants, purgatives, siccatives, astringents, emollients. At the commencement he treats of airs, waters, and situations, pretty much as Hipprocrates does, in his treatise under that title. He discourses largely of the food employed in Greece, the various kinds of bread and grain; then of animal food, amongst which we find that of dogs and horses. Next he mentions birds, and numerous fish which is there largely employed. To these succeed the drinks, pot-herbs, legumes, vegetables, apples, &c., which are nearly all in use at present. Of culinary preparations, and their respective value; and he terminates with gymnastics, funerals, races, baths. He adverts to the proper employment of food in removing the lassitude of unaccustomed or over-fatigue. Extols the use of vomits, and, as in the former book, he teaches that all things are constituted of fire and water.
The consideration of diet follows the relation of the principles and differences of the human body, whereby it is preserved in the same condition, or changed and modified by their quality and quantity. Hence it treats of the nature and situation of the winds and climates; of the faculties and difference of food, derived from animals and vegetables; of baths and external operations; and of different kinds of exercise.
Chap. I. Of the location and temperature of places.
Chap. II. Of the air, and of the nature and properties of the winds, as to heat, cold, moisture, &c.
Chap. III. Of food—in general, in special—cerealia—bread, variety of, and properties.
Chap. IV. Of leguminous vegetables; of flesh and its juices.
Chap. V. Of animal food; quadrupeds, birds, fish.
Chap. VI. Of drinks—water, wine, vinegar, new wine, thin wine.
Chap. VII., VIII. Of plants—potherbs. Fruits, various—mulberry, pear, apple, &c.
Chap. IX. Of certain kinds of flesh—preservation of, effects of, age of, and preparation, &c.
Chap. X. Of baths—anointing, sweat, venery, vomition, sleep, labour, rest, eating,—and, in fine, of all such things that in any way are admitted to the body.
Chap. XI. Of exercise, both general and particular.
Chap. XII. Of some inconveniences from exercise, and from over-fatigue, &c.
Gardeil has no prefatory remarks; his paragraphs are to this effect:
Sec. I. to XI. General remarks relating to the soil and habitations, the winds, of food and drinks, viz., the cerealia and their preparations, wheat, rye, barley, &c. Some observations on fresh meal, hot bread, &c.
Sec. XII. Legumes, and other vegetables, their juices, &c., to sec. xxvi.
Sec. XXVI. to XXXV. Animal food—beef, pork, &c.; dog, horse, fox, &c.
Sec. XXXV., XXXVI. Of birds—they are drier in quality than quadrupeds, owing to their having no bladder, nor urine, nor saliva, and why.*
Sec. XXXVII. to XLVI. Fish—sea, river, lake, &c.; shell-fish, dried, salted, &c.
Sec. XLVI. to XLIX. General remarks on the difference of animals as to nourishment, owing to their modes of life, their peculiar qualities, the parts used for food, &c.
Sec. XLIX. to LVII. Drinks—wines, new, old, sweet, white, &c.; vinegar, &c.; honey, &c.
Sec. LVII. to XCI. Of vegetables—pot-herbs, garden plants, wild, and cultivated, &c.
Sec. XCI. to CIX. Of fruits—summer and autumnal, pulpy fruits, &c.
Sec. CIX. to CXVII. Influence of food variously prepared; general remarks on the effects of sweet, acid, acrid, and other articles, and of condiments.
Sec. CXVII. to CXXI. Of baths—fresh, saline, hot, cold, &c. Exercise—venery. Emetics, &c.; and of their utility in constipation, and also in the opposite state.
Sec. CXXI., CXXII. Of sleep and waking. Inactivity and repose.
Sec. CXXIII., CXXIV. Influence of a single meal daily. Drinks, cold or warm, &c.
Sec. CXXV to CXLV. Exercise; gymnastics. Exercise, natural and ill-timed. Of the exercise of sight, hearing, thought, and voice, in talking, reading, &c. Walking at different periods; before or after eating, &c. Running, riding, racing, leaping, wrestling, frictions, &c. Playing at ball, holding the breath, &c.
Sec. CXLV. On the use of frictions, with sand, oil, &c., before and after gymnastics.
Sec. CXLVI. Fatigue, from want of exercise; from unaccustomed or excessive exercise. Its effects explained as arising therefrom—including remarks indicating ideas of a circulation, &c., to end.
This book, says Haller, has nothing in common with the two preceding, nor is it from Hippocrates. Clerke supposes it the work of Herodicus the Gymnast. It treats of the commencement of diseases, from too much or too little exercise in early life, and of their appropriate remedies. This chiefly depends on regimen, abstinence, vomition, and a due regulation of exercise. A weak stomach is benefited by vomiting, excited by the flesh of whelps.a In every respect the ratio medendi differs from ours. The appropriate change of diet for the different seasons is pointed out. The constant exercise of the Greeks, both in summer and winter, is remarkable. No mention is made of their use of fire. Cold bathing recommended.
Argument. The author considers himself as first properly instituting the method of dietetics. The difficulty of this attempt adverted to. Of the appropriate regimen both of rich and poor at different seasons of the year. Of the symptoms and cure of repletion and of lassitude. Of diarrhœa, crudities, bad complexion, eructations, stercoraceous vomiting, and other affections.
Chap. I. The consideration of human diet proposed. Diversity of food.
Chap. II. A healthy regimen pointed out generally for every season of the year.
Chap. III. How to discover the errors of diet in health from various kinds of repletion. Of the symptoms and cure of the first species of repletion.
Chap. IV. Signs of the second, third, and fourth species of repletion.
Chap. V. Signs of the fifth, sixth, and seventh species.
Chap. VI. Signs of the eighth, ninth, and tenth species.
Chap. VII. Signs of the eleventh, twelfth, and thirteenth species.
Chap. VIII. Of the signs and cure of two species of inanition.
Gardeil has no preliminary remarks. He divides it into twenty-three paragraphs, which are headed to the following effect.
Sec. I. Some previous and general observations on the impossibility of prescribing generally the exercise and diet fitted for all men.
Sec. II. General rules of regimen for labouring people in the four different seasons of the year. Emetics thrice a month; when.
Sec. VIII. Of the regimen for people in easy circumstances. He exults in having first discovered the rules for this, and having thus laid down a body of doctrine.
Sec. IX. Observations pointing out whereon the peculiar regimen for each individual ought to be established; 1st. On account of repletion, in a state of health; symptoms indicating such a state. 2d. Excess of exercise; the means of obviating, &c.
Sec. XI. to XIV. 3d. Of repletion, threatening peripneumony, and how to obviate. 4th. Of repletion, the symptoms of which affect the head chiefly. 5th. Of that which principally determines to the primæ viæ. 6th. Of that arising from a coldness of the stomach, causing crudities.
Sec. XV. Of that induced by excess of exercise, manifesting itself by its influence on digestion, as indicated by acid vomitings, &c., heat of stomach, &c.
Sec. XVII. Of that repletion which manifests itself in lientery. Another with crude and hardened stools; and again with putrid stools, following great fatigue; and another accompanied with dry and burnt-up stools, with vomiting. These are all described as to their respective symptoms, and the means of cure pointed out.
Sec. XXII. Of excess in walking; its symptoms and effects; and in gymnastic exercises; the symptoms, cure, &c.
Haller, in his preface to this treatise, says, one would suppose this to be written by the author of the third book on diet. Such, he adds, is the opinion of Fœsius. Similar precepts are here delivered as to the increase or diminution of food, of exercise, and of medicine. It is in other respects an elegant and connected work, wherein dreams are referred to their physical causes, heat, cold, secretions, repletions. Indications are derived from dreams of those measures by which those diseases may be relieved which give origin to the dreams. Although occasionally recommending propitiations to the deity, it is obvious he regarded it as of little importance. In this book we find a manifest expression of the increased and diminished circulation.
Subject-matter.—Dreams are here explained, from which, in eight chapters, may be obtained some certain signs of good or ill health; and some things which the mind imagines in the state of sleep.
Chap. I. Prefatory remarks of the importance and utility of indications from dreams. Of the soul in wakefulness and sleep. Sleep is either natural or preternatural.
Chap. II. Of dreams depending on daily occurrences, of a healthy or morbid character; curative measures.
Chap. III. Of dreams connected with the heavenly bodies, significative of health or disease; and of the cure of disturbed repose.
Chap. IV. Variations of the heavens and its luminaries in dreams, indicative of different affections; and variety in the methodus medendi.
Chap. V. Of dreams connected with corporeal and civil functions; and of those relating to the earth; trees, rivers, fountains, and seas.
Chap. VI. Of dreams relating to earthquakes, inundations, darkness, fires, swimming, &c.
Chap. VII. Of dreams of various forms of bodies, or their parts, and of the dead, clothing, &c.
Chap. VIII. Of dreams from eating, drinking, seeing, fighting, crossing rivers; enemies and monsters.
It is plain, says Gardeil, from the termination of this treatise, that it is a continuation of the third book on regimen. Yet it is so full of superstition, that we are not disposed to regard it as a production of the same writer to whom we are indebted for the excellent treatises that precede it; without, at least, rejecting a number of things that appear as unfortunate attendants on the weakness inseparable from the nature of the human mind, and of the age in which Hippocrates lived.
Sec. I. Preliminary remarks on dreams.
Sec. II. Inductions to be derived from natural dreams, from which to attain a knowledge of the good or bad state of the body.
Sec. III. to XII. Of dreams of the heavenly bodies. 1. When serene, or troubled. 2. When changes of the moon are observed. 3. Or in the sun. 4. When they represent the firmament in a state of drought. 5. Or fires in the heavens. 6. Or falling stars. 7. Or dews and vapours. 8. Or when good gifts appear to be sent from heaven. 9. Or when the dreams are of rains and storms.
Sec. XII. Of prayers to the deity under these circumstances to avert misfortunes.
Sec. XIII. Considerations from dreams relating to different states of the earth and of travelling, trees, rivers, &c., indicating the state of the blood, &c., and of the regimen and prayers required under such circumstances.
Sec. XIV. Indications from dreams relative to the particular constitution of the body; and such as represent strange objects, the dead, monsters, &c.
Sec. XV. Of dreams of eating, drinking, &c.
Sec. XVI. Of dreams of massacres, battles, sieges, &c. The author terminates by assuring good health to all who will attend to his advice; and says, he thinks, by the aid of the gods, he has discovered dietetic rules, as good as it is possible for any one to give.
This book, says Haller, contains much of the brevity and antithesis of the treatise “De Humoribus.” It imitates the Hippocratic brevity. Mercurialis considers it as a genuine production of the divine old man, although he places it in his second class. Galen deems it genuine, and wrote four commentaries to illustrate it, and frequently quotes passages from it as such. Others have equally deemed it genuine. In this is to be found a passage, which, by too free an interpretation, has been applied to the circulation of the blood. The clearest parts are those that refer to the perspiration, and its importance to health. Here also we find the liver regarded as the root or source of the veins, and the heart of the arteries, by which the blood and spirit flow to every part,—from which we might imagine the work not to be more ancient than Erasistratus, since it contains his views. It treats of the time in which the fœtus is formed,—and gives a short and incorrect osteology. Adverts again to the pulsation of the vessels,—and of the spirit which is its aliment. It contains nothing of a dietetic character.
Subject.—Of food, its varieties and powers; to what parts conveyed; which most easily, or with greater difficulty, changed; what are the principles of which it is formed; which are, and are not, nutritive.—Ed.
Chap. I. Of the varieties and forms of food. Effect and influence of. Of the variety of juices, hurtful, or innoxious. Of the difference of diseases, and their signs;—remarks, &c., cognizant of a circulation here, and in the next chapter.
Chap. II. Of perspiration and its importance;—aliment,—various,—not equally fitted in all cases,—differing in different periods of life. Fœtal formation, &c.
Chap. III. Of the nutrition of bones—length of time in healing when fractured, &c. Of the change of food and its conversion into different parts.
“This treatise,” says Gardeil, “would be more correctly entitled ‘On Nutrition’—both from its Greek derivation, and from the subjects it treats of. It ought rather to rank in Fœsius’ third section, since it is more of a physiological than of a dietetic character. It is pretty abstract, and somewhat tiresome, not only in my own translation, but in the original, and other translations, arising either from the generality of ideas, or from the extreme brevity in which a number of objects are presented at the same time, in order to subject them to one single principle, which in the present period is denominated the vital principle. Several of its parts appear to be susceptible of different construction or explanation by different readers. Galen wrote four commentaries on this treatise, a considerable portion of which has reached us; but I have not derived much benefit from them.”
Sec. I. Aliment; what is to be understood by it; general principles on.
Sec. II. Physiological principles as to nutrition.
Sec. III. Of the natural excretions, and of unnatural growth, &c., of parts.
Sec. IV. Continuation of the principles respecting aliment.
Sec. V. Numerous sources of derangement which induce symptoms that accompany different diseases.
Sec. VI. Every thing is but relative in the animal economy—nothing absolute.
Sec. VII. Of the various channels for aliment—immense variety observed, as well relatively to good and evil, as to many other circumstances—amongst others, the variation as to the period of pregnancy.
Sec. VIII. Of the variation as to the period of the callus produced after the fracture of different bones;—other differences and their causes.
Sec. VIII. (bis.) Of the benefit of liquids in alimentation—and also of motion.
Sec. IX. Of pus, and of the marrow.
THE RATIONALE OF FOOD IN ACUTE DISEASES.
Although Fœsius constitutes but a single book alone of this treatise, Haller (why, is not adequately explained) has divided it into four,—the heads of which are here successively given, together with the preface and argument of each.
Preface. The first three parts of this work seem to be genuine; the fourth, although very ancient, even anterior to Erasistratus, appears to Galen to be spurious. In the first book, Hippocrates writes upon his Ptisan, in opposition to the Gnidians, who had entirely neglected the rules of diet. He next attacks the physicians of his own period, who, in the commencement of an acute disease, exhausted the patient by starvation, but allowed food at a period more advanced. In opposition to which, he contends, that in the beginning of acute diseases, the diet should be of the lightest kind, such as mulsa,a or barley water; and that the physician might gradually advance to more substantial food, as ptisan, &c.b
Chap. I. The ancients wrote nothing worthy of record on the subject of diet, so far as we can judge from the Gnidian sentences. The physician is best appreciated in acute diseases. Great discrepancy of opinion among them in these.
Chap. II. The ptisan is preferable in acute diseases. It should be prepared from the best barley, and thoroughly boiled. It should be very slippery (lubricissima)—and is an excellent corrector of thirst. It is sometimes useful, at times injurious. What the ancients meant by siderati. Of the proper or improper time of giving slops, or broths (sorbitiones).
Preface. In this book is contained Hippocrates’ treatment of pleurisy, by venesection, fomentations, mulsa, oxymel;—in lowseated pain of the side, he prescribes venesection.
Subject.—In case of pleurisy, the treatment is stated, as consisting of fomentations, venesection, glysters, purging, and other evacuations. It then treats of barley water, ptisan, maza, and bread; of water, wine, aqua mulsa—vinegar and mulsa; finally, an ample detail is afforded of the varied and frequent changes of appropriate measures in five chapters.
Chap. I. Of attempts to be made for removing the pain of pleurisy, by means of warm fomentations, or venesection, or loosening the bowels by black hellebore, peplium,a or such like articles, and of the proper occasion of using them.
Chap. II. Accustomed food and drinks to be preferred; a sudden change of diet is injurious in health, but not in disease.
Chap. III. Hints as to the safe prescribing of diet to the sick. In the commencement of disease, the patient should be fed with slops and barley water; and during its violence the lightest possible diet must be employed.
Chap. IV. Symptoms of depraved diet, and indicating a fatal issue, &c. Of rest and exercise under like circumstances, &c. Of what concerns the bowels.
Chap. V. A change from spare to copious diet, or from continual rest to excessive labour, is very injurious: it is useful to be aware of this. Of the use of barley water; and of the symptoms of watchfulness and of somnolency.
Preface. Here Hippocrates states the efficacy of drinks in acute diseases. Of water alone he speaks unfavourably; of mulsa; of oxymel; of wine, in the use of which he is liberal. Of baths, in what cases most useful.
Chap. I. Of wines, and their effects.
Chap. II. Of aqua mulsa (hydromel), when useful or the reverse.
Chap. III. Of oxymel (acetum mulsum), when useful or otherwise.
Chap. IV. Water alone of little benefit in acute diseases, and why so?
Chap. V. Bathing, not proper for all persons, nor at all times.
Preface. To me, says Haller, this book appears undoubtedly spurious, both from its numerous prescriptions, and various remedies not mentioned in the legitimate writings of Hippocrates. Comments are interspersed on subjects totally different from his. Pretty good histories are given of various diseases, as pleurisy, angina, cholera, dropsy, for which last are recommended cantharides and other acrids. Then follow dietetic precepts respecting flesh and vegetables, aphorisms on condiments, and conclusions of too general a character, deduced from individual events: vomits are ordered dietetically three or four times a month, as in the books on diet. Some chirurgical observations also are given.
Subjects treated of.—Treats of many acute and other diseases. Of causos, angina, aphonia, inflamed præcordia, catarrh, ulcerated trachea, [arteriæ ulceratione,] heat of the lungs, different fevers, pleurisy, peripneumony, dysentery, jaundice, tetanus, dropsy, hemorrhoids; abscesses; their symptoms; pains of the side, eyes, loins, and other parts; of all which the diagnostics, prognostics, and therapeutics are given.
Gardeil has but few remarks on this treatise; he includes the four books, as given by Haller, in one, as Fœsius does. He merely remarks that this is the fifth treatise in the fourth section of Fœsius, and that we find in it the same attention in observation, and the same excellence of judgment, which have rendered Hippocrates so admirable in all that has reached us of his writings in more than 2000 years.
The headings to 64 paragraphs are to the following effect:
Sec. I. The insufficiency of the doctrines contained in the Gnidian Sentences.
Sec. II. Justice rendered to physicians as to certain remedies in sundry diseases; observations as to their bad classification.
Sec. III. Of the objects of medicine, and difference in their use from the judgment of practitioners.
Sec. IV. Regimen, its previous and complete neglect. The appropriate use of the ptisan as nourishment is of the greatest importance.
Sec. V., VI. Chief regulations for the administration of ptisan.
Sec. VII. The ptisan, how to be made, and its effects according as it is employed. The inconvenience of insufficient nourishment, or of one too strong, after great abstinence.
Sec. VIII. General rule respecting the administration of the ptisan, and as regards regimen.
Sec. IX. Rule as to the proper time of giving food.
Sec. X. Utility of different fomentations; of blood-letting and purging in a stitch of the side, as it may differ in situation; and of the subsequent administration of the purée.*
Sec. XI. The question examined, if it is best to keep the patient at the beginning on a strict abstinence, or to use the ptisan.
Sec. XII. Bad effects of eating more than usual; how to remedy this. The reverse of this considered, and its remedy. Great changes hurtful.
Sec. XIII. XIV. Some general remarks on regimen, on different kinds of bread, &c., and on the different species of wine. Exceptions.
Sec. XV. General rule—It is better to err at the commencement, by defect rather than by excess. Faults from excess are more readily repaired than those from defect. Cases stated, in which an almost absolute abstinence may be pursued.
Sec. XV. (bis.) Diversity of cases from which death may ensue.
Sec. XVI. All sudden changes are injurious.
Sec. XVII. Application of what has preceded, to nutrition.
Sec. XVIII. Brief conclusion concerning the changes of nourishment in acute diseases.
Sec. XIX. to XXIII. Examination as to drinks. Different kinds of wine.
Sec. XXIII. Of hydromel. It is more nourishing and more strengthening than the small white wines, and should be given before, and not after the purée.
Sec. XXIV. Of oxymel—its variety, crude and prepared. It is an excellent drink in acute diseases, as well as hydromel, but is more purgative.
Sec. XXVI. Of water. The author no friend to it in acute diseases.
Sec. XXVII. Of medicinal ptisans.
Sec. XXVIII. Of baths; remarks on their employment; hurtful or beneficial according as they are employed. In whom useful, &c. In whom hurtful.
Sec. XXIX. Of different species of diseases. Ardent fever and its cure, &c. Rules for bleeding in acute diseases.
Sec. XXX. Of orthopnœa, (probably what we call dry asthma.) The inconveniences of purgatives given at its commencement, and generally in the beginning of every inflammatory state. Important rule in their administration.
Sec. XXXI. This paragraph seems to relate to apoplexy, and its treatment.
Sec. XXXII. Of quinsy—its course, symptoms, and cure. [Qu. croup?]
Sec. XXXIII. Fevers from intestinal plenitude, called improperly in our days, putrid.
Sec. XXXIV. Ardent fever with inanition; not to purge before the fourth day; its treatment. Coldness of the extremities in the increase explained.
Sec. XXXV. Of diarrhœa and some other dangerous symptoms in ardent fevers.
Sec. XXXVI. Of fevers in general, &c.
Sec. XXXVII. Of the fever called asodes.
Sec. XXXIX. Of fever with hiccup. Probably a symptom only, not a particular species.
Sec. XL. Of pleurisy and peripneumony, and their modes of cure.
Sec. XLI. Of dysentery.
Sec. XLII. Of bilious fever and bilious colic. General rule as to the termination of diseases.
Sec. XLIII. Rules for administering hellebore.
Sec. XLIV. Distinction between symptoms arising from fatigue and other causes.
Sec. XLV. Inconvenience of aqueous drinks; and those too strong.
Sec. XLVI. Conduct necessary when one repast only is made, if accustomed to two.
Sec. XLVII., &c. Effects of garlic, of cheese, of legumes, of beef, goats’ flesh, pork.
Sec. LII. How to treat cases of fulness of the bowels, but not of the stomach.
Sec. LIII. Two kinds of dropsy, aqueous and flatulent.
Sec. LIV. Of discharges from the bowels, with great heat and irritation.
Sec. LV. General remarks for all diseases.
Sec. LVI. to end. Some recipes and treatment of sundry diseases.
About fifteen or twenty lines in Fœsius and Haller are here omitted, as consisting of a number of recipes, and which Gardeil could not make out.
ON THE DIFFERENT PARTS OF MAN.
This is one of those books admitted generally to be genuine, but not perfected by Hippocrates: so that Haller concludes the analysis of it, in his preface, by saying,—It may be the work of Hippocrates, for the methodus medendi differs not from that of his genuine writings. Many choice things are, however, mixed up with foreign matters difficult of explanation.
There is, adds he, in this book a mixture of argument, somewhat of anatomy, as of the membranes of the eye and brain, of the nares, a part of the angiology of the head, of the temporal arteries; which he denies to carry blood, yet in the same place admits of two opposing streams of blood. Here we find an account, (altogether different from that given in the treatise, De ossium natura), of those vessels from the tendons of the neck which go to the testes, also of others, and of the vena cava; of those going to the malleoli, which, if divided, cause impotency; of the vein of the arm, which is incised for affections of the spleen; and notice is taken of the anastomosis of the vessels. Something is said of the nerves, with which he appears to confound the tendons. Something, also, as to a history of the bones, the sutures, and a complete skeleton. The author seems acquainted with the articular synovia. He admits of fibres from the stomach to the bladder; of metastasis of humours from one part to another, and the channels of such conveyance; of diseases arising from fluxion, and their remedies; of diseases of the eyes, wherein no remedy is to be employed immediately to them, but an incision to the bone is recommended on the head, and the pulsating veins [qu.? temporal arteries] between the ear and the temples, are to be cauterized. He then passes to the consideration of different species of bile, to which he imputes diseases of the breast, which he cauterizes, when suppurated. His cure for pleurisy, of mulsum and vinegar (hydromel). In dropsy he cauterizes the neck in three places, and in sciatica employs cups. He uses fire also in enlarged spleen. The book next considers the cause of fever, as originating in a stagnating humour falling on a weakened part, and of the cure by mulsum and posca (oxycrat). Also of refrigerants, as cucumbers, in fever; of jaundice, and the use of elaterium in it as a purgative; after which he gave wine. In true angina, he bled and purged. He then proceeds to fractures of the head. Diarrhœa removed by vomiting. His prudent counsel to abstain from violent remedies in unknown diseases. He gave mandragore in melancholy and convulsions. Of cauterizing the veins in disease, and which. Of the difficulties and opposite indications in medicine, which cannot be reduced strictly to a certain art. Something is said on the classes of medicine. He recommends the physician never to be cast down by fortune.—Ed.
Subject of the treatise in general.—Something is here stated as to parts of the human body, generally. Of the external senses. Of the veins, nerves, sutures, joints, and other parts. Of fluxions, fevers, ulcers, and other diseases; together with the appropriate use of several remedies.
Sec. I.—Chap. I. The human body is a circle, of which each part may be esteemed as both the beginning and the end. Bodies are obnoxious to disease, in proportion to their aridity. A primary affection of any part, induces sympathetic and secondary diseases. A stoppage of humours is a cause of fluxion and of disease. The principle of cure is deducible from the primary disease. Of the knowledge of parts, their sympathy and communication. By the affection of one part, the whole body may become affected.
Chap. II. Of hearing, smell, and sight; their organs and vessels. Of the three membranes of the eye, and the two of the brain. Of the distribution of veins from the brain, and their inter-communication. Of the distribution of the vena cava. Of the causes of impotence, loss, and disturbance of vision; and of bloody urine.
Chap. III. Of the nature of the nerves, their nutrition, substance, situation, colour, strength, and diseases. Of several sutures of the head. Of the bones of the whole, and of parts, of the body. Of their articulations; and of the diseases, pains, mucus, and lameness of the joints.
Chap. IV. The stomach a receptacle for food and drinks; the bladder for serous fluids. Fluxions are caused by cold applied to, and contracting the body; by heat, rarefying the flesh, and attenuating the fluids; by repletion which obstructs, and evacuation which enlarges the passages. The inferior parts are drier than the upper, owing to their less vascularity.
Chap. V. Seven different fluxions from the head. Three of them conspicuous from the ears, nose, and eyes. Four are latent; in the breast, producing bile, lassitude, empyema, tabes; in the spinal marrow, productive of dorsal phthisis; in the vertebræ and muscles, inducing dropsy; in the joints, causing gout, sciatica, and œdema.
Chap. VI. Of the cure of those fluxions, as manifested in coryza. Otalgia and fistula of the ears. Ophthalmia, prurigo palpebrarum, epiphora, and albugo, &c., cure by chirurgical means, as incision and cautery; or pharmaceutic, by topics and cathartics.
Chap. VII. Of a bilious fluxion from the head upon the thorax, inducing peripneumony, pleurisy, suppuration, tabes, and cough; also inducing, when flowing on the spine, icterus, and tabes dorsalis. Of the rise, causes, signs, both diagnostic and prognostic, of the same.
Sec. II.—Chap. VIII. Of the cure of pleurisy, peripneumonia, empyema, consumption; and of an eighth fluxion of the fauces, falling on the belly.
Chap. IX. Of the cure of dropsy, sciatica, and tabes from fluxion from the head to the hinder parts; and of the enlarged spleen and dropsy of boys.
Chap. X. Of a dry pleurisy, unaccompanied by catarrh, and of its cure. Of the origin and cure of fever.
Chap. XI. Of the cure of icterus, malignant ulcers, and angina.
Chap. XII. Of fractures and fissures of the skull, and their cure by the saw or terebra. Of fatal purgations, wounds and ulcers. Of the cure of a person labouring under purgation. Eruption of bile is with difficulty allayed; vomiting assuages the evacuation.
Chap. XIII. Of the cure of unknown disease, of strong and weak persons, of ulcers, fluxions, melancholies, and convulsions.
Chap. XIV. Of cauterizing the veins, and mode of, and use. Whatever stops the blood arrests a fluxion and cures headache.
Chap. XV. Medicine is an art of long and difficult attainment, on account of the variety of subjects, the different complaints, and frequently contradictory effects of remedies.
Chap. XVI. What a remedy is. Of mild and powerful remedies in purging and binding, and of their employment.
Chap. XVII. The art of medicine is certain and constant to him who is acquainted with it, and depends not on chance. With or without chance he will act correctly, and may expect success.
Gardeil, without affording a reason for the omission, has left out what constitutes nearly a column in Fœsius, and the first chapter in Haller. A reference to the foregoing will be sufficient however to establish the connexion, and to show the views of sympathy held by Hippocrates. In proceeding from that point, Gardeil gives a brief enumeration of the parts of the body, thus—Ed.
1. Of the organ of hearing. 2. Of that of smell. 3. Of that of vision. 4. Of the brain, and of the origin and distribution of the blood-vessels; continued in 5 and 6; in which last, the communication or inosculation of the vessels is particularly stated. In 7 the diseases of the fleshy parts, the nerves, membranes, and tendons are treated of, and are regarded as being more difficult to cure than of the fluids. 8. Of the sutures of the cranium. 9. Of the bones of the trunk. 10. The superior extremities. 11. The hand. 12. The pelvis and lower extremities. 14. Of the synovia and articulations. 15. The stomach receives the food and drink taken; and certain vessels convey liquids to the bladder. 16. Hippocrates here commences to treat of diseases, and first, of fluxions, or catarrhs. 17. Explanation of the causes of fluxions, of which there are seven, proceeding from the head; one to the nose, one to the ears, and one to the eyes, all which are conspicuous to every one; a fourth goes to the breast, and causes suppurations and phthisis. 20. When the fluxion is to the spinal medulla, dorsal phthisis is the result. 21. If it goes to the vertebræ and to the flesh, a peculiar kind of dropsy follows. 22. If the fluxion proceeds slowly, sciatica and rheumatism ensue. 23. The tratment of these seven species is given in this and the succeeding numbers. In 32 is a detailed description of the fourth species, viz., that on the breast and trachea, producing suppuration and phthisis, and accompanied with the views of Hippocrates, as to peripneumony and pleurisy. 33. Of dorsal phthisis, from fluxion on the spine. 34. Treatment of pleurisy. 35. Of the cure of empyema. 36. Of fluxion on the belly through the œsophagus. 37. Treatment of fluxions on the soft parts near the vertebræ, inducing dropsy. 38. And of fluxions inducing sciatica. 39. Treatment of enlarged spleen, with wasting away of the omentum. 40. Of that of dropsy in children. 41. Of a dry pleurisy without catarrh. 42. Of fever from repletion, and its opposite. 43. Of jaundice. 44. Of malignant ulcers. 45. Of quinsy. 46. Of ulceration of the tongue. 47. General rules for treating diseases. 48. Wounds of the head. 49 to 57. Sundry aphorisms relating to treatment. 58. Of treatment of unknown diseases. 59. Of tumours and ulcers. 60. Of the use of mandragore in some diseases. 63, 64. Aphorisms. 65. On cauterizing the vessels, and precautions in, as to hemorrhage. 67. Of the difficulties attending the learning of medicine. 68. Apparent contradictions in medicine, and reasons assigned in 69 and 70. 71. Importance of seizing on opportunity, or acting apropos. Whatever induces a change in the actual state of the system, is to be viewed as remedial. The subject continued in 72 and 73. Repudiation of chance in medicine, for medicine is founded on solid grounds, unmixed with chance; and chance is, in all things, to be denied. If a proper treatment is pursued, the result is beneficial; the reverse is the result of ignorance. (This seems to be omitted by Haller, but is found in Fœsius.) 74. Of female diseases; all which are ascribed to the uterus, and its asserted movements. The menses in young persons are affirmed to be good blood; but in old, mixed with mucosities.
I have given the outline of this treatise, as afforded both by Haller and Gardeil; but inasmuch as it is considered as an important Hippocratic work, I have added the following full translation. Towards the close many aphoristic sentences seem intermingled with the text.—Ed.
It appears to me that no particular part of the body can be regarded as its beginning; each individual part may, in fact, be so considered, and equally so as to its termination. In describing a circle, no beginning is found, and so it would seem to be in respect to the members of the body.a The drier it is, so is it the more calculated to originate and labour under disease; less so if moist, for disease in the dry body is fixed, and does not yield; but if in the moist, it circulates and occupies different parts, and by this change induces rest, and is more readily tranquillized, from not being attached to any particular spot. Changing thus from one part to another, disease shows itself accordingly; as in a metastasis from the belly to the head, from the head to the muscles and abdomen, and so of the rest for a similar reason; for when the belly does not moderately discharge itself, and food is taken in, the body is moistened by the humours of the food; but that humour interrupted by the belly, the passage to the head is excited, but not being there readily received by its vessels, it flows where chance may direct, and is carried into the circuit of the head and brain; but should it again be conveyed towards the belly, it there induces disease, or in any other part on which it may fall. Hence it is best to undertake the cure of diseased parts through those which cause the disease, and therefore it is more readily cured by taking it at its onset. But the body itself is similarly constituted, although all its parts, large and small, are not exactly alike, neither are the superior and inferior parts; yet, if the smallest part be intercepted, it becomes affected, and that affection, whatever be its nature, is soon felt by the whole body, because its smallest part is constituted alike with the largest, and that smallest part, whatever may affect it, affects its congeners, each conformably to its nature, whether that be good or bad; and since the body, from the intimate connexion of its smallest part, feels pain or the reverse, from whatever reaches that smallest part, such is then carried to, and felt by all that resemble it, and thence it is, that every part is threatened thereby.
The nature of the body claims the first rank in teaching the art of medicine. I begin then by observing that the body has several openings, and first of that which serves for hearing. The external parts of the ear serve merely to increase and strengthen the sound; that which reaches the brain through the membrane of the tympanum, is clearly what causes hearing; there is a passage by means of a foramen that conveys it to the brain, which is surrounded by meninges.
As for the nostrils, properly speaking, there is no foramen; but there is an apparatus pierced somewhat like a sponge; hence sounds are heard at a greater distance than we perceive odours; the odorant particles separate and divide in passing through the organ of smell. In respect to the eyes, there go to the brain, in order to induce vision, two small vessels, which traverse the meninges that envelope it; they produce vision by means of a very pure humour furnished by the brain, on which we see in the eyes a representation of objects. If these vesselsa dry up, vision is lost. The eyes are enveloped in three membranes for their security; the external one is very thick, the middle much less so, and the third, containing the vitreous humour, is extremely delicate. When the external one is wounded, it produces disease; laceration of the middle one is replete with danger, and when torn, we see a kind of bladder protrude; the third presents still greater danger, because it is that which contains the humour on which vision depends.
The brain has two membranes; an external one, very strong; the other, immediately investing the brain, is very delicate, and does not reunite if it is wounded. There are vessels that adhere to the bones after traversing the muscles. Two descend from the vertex and go towards the eyebrows and terminate in the angles of the eyes. One other is carried to the nostrils; whilst two others pass along the temples behind the ears, and go to supply the eyes, and have a constant pulsation. These are the only vessels that divert away the blood, instead of moistening the parts; that part that is thus turned back does not harmonize with the progressing portion. The former in its route meets the descending portion, and rebounding against each other, a shock is produced that gives rise to the pulsation of the vessels. I have stated that vision is maintained by a very pure humour coming from the brain; now if any thing from these vessels mixes with it, the humour becomes turbid, and is no longer fitted to represent objects. We sometimes, then, see as it were flies, nubiculæ, or dark moving spots, at others, nothing clearly marked. There are two other vessels located between those above-mentioned and the ears; they go towards the ears, and there dip down; two others, arising near the junction of the temporal bone, go to the ears; two pass near the tendons of the neck, towards the vertebræ, and terminate in the kidneys and testicles; when these are affected, bloody urine is discharged. Two more go from the head to the shoulders, and are properly called humoral. Two more from the vertex, passing near the ears on the forepart of the neck, go to the vena cava. The vena cava, elongated like the œsophagus, is located between it and the trachea, and going towards the diaphragm, enters the heart; passing through the diaphragm downwards, it divides and goes to the groins and thighs, branching off, and proceeding to the legs and ankles inside of the tibia. If this last is divided, impotency is induced. It then proceeds, and is lost in the toes. A ramification of the vena cava goes to the left hand; another passes under the spleen to the left flank, at the place where the spleen lies under the epiploon, and which terminates at the lower part of the thorax: it arises near the diaphragm, and communicates as it mounts up, with the humoral, and goes under the elbow-joint, after having divided into two branches, one of which is divided in affections of the spleen. There is another in the belly, which takes a similar course. In other respects we find all the veins communicate and empty into one another; some unite amongst themselves; others, by the means of small vessels that emanate from them, give nourishment to the muscles at the place where their extremities communicate together. Now it is more easy to cure diseases of the vessels than those of the nerves.a In the first case, the disease is in perpetnal motion; it is carried by the fluid contained in the vessels, which is never at rest. The nature of the veins is to contain the humours in the flesh; the nerves, on the contrary, are dry, solid, and attached to bones; from whence they derive their ordinary support. They are also nourished by the flesh; they are moister and softer than the bones, but firmer than the flesh. When disease attacks them, it becomes fixed there, and stronger, and it is difficult to remove it. Tetanus then ensues, with spasms of the limbs and body. The nerves (tendons) serve to strengthen the articulations; they are spread throughout the body, and give strength to the parts, and we observe that they are always very strong in those parts of the body where the flesh is in smallest amount. The body is filled with nerves (tendons); there are none in the face or head, but we there find vessels similar to nerves, between the flesh and bone, very strong and small; they are, as it were, nerves with a cavity.
We see in the head, sometimes three, sometimes four sutures. When there are four, one is seen on each side, going towards the ear, another before, and another behind. Such is the case with four sutures. When there are three, one is in front, and the two others on each side going to the ear, as in the case of four, but the hinder one is wanting. Those who have more, enjoy better health. At the eyebrows there is a bone that connects them; two others are connected at the chin: those of the upper jaw are united with those of the head.
The vertebræ are more numerous in some subjects than in others: their smallest number is twenty-two; the upper are near the head, the lower lead toward the anus. The ribs are seven in number; they are articulated behind with the vertebræ; in front of the chest they unite together. The clavicles unite together in front of the breast near the trachea, where they join the sternum; they are covered behind by the shoulder-blade, which bends forward, and is always fixed at the upper part of the back. The shoulder-blade is attached to the bone of the arm by a projection that joins to the humerus. This bone has, at its upper part, two eminences, one internal, the coronoid, the other external, the acromion, besides the lower one that articulates with the humerus, that is, the head of the shoulder-blade, in which is the glenoid cavity. The prominences at the elbow on the lower part of the humerus, serve for the articulation of the radius; and a little lower on the inner side with the cubit. It is this, which with the radius forms the elbow-joint. Four small prominences are there noticed, two superior and two inferior. The cubit presents two superior, that assist in the articulation, and form a projection at the part where the humerus terminates; the two lower, which are also a little internal and very near each other, inside the elbow, belong to the articulation of the radius with the other bone of the forearm. At the lower part of these two bones, the carpus is articulated with the radius: the tuberosities of the bone at this part being movable in every direction, do not form separate and distinct articulations, except at the upper and lower parts.
The hands have numerous joints, for all the bones articulate with those adjoining: the fingers likewise present many joints, each one having three, one of which is below the nail, between it and the tuberosity; the second between the first and second tuberosity, where one of the flexions of the finger takes place; the third articulation of the fingers is at the part where they are connected with the hand.
We observe two cavities in the os ischium called cotyloid, with which the thigh-bones articulate. At the upper part of the thigh-bone two eminences are noticed, one tending outwards, the other inwards, neither of which forms the joint, but constitute a part of the bone itself. The femur at one of its upper portions enters the cotyloid cavity; for its upper extremity has two terminations, one of which, internal, is round and smooth, and forms the joint; the other is exterior and smaller, and projecting. Towards the bottom of the buttocks we see a projection that belongs to the ischium. At its lower end, the thigh-bone has two condyles that have a hinge-like articulation or ginglymus with the tibia, above which the rotula adapts itself, and prevents the fluids from the soft parts entering the joint when the leg is bent. We see at the upper part of the leg two eminences, one internal; the external one does not form a part of the knee-joint. Another eminence at the inferior part assists in its articulation with the foot. In the foot are numerous articulations as in the hands; for as many bones, so many articulations. We reckon as many bones in the foot as in the hand.
We find likewise in the body many small articulations, not all of equal size, but resembling those I have described: there are also many small vessels besides those already mentioned, but they are of not much importance.
The synovia (μύξα, mucus) is natural to all the articulations; when it is pure, the bones are moistened by it, and by this lubrication their motion is easy. On the contrary, it is difficult and painful, when the soft parts pour out a vitiated humour. The joint stiffens whenever the humour supplied by the soft parts is not unctuous. As the synovia is exhausted by motion, if the soft parts are not continually moistened, the joints become dry; if it is in too great quantity, the joints being unable to contain the humour, it spreads around, and infarctions are the consequence. The nerves, which serve to connect the bones, swell and relax. We often see lameness produced by one or other of these causes. When they are powerful, the lameness is more considerable, but less so when weak.
What we eat and drink goes to the stomach, from whence vessels convey a part of the liquids to the bladder.
Fluxions ensue from refrigeration and tumefaction of the flesh. Sometimes, when the cold acts upon the distended flesh and vessels of the head, they are contracted, and the humours contained in them are expressed: the soft parts are compelled to pour them out from their diminished bulk; the contraction of the skin by pressing on the roots of the hair causes its erection; the fluids thus pressed upon spread wherever a passage can be found. Fluxions are caused by heat, because the soft parts are rarefied when heated; the pores are thus enlarged, and the humours they contain are attenuated, and yield readily to every pressure. The greater the rarefaction the greater is the flow, particularly when the soft parts are replete with humour; that portion which they cannot any longer retain, is poured out from every part, and a passage once made, they issue through it, until the body drying, the passage contracts. As every part communicates, the moisture taken up is attracted to the dry parts. The body of man being permeable, it is easy for those parts that have not augmented in volume or imbibed any thing, to attract humours, especially if it is the lower parts that are dry, and the upper that are moist, as in fact is the case; for in the superior parts there are more vessels, and the thinner soft parts of the head require less moisture; the passage is thus very easy from the over-moistened to the dry parts, especially as every dry part absorbs moisture; nor can it be denied that the humours tend naturally downwards, however light they may be, and by whatsoever power they are moved.
There are seven fluxions from the head, viz., one to the nose, one to the ears, and one to the eyes; all which are visible to every one. When the fluxion is to the breast, in consequence of cold, bile exists. Catarrh caused by cold readily falls upon the breast, because the passage by the trachea is very easy, and because the trachea is exposed to the air, and is in constant motion. When then the soft parts are charged with moisture and with bile, as they never are at rest, but always agitated, they find themselves in pain and fatigued, resembling that felt in the limbs by the agitations of a journey; from hence result suppuration and phthisis, when the fluxion is to the breast. If the fluxion is to the spinal marrow, a dorsal, or blind phthisis ensues. Should the catarrh go to the vertebræ and soft parts, a peculiar species of dropsy is the result; the forepart of the head, the nose and eyes are not œdematous, but the sight is affected, the eyes are dry, and assume a greenish hue like the rest of the body; the humours do not flow out, although falling down largely from the head, through the soft parts, posteriorly, leaving the foreparts dry, whilst those behind are inundated; the humours tend internally, and find little or no passage externally by the nose. The body becomes firmer externally than within, the pores of the former contract, mutually approximate, and oppose a resistance to any fluxion: internally, on the contrary, all expands; the solid parts become attenuated, and the fluxion from above finds little opposition from them, and fills the soft parts with fluids. That which is derived from food is corrupted by mixture with the impure humours from the head, so that the body is imperfectly nourished; the soft parts therefore surcharged with humours, and receiving only aqueous matters, become engorged and tumid.
If the fluxion is slowly effected, it produces sciatica and rheumatism, after which it stops flowing; the humour coming insensibly, is repelled by the stronger parts, by which it is compelled to fall upon the joints. Sciatica and rheumatism are also produced at the conclusion of some diseases, whenever that which has given rise to them, having lost its noxious quality, still remains to be expelled. The humour, unable to escape externally, or to be internally retained, causes swellings beneath the skin; or else, if it leaves the part, it is transported towards the joints, which yield to it, and it there excites either sciatica or rheumatism. If the fluxion is on the nose, it fills it with thick and pituitous humours, and requires to be attenuated by fomentations or other means, so as not to be driven to some other part; for should this be the case, it will induce disease of a more dangerous nature. Should the fluxion be upon the ears, it there first induces acute pain and suffering, which continues until a discharge ensues, from which time the pain decreases. Whilst the pain is severe we must employ warm applications, and drop into the ear some balsam, apply cups behind the right ear if the left is affected, or reversely;—it is unnecessary to scarify, it being sufficient that the cup should merely draw. If after this the pain continues, we give cooling drinks and a purgative, but by no means an emetic, for it will do no good; the refrigerants must be continued, and those remedies changed that are productive of no good. Should any produce a bad effect, their direct opposites must be employed; and if any benefit is perceived, the measures must be pursued without alteration. So soon as the humour finds an issue, and a bloody fetid pus is discharged, we must pursue the following plan: fill a sponge with some desiccative remedy, and thrust it as low as possible into the ear; let the patient snuff up some errhine, in order to draw off by the nares the humour falling on the ears, and thereby prevent its return to the head.
When the fluxion attacks the eyes, they inflame and swell. We must first apply drying remedies, and employ errhines, which evacuate the head through the nose, thereby determining the humours from the affected part. If a sensation is felt like that of fine sand rolling over the eye, we use applications that largely provoke a flow of tears; at the same time moistening and relaxing the body in order to relieve the eyes, by dissolving and carrying off those small concretions. Should the fluxion only slowly attack the eyes, exciting itching, mild liniments should be employed, calculated to dry up and diminish the discharge of tears, and errhines to promote the discharge from the nose of about two ounces in twenty-four hours, and repeated every third day. We should attract the humours by mild remedies from the eyes, and thus dry them. Errhines that purge the head powerfully, attract the humours from all parts, but if mild and weak, from the eyes only and adjoining parts. If the fluxion attacks the soft parts and cellular tissue between the bones and the muscles of the eye, we know it by the flow of humours which ooze out on pressure. Ulcers ensue there, with headache; the eyes weep much without the eyelids ulcerating; no itching is felt, and the sight, far from being obscured, is rendered more acute. The humour not coming from the brain, is not saline but mucose. The proper treatment is as follows. The head is purged by mild errhines; the amount of humours lessened by means of food and remedies of a laxative nature in order to dry the whole body slowly, and thus turn aside the moisture, in conjunction with the errhines. If the headache is not dissipated, we must make transverse incisions on the head, even to the bone, that the catarrh may flow promptly by the various openings thus made in the soft parts. Such is the treatment by which we may hope for success; should it prove abortive, and the humours not be thereby evacuated, and the sight improved, the eyes become more sparkling, and at length vision is destroyed. When bloody humours apear in the eye, by which the purity of its natural fluids is soiled, the pupil appears bloodshot, and has an irregular appearance; the part in which the bloody humour is seen, is not transparent, which is also another reason for the irregularity of the pupil; for this humour like a moving opaque body flits before it, and hence no object is seen correctly. In this case cauteries should be applied to the vessels which constantly pulsate between the ears and the temples. After which, moistening and relaxing remedies are applied to the eyes; the tears should be abundantly excited, in order to divert the humour carried to them, in which the disease consists. When any rupture of the eye takes place, emollient and astringent applications are to be employed, in order to contract the wound, and form a cicatrix as small as possible. If albugo appears in the eyes, the tears must be excited.
When the catarrh falls on the breast, and is accompanied with bile, it is known by the pains felt, extending from the flancs to the clavicle of that side; there is fever, the tongue is of a palish green, and viscid sputa are discharged. The danger of this disease is on the seventh or ninth day. If both sides are affected, it is of the same character. Sometimes it is an inflammation of the lungs, sometimes a pleurisy. These diseases are induced, because the catarrh flowing from the head by the throat and trachea, the lungs, whose substance is soft and dry, attracts all the moisture it can, and to whatever part it goes, the bulk is augmented: if both sides are filled, it produces peripneumony; if one side only, a lateral affection, or pleurisy, ensues. The former is by far the most dangerous, the pains are greater in the flancs and sides, the tongue is much paler, the throat suffers from the fluxion; the labour and oppression in respiration are extreme on the seventh or eighth day. If the fever does not diminish on the seventh day, death ensues from suffocation or weakness, or from both. If the fever, after diminishing for two days, returns on the ninth, death usually ensues, or else an internal suppuration takes place. If the fever returns on the twelfth day, suppuration has ensued; but if the fever is delayed to the fourteenth day, the patient is safe. All those in whom suppuration takes place in the termination of peripneumony or pleurisy do not perish; some escape. Suppuration happens when the fluxion goes to the same place to which the flow of bile has been conveyed; which last being movable, it finds a passage, and checks the flow; but if excretion is diminished, and the fluxion has accumulated, suppuration follows, because more humours flow to the lungs than those organs discharge, and this excess then is converted into pus; this remaining in the lungs and in the chest, ulceration and putrefaction follow, and when the ulcer is fully established, the lungs melt down, and are coughed up with the sputa; the cough, by its succussion, invites still more humours from the head; the ulcers in the lungs open in every part in consequence of this motion, so that, if even the head could not furnish any more humours, the ulcers of the lungs would alone suffice to continue the disease. The ulcers sometimes induce empyema, which is more easily cured, especially if exterior to the lungs, when it points outwardly, and occasionally forms an opening where the flesh has been softened by it, and frequently, on shaking the body, we can perceive a fluctuation, and hear a sound.a Such cases are cured by fire. If the fluxion, instead of this general character, is carried to a single spot, and enters into the structure of the lungs, phthisis ensues; for when the humour reaches there slowly, bringing consequently but little moisture into them, it thickens, concretes, and dries in the bronchi; it excites cough by adhering to and filling the narrow cavities, rendering thereby an entrance to the air more difficult; from a defect of respiration, oppression of the breast ensues; a pricking sensation is felt in the lungs, which is not experienced when the flow from the head to that part is more copious. If the fluxion becomes great, the whole body is surcharged, and the phthisis is changed to an empyema; and reversely, when the body becomes dry, the empyema passes from that state to phthisis. We know an empyema by these indications. The patient at first feels a pain in the side, pus collects, and the pain continues, with cough and expectoration of pus, and difficult respiration. If, however, the pus has not yet found an exit, concussion of the body renders it perceptible in its fluctuation, by a sound similar to that of a fluid shaken in a bottle. When these signs are absent, and yet empyema exists, it may be suspected from the great oppression and the hoarse voice; the feet and knees swell, principally on the affected side, the thorax curves, lassitude is extreme, universal sweats, alternately cold and hot, the nails becomes crooked, a sense of heat in the abdomen, all of which are so many indications of an empyema.
Should catarrh fall upon the spine, a phthisis ensues, of which the following are the signs. Pain in the loins, a sense of vacuity in the forehead; the bile that shows itself is of the worst character if it gives a yellow tinge to the eyes. The nails turn livid; if any ulcers exist, their edges also assume a livid hue. The sweats are partial, and confined to some local spot; fever follows, with livid sputa, or if not discharged, what continues in the lungs is equally so. What thus remains, causes the respiration to be sonorous, with a croaking noise; breathing is difficult, hiccup and fever diminish, whilst the sputa are retained; and as the debility increases diarrhœa comes on. When such symptoms occur in peripneumony or pleurisy, the greatest degree of danger exists.
The cure of pleurisy is as follows. Do not endeavour to check the fever before the seventh day; prescribe either oxymel or oxycrat for drink, and give it copiously, in order to facilitate expectoration by dilution; heating remedies are to be used to calm the pains, and to favour a discharge from the lungs. On the fourth day the patient must be placed in the bath; on the fifth and sixth he is to be anointed with oil, and on the seventh the bath is to be renewed, unless the fever is diminished, and thereby excite perspiration. From the fifth to the eighth day the most active expectorants are to be employed, if the disease progresses favourably. Should the fever not decline on the seventh, it ought to do so on the ninth, unless some dangerous symptoms supervene. When the fever terminates, we employ the weakest broths: if diarrhœa ensues, the system being still vigorous, we omit the drink, and give barley water if the fever has ceased. Peripneumony is to be treated in the same manner. In case of empyema, mild errhines, to excite a discharge from the nose, and thereby relieving the head, are to be employed, and such food as will loosen the bowels; if the disease is thereby arrested, and the humours diminish, we are then to promote expectoration, both by medicine and by appropriate food, by means of which coughing is excited. In order to effect this, the food should be of a fatty and saline quality, with wine of a rough character. Phthisical patients are treated in the same way, with the exception of giving less food at a time, and wine more diluted, so that the debilitated system may not be too greatly heated, and an afflux of humours thereby induced.
When the fluxion falls down upon the bowels by the œsophagus, an accumulation takes place below, and sometimes in the superior parts. From the commencement, if pain of the belly exists, we must purge by means of laxatives, either of food, or mixed with the drink, and employ stronger purgatives as the pain declines, together with more substantial food. This treatment is pursued for some days after the disease has terminated. If the patient is weak and cannot support it, he is to use the ptisans, and after being thereby evacuated, astringents are to be given. If the fluxion tends to the soft parts near the vertebræ, inducing anasarcous swelling, the following plan must be adopted. Fire is applied to the flesh near the neck in three places, and when the eschars fall off, approximate the edges, so as to make the cicatrices as small as possible. After opposing this barrier to the fluxion, we use errhines to cause a determination to the nose, at the same time keeping the forehead warm and the occiput cool. The front being thus heated, warm food is given that does not relax the belly, in order that the fluxion should direct itself to the front openings for its exit. If, when thus restrained, any portion of the fluxion shall have found a passage internally before taking the above direction, we proceed as follows. If it is intercutaneous, fumigations are employed; if abdominal, and not anasarcous, we purge; if both anasarca and ascites exist, purging and fomentations are appropriate, being careful always to evacuate by the channel nearest the collection, whether up or down. When catarrh produces sciatica, cups should be applied to draw outwards, but without scarification; and internally, heating remedies and purgatives, so as to clear the passages, externally by the former, internally by the latter. It happens that when a fluxion has been confined, not knowing by what channel to escape, it fixes upon the joints which yield to it, and thus produces sciatica or a dorsal phthisis. In this case we must purge the head by mild errhines until the humours are diverted, and employ the same regimen as in the former case. Elaterium is used to purge, and the belly is kept open by means of whey; and fomentations must not be neglected.
When the spleen becomes enlarged, and the body wastes away, the fat of the omentum melting down leaves the vessels empty, towards which a flux of humours takes place; they swell up the spleen which is near the omentum, and when any disease attacks the body, these parts become one of the places of attack, in which if not remedied it fixes obstinately. Even if well attended to, this state is highly dangerous. We administer hydragogue purgatives, and very nourishing food. If this proves inefficient, we burn lightly and superficially around the navel, to allow an issue to the humours. We likewise burn the navel itself, and abstract the humour daily. This is one of the most dangerous states, and it is therefore expedient to risk something: if successful, the patient is cured; should you not succeed after the burning, the danger of death, which must have ensued without them, is not thereby augmented.
Anasarca in children is cured thus. We open with a lancet the tumid part by several punctures. This plan is adapted to every part; and to the part thus scarified fomentations are applied, and the punctures anointed with some warm balsam.
There is a dry pleurisy without catarrh, occurring when the lungs, naturally dry, become preternaturally so from excessive thirst; the lung becomes thin and weak, and inclines to the side, so as to come in contact with the pleura; the pleura being moist, attaches it, and a pleurisy ensues, with pain in the side extending to the clavicle; fever follows, and whitish sputa are expectorated. This disease is cured by copious drinking and using the bath; expectorants are employed, and remedies to relieve the pain. It is cured in seven days, and is not dangerous, nor is diet necessary.
Fever takes place when the body, being replete with humours, the soft parts swell; the bile and pituita continue stagnated, and from want of movement are unrefreshed; nothing passes out, nothing enters to renew them. As soon as this repletion, fever, and consequent lassitude appear, we should at once dilute largely, employ embrocations, and excite warmth, in order to open the passages, and remove the fever by sweating; this is continued for three or four days, when, if the disease is not abated, we purge with chologogues, and endeavour to arrest the fever before it changes to a quartan. Whilst the swelling is considerable, purging is to be avoided, for the disease will not terminate whilst the system is replete with humours; in order to cure the fever, we omit purgatives until the body begins to discharge those humours; we enjoin abstinence, even from slops that are laxative, but give abundantly of water, hydromel, and oxycrat. Warm drinks thus taken in, soon carry off a part of the disease, either by urine or sweat; and every evacuation thus produced is beneficial to the patient by exciting an internal movement. When fever attacks an emaciated body, it assuredly cannot be from repletion; and if not quickly checked, we must give nourishment to the system, which, if not speedily beneficial, will aggravate the fever, and render purgation necessary, thus attacking it in its stronghold, by emetics or cathartics, according to its upper or inferior location. Without reference to debility, strong remedies are required, though not of equal force to all alike, but proportioned to their vigour or weakness. Scalding in passing the urine is moderated by dilution and broths, as in fever by refrigerants and the like. If these cooling remedies produce nausea, calefacients are employed, and we recur to the former if the ardor urinæ continues.
Jaundice is treated in the following manner. Commence with nourishing and fat substances, and drinks, and baths, for three or four days. After adequate moistening, purging is pursued, and the body is then dried by promptly suppressing all substantial food, and striving at the same time to discharge the humours by every emunctory. To evacuate the head, errhines of a medium force should be used. Diuretics are likewise proper, administered with the view of evacuating humours thus set in motion, and checking in some degree the nourishment afforded by food. When the body is moderately reduced, baths are employed, in which slices of the roots of the wild cucumber are infused. Chologogues are abstained from, lest the body should be too much irritated; and after it is adequately dried, and the disease is lessened, good food and red wine are directed, together with every other measure adapted to restore a healthy aspect. If, in spite of all these measures, a yellow colour still continues, we again reduce the system without drying it, lest that colour should become permanent.
Malignant ulcers take place on the body when the surrounding soft parts inflame, and the lips become thickened; a sanious discharge of abundant serosities, and ichorous matters that dry up, and appear to close the ulcer; this putrid matter cannot then escape; the flesh surcharged thereby inflames and swells. Wherever this ichor reaches, swelling and putrefaction are excited. These ulcers should be treated by humectants and balsamics, to permit the escape of the humour, and prevent its spreading among the soft parts; refrigerants are likewise employed to obviate the passage of the humours to the ulcer. We must endeavour to strengthen the flesh, and enable it to resist the afflux when not already injured. Generally speaking, humectants and refrigerants are employed in the treatment of all ulcers.
Angina arises from blood arrested in the vessels of the neck. We must bleed in the arm and purge, to divert downward the humours that cause the disease; and the same treatment is pursued in extensive ulcerations of the tongue.
We should attend to all diseases at their commencement; and wherever there is a tendency to a flow of humours, it should be at once arrested, and any other cause that may give rise to disease, must be obviated at its onset by appropriate treatment. Thus when the fluxion is abundant, it should be diverted; if moderate, by a fitting regimen.
In fractures of the skull, if the bone is comminuted, there is less danger than when it is a fissure, and that internal; in the first case, humectants only are required; but in the last, we must use the trepan to prevent the extravasated blood from corrupting the meninges; the blood thus extravasated, and having no exit, induces great disorder and delirium. By means of the trepan, such a passage is procured to the sanious matters, and appropriate remedies are topically applied to abstract them, and deterge the wound.
Errhines should not be administered in fever for fear of inducing delirium; for such remedies heat the head, and that, in addition to the febrile heat. Wounds are mortal in those, who already, in consequence, vomit atrabilis; so also, if the discharge is great, and great debility follows, if the wound contracts and dries up rapidly. In fever, if the patient is greatly debilitated, it is a mortal symptom if small livid ulcerations occur. If a disease augments after administering a remedy, and the patient is evacuated both upwards and downwards, diluted wine should first be given, then stronger; this allays the discharge; give neither purgatives nor emetics. Bile discharged up or down of its own accord, is restrained with difficulty, for it arises from its internal acrimony; but when it results from a remedy given, such acrimony may not exist. The vomiting of a drunken man should not be checked. Excessive purgation is checked by emetics, which last, may then be easily stopped; and if, after vomiting, much debility is exhibited, anodynes should be recommended. If blood is the source of disease, pains are an accompaniment, but a sense of weight, if it be pituita; at least such commonly is the case. When unacquainted with the disease, we should give weak remedies, if any. If the patient is relieved, we pursue the treatment, for the road is clear; reversely, if he feels worse. When great abstinence is the cause, employ food of more nutritive character, frequently changing it from one to another. If the patient is strong, and the disease of feeble description, should we be obliged to change our plan in order to discover the proper treatment, we may with safety resort to more powerful remedies than the disease, because, operating on healthy as well as diseased parts, no great danger can be apprehended; but when the disease is strong, and the patient weak, milder remedies should be chosen, such as are fitted to cure, without further debilitating the patient. Gymnastics differ greatly from medicine; the former do not induce changes in the system; which, though required in disease, is by no means necessary in the healthy state.
Diseases productive of ulcers, or tumours externally, should be treated by abstinence and appropriate remedies. When humours flow from the head, vomits must be used. Chronic diseases are more difficult to cure than recent ones. Callous ulcers require a renewal of their surface by means of suppurating remedies, and then to be cicatrized. If the applications produce tumefaction, the body should be extenuated by purgatives. To create cicatrization too early, is to afford nutriment to the morbific matter, and increase the ulcer. When the proper time has arrived for this, and to fill it from the bottom, the tumefaction is beneficial, even in ulcers of the head; the proud-flesh pushes up from the bottom the decayed parts, notwithstanding their resistance. When it is elevated to the surface, the food is to be diminished. In case grief induces disease and a disposition to suicide, we give mandragore root in the morning, but in amount not calculated to produce madness. To cure convulsions, we use the same remedy in small doses; a small chaffing-dish of coals on each side of the bed serves to heat those applications that should be applied to the tendons on the nape of the neck. If fever occurs after convulsions, it ceases either at once, or in two or three days. When fever caused by a rupture takes place, it ensues in three or four days. Care must be taken, however, for if it arises from some other cause, the treatment is different. A person suffering from a violent strain of the hands or feet, will be apt to fall into convulsions. To cauterize the vessels, the disease and the state of the patient should be considered: in case of hemorrhage, two precautions are required for safety before applying the cautery; 1st. Whether it may not be proper to prevent reunion, and whether the discharge is not itself useful; for, after cauterization, the discharge will cease, the two extremities of the vessel contract, and they dry up. If any vessels are left uncauterized, the bleeding will continue. 2d. To arrest the hemorrhage, the vessel should be burned across. When the burn is inadequate, we make incisions on either side above and below, by way of derivation; the applications will then be more effective, from the force of the blood being diminished.
In pains of the head, bleeding must be resorted to; should this not succeed, then we must cauterize the vessels, and the pain will cease; errhines tend to increase the complaint.
It is impossible to acquire a knowledge of medicine quickly, for invariable principles cannot be established. A person acquiring a knowledge of painting, by learning all that is taught him, soon attains all that others know, because the practice is the same with all, both now and to-morrow; it does not vary; nor is it necessary for him to seize on an especial occasion that will never again recur; but medicine requires that some one thing be done at one moment, and its opposite at another, for it has to reconcile contradictory points frequently. Thus it is with purgatives; they do not fulfil that indication always, but sometimes are even promotive of a contrary effect. In great constipation, the body becomes charged with pituita, which, falling on the bowels, produces a purgative effect; for the collected pituita acquires thereby a purgative influence. In like manner purgatives, by drying up the belly, induce costiveness. If you do not give purgatives, that which produces the disease will moisten, and thus purifying, health will be restored when the body has thus been washed out. Remedies binding the body, prepare the way for the evacuants, as these prepare the way for the former. It is precisely the same in regard to the complexion: watery humours dispel a good complexion, and render it pale; tonics on the contrary restore it. Every remedy has its opposite. If any one becomes tumid and pallid, he wastes away if remedies are not employed, which, by dispelling that tumid state, restore a healthy complexion. In this case, attenuants are useful and dissipate the pallor; but if it proceeds from inanition, analeptics are to be resorted to. Pains are also the result of cold or heat, either in excess or reversely; those whose surface is rendered cold, experience pain when exposed to heat, and those greatly heated suffer by exposure to cold. Such as have naturally a dry surface suffer from moisture, whilst those naturally moist suffer from dryness. All unnatural changes are followed by pain, and pains are dispersed by what is opposite to their productive causes, independently of what may be a peculiarity in the disease. Persons of a warm constitution, who are made ill by cold, are relieved by warmth, and thus it is in other cases.
There is another mode in the production of disease, viz.: from their congeners [Homœopathy! two thousand years before Hahnemann!]; for the same things that cause, also cure the complaint; (“alio modo per similia morbus oritur et per similia oblata ex morbis sanantur!”) Thus we find strangury cured by the very means that otherwise induces it; and a cough, like dysury, is caused and cured by the same things, although also by contraries.
There also exists another mode, as in the fever of inflammation; here the fever excited by inflammation is sometimes cured by the inflammation itself, and also by its opposites. Sometimes water, warm, and copiously drank and used as a bath, will restore health, by dissipating a fever by such means as are capable of promoting inflammation.
The effect of a purgative or emetic may be arrested by irritants, and augmented by calments. In making a person who is vomiting, drink water copiously, he often with the water discharges in vomiting that which occasioned it; thus vomiting is cured by vomiting. On other occasions we cure by calming it, and causing what produced it to pass downwards by stool; thus it is, that health is recovered in similar cases by opposite means: were this the case in every instance, we should at least have this rule, that we must cure either by contraries or by the same, whatever be the disease or its cause,a in such and such cases. But the debility of the body is a reason of the infinite diversity that is seen. The body is every where equally nourished by food that is appropriate to all its parts; but when more or less than is required is taken, or when changes are made, the body is incommoded, and the digestion becomes imperfect. If it is overpowered by nourishment, it induces repletion, and from thence an opposite tendency ensues. Warm bathing invigorates the system whilst in a vigorous state, but otherwise it tends to weaken it: the same results from good living. So long as the body is strong, health is afforded by food; but the same food in a debilitated system is productive of diarrhœa and other evils. When the recipient is altered, that which is introduced into it must of necessity be likewise modified; the body then, altered and overpowered by the food, wastes away, having many enemies to struggle with. It is the same with evacuants or tonics; all may bring destruction to the body; and the same is equally true with every thing, even the most opposite.
Opportunity, in the practice of medicine is very brief, and he that comprehends this will duly expect it. He distinguishes essential from merely accidental symptoms, such as are not necessarily connected with the existing state; he knows that purgation is not a necessary result of purgatives, and that what are contrary to one another are not so invariably. In giving nourishment, the fitting time is when the system can master it; if seasonably given, such food as is laxative will loosen the bowels, and that which is substantial will tend to invigorate it. Whenever the state of the system is superior to the food, its state being natural, the food produces no unexpected effects; and such is the opportune occasion with which the physician should be acquainted, for if he does not take advantage of it, the patient, so far from an easy digestion, will feel it as a load on the stomach, with heat and oppression. The body is nourished by that only which it is enabled to overpower. If aliment is taken inopportunely, its effects differ from what had been anticipated; the person falls away. It is the same with every thing that might tend to improve it; its action being relative to the powers of the system, to its intrinsic nature and existing circumstances. If those circumstances are unattended to, contrary effects will ensue. Every thing that effects an alteration in the actual state of the system may be regarded as remedial; the strongest overthrow it, and hence we can destroy the body by remedies; we can induce changes in it by means of aliment, and change is favourable in disease. Should no change take place, the disease must augment. In diseases of an intermediate strength, powerful remedies are improper, their action is to be feared; powerful remedies should be reserved for such diseases as are powerful; weak ones for those of inferior force. Neither ought we to denaturalize remedies by admixture, but as much as possible administer them in their natural state, employing the most powerful in robust constitutions, and the weaker in cases of an opposite tendency. Evacuations should be made by those emunctories that are nearest to the part affected, for it is there an exit will be found for them. Such articles as loosen the belly are lubricating, and are attended by heat; the belly being hot, saline matters are not readily discharged, but give rise to flatulence. What causes flatulence is for the most part fixed, and gives it off in drying, as all humours do. Astringents are of this nature, and every thing that by heat is rendered consistent, dries and becomes friable. Every thing that, internally applied, induces a flow of humours, causes dryness on the surface; such are tonics and stimulants. Purgatives weaken and heat the body; acids also provoke humours. Refrigerants induce evacuation, and equally so if they are of a humid nature; but if they should not purge, they induce heat. Such remedies as are heating, become refrigerant if they induce evacuation; otherwise they heat the system. Those are most heating that induce a large flow of humours; and such as in large doses do not excite so great an afflux, are simply laxative.
It appears to me that medicine, at the present day, has made as great a progress as could reasonably be anticipated. It teaches us to compare those circumstances that spring up from time and opportunity; and whoever attains to this knowledge, will ascribe nothing to chance. Let chance favour him or not, he will pursue the most appropriate measures in his treatment of disease; for medicine is established on a firm foundation, that does not require the co-operation of chance. Science effects the benefit, if we know appropriately how to employ it. What need have we of chance? If remedies in their very nature have a faculty fitted to cure disease, as to me seems the fact, chance can have nothing to do in the business. If chance is essential, it should follow, that that which is not a remedy, would be fully as efficacious as the best remedies, curing thus diseases by mere good luck. If we were altogether to exclude chance, not only in medicine, but in every case whatever, we should, in my opinion, act correctly. Let us avow then, that fortune, good luck, or chance, is for those only who always act correctly. It appears to me, that we succeed or fail exactly in the proportion of our acting properly or the reverse. To act properly is to succeed, and this is the lot of the skilful practitioner; to act badly is to fail, and such is the lot of ignorance or presumption. How can we possibly assert that ignorance is successful? We cannot make account of such success; nothing is certain from one who does not conduct himself with certainty, but is determined to act, without knowing whether what he does will or will not effect his intentions.
[The following is omitted by Haller.—Ed.]
Those affections denominated female diseases, all arise from the uterus; whenever it agitates itself, it occasions disease, whether it advances or retreats by change of situation. When its mouth does not approach the labia pudendi so as to be readily felt, the evil is not very considerable; but when it advances considerably, it is painful when it is touched, and the womb finding itself restrained and closed, does not readily allow of the menstrual discharge, and consequently becomes tumid and painful. If in descending still lower it turns upwards towards the groin, it produces a tumour that is extremely painful. When it mounts upwards beyond its limits, its body becomes rarefied, causing afflicting complaints, with headache and ischiatic pains; the womb continuing to swell, the menses are arrested, and its bulk thereby is augmented; the pains extend to the thighs; the female often feels the motion of the uterus to and fro, like a globe, sometimes to the right, sometimes to the left, and sometimes over the whole abdomen. This is accompanied by headache, and such being the state of things, the following treatment is to be pursued.
If it is merely a descent of the womb, we should if possible anoint it with some fetid substance of any kind, such as oil of cedar, or the pulp of garlic or onions, or even something more unpleasant. We also employ fumigations, taking care not to burn the parts. During this time we avoid drinks and diuretics; as also washing with warm water. When the womb ascends and there is no longer any obstruction, we use aromatic fumigations of an agreeable odour, such as myrrh, balsam, or any other heating article of the same nature; we bathe with hot wine and employ diuretics. We know when the womb ascends that there is no obstruction, from the flow of the menses; if it is obstructed they are suppressed. We must then begin with fumigations as follows. After boiling figs in wine, we put the decoction into the half of a gourd, divided in two parts, one-half of which serves as a cover, in which is a hole to direct the steam towards the womb, by means of this small aperture. Hot water is added, as necessary; after which, the hot remedies mentioned are to be employed, together with the dung and gall of an ox, alum, galbanum, and such like. We purge frequently with elaterium, which also vomits in delicate temperaments, by which superpurgation is prevented. If strong pessaries are required, take honey boiled one-half away, and incorporate it with the heating remedies above mentioned: after the mixture is made, pessaries are formed from it, long and slender like suppositories. Place the woman on her back, her feet elevated and separated, in order to introduce the pessary, and maintain it in its place by cloths or other material, warmed, so as to promote relaxation, and gradual melting of the pessary. If less active ones are required, they may be enveloped in fine linen. When the womb is over-moistened by humours, which swell its mouth, and prevent the menstrual flow, we must apply to it perfumes, &c., similar to those mentioned in a previous case, when speaking of the descent of the womb as obstructing the expected catamenial discharge. When this discharge is too abundant, we must avoid heating by means of warmth or other calefacients, nor must we use diuretic drinks or laxative diet; the patient should sleep in a bed elevated at the feet, to obviate the flow of blood towards the womb, and astringents should at the same time be prescribed. Menstruation, when regular, shows its appropriate sanguine character; but when it is irregular, it becomes somewhat purulent. Young persons discharge good blood, but in aged persons, it is mixed with much mucosity.
OF THE EMPLOYMENT OF LIQUIDS.
Haller, in his preface to this treatise, tells us it contains ten aphorisms from the tenth book (No. xvi. to xxvi). Something is said of wines and vinegar. It was read by the ancients, who occasionally extracted from it, though without quoting the title. It is amongst the shortest of the tracts, and nearer than many to the original tracts of Hippocrates.
Subjects considered.—Of the effects and powers, &c., of warm and cold waters, wine, vinegar, &c. Of the effects produced by warm rather than cold water, and on what parts.
Chap. I. Of the powers and uses of warm and cold water employed as drinks.
Chap. II. Of the use of hot and cold water; what parts are benefited or injured by either of them; what affections they induce or cure.
Chap. III. Of sea-water, wine, vinegar; their powers; what parts they benefit, or what diseases they cure or induce, &c.
Chap. IV. Of the different powers of cold and hot waters; what parts are benefited or hurt by them; and what diseases cured or induced by them.
Gardeil says, that from the title of this treatise, it might be supposed that liquids in general were here considered. It, however, chiefly has respect to water, the liquid “par eminence.”
Sec. I. Of the advantages of water, and its different effects. Affusion of cold and hot water on the skin. Vapour-baths, general and local; highly extolled on many occasions; injurious, from inattention. Frozen feet, separated by immersion in hot water.
Sec. II. Bad effects of cold and hot water; what parts of the body each is best adapted to, and continued in Nos. iii., iv., v., vi. Skin, its connexion with every part of the body, by means of the nerves and blood-vessels that compose the fleshy pannicle; the effects of heat and cold on the vessels, and some remarks tending to strengthen a credence of the circulation.
Sec. VII. Sea-water as a bath; fumigations useful in phagedenic ulcers; salt, nitre, pickle, &c., their uses as stimulant applications.
Sec. VIII. Vinegar, lotions of, fumigations, &c., of great utility.
Sec. IX. Sea-salt, use of, in solution.
Sec. X. Wines, various, sweet, rough, white, &c.
Sec. XI. Cases wherein cold water is good; others in which hot water is preferable; both are good in diseases of the joints, gout, convulsions; greater care required in the use of cold than of warm water; constipation cured by;—warm in affections of the eye;—when cold water is preferable. Of cold water in tetanus; numerous other cases.
It would appear from this treatise, that water, cold and hot, sea and other waters, were among the most frequent medicamental resources of Hippocrates, by bathing, drinking, aspersion, sponging, &c.
[a ]“Idem mire brevis, obscurus, et hactenus Hippocraticus.”
[* ]Apparently these deficiencies should render them moister; however, Hippocrates finds no difficulty in explaining this.—Ed.
[a ]Catulorum carnibus.
[a ]Hydromel—sive potus ex aqua et melle fermentando paratus.—Blanchard Med. Lex.
[b ]A decoction of pearl barley, with mashed raisins, liquorice, &c.
[a ]A species of spurge.
[* ]Porridge, Fr. Dict.
[a ]Νοοσυματων, Hipp.;—Membrorum, Fœs.;—Morborum, Hal.
[a ]Doubtless the optic nerves are here intended.—Ed.
[a ]Apparently, the term nerves here implies tendons, aponeuroses &c.—Ed.
[a ]“Ac siquidem in omnibus hoc modo sehabeat, constitutum quidem sic fuerit, hæc quidem contrariis curari quæcunque sint et quacunque ex causa fiant, illa vero similibus, quæcunque tandem sint et a quacunque causa fiant.”