Front Page Titles (by Subject) SECTION V.: ON DISEASES. - The Writings of Hippocrates and Galen
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SECTION V.: ON DISEASES. - 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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In his preface to this treatise, Haller says, “its author is uncertain; nor is it perfectly agreed, that these four books are those which, under the same title, the ancients largely quote from, for much of them is wanting here. Galen refers them to Thessalus, to the younger Hippocrates, or to Polybius.” But why (Haller adds) may they not be the production of some physician of the Gnidian school, as is conjectured by Fœsius? for the ancients found fault with the physicians of that school, that from the slightest difference, they established new species of diseases, so that they made seven or eight species of pleurisy; and this fault is to be found here. The remedies are repeated from the treatise “De victus ratione,” or they consist of the most powerful purgatives, very frequently prescribed in another place. The first book contains the theory that refers diseases to pituita and bile as their causes. We find also the pathology of diseases of the breast, of fevers, phrenitis, &c. There is much suspicion as to this book being known to the ancients. Saving the theory, it would appear to be not unworthy of Hippocrates.
Subjects treated of.—What is necessary to be inquired into by the physician, is here considered, and replied to. Of the internal and external causes of diseases. Of the appropriate and improper times for prescribing. Of proper and improper doings and sayings. Of good and evil, arising either spontaneously, by chance, or from error. What divided parts do not coalesce. Of the times for prescribing. Of manual dexterity. Of suppuration of the lungs, thorax, and stomach. Of erysipelas of the lungs, and tubercles of the lungs and side. Of fever, horror, rigor, sweat. Of pleurisy, peripneumony, ardent fever, phrenitis, melancholia. Of partially bloody and livid sputa.
This book is divided by Haller into two sections, containing thirteen chapters, the contents of which are as follow.
Sec. I.—Chap. I. What is to be observed by the physician when about to prescribe, that he may correctly interrogate the patient and the attendants, and reply to them, or oppose their questions.
Chap. II. Of the causes of diseases, external and internal. Of fatal diseases, of doubtful, variable, chronic, or acute; of convertible diseases, and of such as necessarily supervene.
Chap. III. The opportunities of prescribing are numerous, varied, fleeting, and sometimes inappropriate; of what may be properly or improperly done or said, both in medicine and surgery.
Chap. IV. Of things beneficial or hurtful in disease, as well spontaneous as from the fortunate or unlucky lot of the physician; and of evils arising from the physician, and not necessarily imputable to the disease.
Chap. V. What parts, if divided, do not coalesce; no general principle of practice, either in theory or treatment, will apply to every case. In what manual dexterity consists.
Chap. VI. Of pulmonary suppuration from peripneumony; of a defluxion of pituita from the head; of rupture of the small vessels; of the contraction of varicose vessels; of the cure, and of death from suppuration of the lungs.
Chap. VII. Of empyema of the thorax arising from a defluxion of pituita from the head, from pleurisy, from pituita impacted in the side, from labour, and from rupture of the vessels; of suppuration in the lower belly, and its causes; of a collection of pituita and bile between the skin and muscles, and of convulsions.
Sec. II. Some preliminary remarks are here made, as to the influence of abdominal suppuration, and its effects on the system; and of defluxion from the head; the influence from age and other causes thereon, in hastening or checking the issue, &c.
Chap. VIII. Of the origin, causes, signs, and cure, of erysipelas of the lungs; of tubercle of the lungs and sides; of rupture and evulsion of the flesh and vessels.
Chap. IX. Of the cure, restoration, and death from suppuration, arising from wounded flesh or vessels; and in the cure, what is to be attended to, as respects sex, age, season, period, affection, and other circumstances.
Chap. X. Of the origin and causes of fever, rigor, horror, and cold and hot sweats.
Chap. XI. Of the origin, causes, parts affected, and cure, of pleurisy and peripneumony, with and without expectoration; which of the affected perish, which recover, or escape, if suppuration has taken place.
Chap. XII. Of those most obnoxious to ardent fever; its origin, attack, causes, symptoms; its passage into peripneumony, and its danger. Of phrenitis and melancholia; of the influence of the blood and bile in these cases.
Chap. XIII. Whence arise the half bloody and livid sputa in pleurisy and peripneumony; and who perish, and wherefore, from these diseases, as well as from ardent fever and phrenitis.
Gardeil, who makes thirty-one divisions of this book, says: Physicians who are desirous of knowing the mode of acting and of thinking, in the time of Hippocrates, of those who attended to external diseases, will have reason to be content, I think, with what they have already thus far seen. The present treatise, divided into four books, will satisfy them in many respects, as to what concerns internal affections. It will not always be easy to arrange what is said in them, as to the order, nomenclature, and classification of many internal diseases treated of by modern authors, either generally, or particularly. For the rest, I am persuaded in reading what has been thus far accomplished, much will have been found to be very abstruse; especially in the Prognostics, Humours, Predictions, on the Nature of Man, Aliments, the Parts of Man, &c. Yet I am persuaded, also, that they will give rise, some day, to excellent comments, by able men, who will develope them by explaining them in their schools. Many of the remainder, I am far from thinking deserving of such attention, but that, on the contrary, they would be improved by being compressed.
I. Preliminaries. As to the necessary previous knowledge of the origin of diseases, and why some are chronic, others rapid or acute in character, and mortal or otherwise; destructive to certain parts, or not so; their good or injurious tendency, their issue and other particulars; and as to the knowledge requisite properly to prescribe for them.
II. Of the causes of diseases, external and internal; their principal differences in respect to danger, duration, &c.
III. Of opportunity, or the proper occasion for action, the most important part of medicine.
IV. Of incorrect judgment as to the time of action.
V. Of errors in judgment as to the nature of the disease, or of the appropriate treatment. Continued in VI. and VII.
VIII., IX., X. Of spontaneous circumstances, either good or bad, dependent on nature, or on the physician.
XI. No general principle of treatment fitted for all cases; hopes to be excited at times, promptitude of action at others; cautions to be attended to in our manipulations.
XII. Of internal suppuration of different parts.
XIII. Three cases of pulmonary suppuration; from peripneumony, from pituita falling on the lungs, and from rupture of vessels, or their varicose state.
XIV. Of suppuration in the cavity of the pleura, from which the patient usually recovers, if a discharge by incision or cautery is not too long delayed. The causes of empyema are various. Of the influence of age, season, temperament, &c., on these cases.
XV. Abdominal suppurations, from bile, pituita, spasm, &c. Encysted tumours are difficult to know, when deep-seated.
XVI. Erysipelas of the lungs; its great danger, and metastasis of.
XVII. Of tubercles of the lungs; their suppuration; occasional cure; great danger of, and accompanying diarrhœa.
XVIII. Tubercles of the pleura. [Qu.? if not here connected with aneurism of vessels.—Ed.]
XIX. Pleurisy from inflammation of the intercostal muscles. Continued in XX. [This seems somewhat connected with hepatic inflammation.—Ed.]
XXI. Internal suppuration from external causes, as wounds, &c.
XXII. Conclusions on the preceding statements; on sex, age, strength, seasons, &c.
XXIII. Of fever: its formation, causes; coldness, chilliness, why they precede fever.
XXIV. Sweats, explanation of; hot and cold sweats, difference of, &c.
XXV., XXVI. In what manner pleurisy and peripneumony are formed, &c.
XXVII. Of pleurisy and peripneumony, unaccompanied by expectoration; treatment of.
XXVIII. Of ardent fever; who attacked by it; internal heat, and cold externally; danger frequently induces pleurisy and peripneumony.
XXIX. Of phrenitis, how produced. The blood by some persons supposed to be the principle of the understanding.a
XXX. Causes of the difference of expectoration, in pleurisy and peripneumony.
XXXI. Why death takes place in pleurisy, peripneumony, ardent fever, and phrenitis.
Haller, in his preface to this second book, says that “What was said of the first book, is applicable to the second and third, for they are full of the names of diseases, derived from some peculiar symptom; the remedies are almost every where the same: rest, vomits, purging, ptisans, and preparations with honey and vinegar, &c. In the second book, however, dietetic co-operation is more insisted on; whilst in the third book, medicines are predominant, and those of the most powerful description. The history of diseases is better, such as of pleurisy, peripneumony, empyema, whose description was given in the preceding book. It may be referred to the Gnidian physicians, from the praises of powerful remedies, as well as of the use of verdigris, arum, hellebore, thapsia, and peplium, to promote expectoration. Galen designates these books as the large and small.”
Contents.—Many species of diseases are here enumerated, both general and local; as of the head, brain, nose, ears, eyes, mouth, fauces, heart, lungs, trachea, breast, back, belly, liver, spleen, and limbs; with their causes, signs, and cure.
Sec. I.—Chap. I. Of an overheated temperature of the head, with pituita and bile; as such or such parts are inflamed by the fluxion to them, various symptoms follow; such as copious urine, strangury, loss of sight or hearing, &c. Several other affections of the head are enumerated, and their accompanying symptoms.
Chap. II. Of diseases of the head; sideratio; caries of the bones; sphacelus, &c.; their causes, symptoms, and prognosis.
Chap. III. Of angina; uva; inflammation, &c., of the tonsils, and surrounding parts.
Chap. IV. Of diseases arising from fulness of the head, attended with torpor; incontinence of urine, strangury; and of their dietetic, pharmaceutic, and surgical treatment.
Chap. V. Of ulcers of the head and legs, and swelled legs; of headache, with bilious vomiting and dysury, and of their cure.
Chap. VI. Of hydrocephalus;a of coldness, pain and fever in the head; excitement of vascular action in and about the brain; their causes, signs, and cure.
Chap. VII. Of the rise, causes, symptoms, signs, prognosis, and treatment of those affected with bile, &c., or from drunkenness.
Sec. II.—Chap. VIII. Of sideratio cerebri (qu.? σφαϰελος, ενϰεφαλȣ); caries of the bones, &c.; causes, symptoms, signs; dietetic, pharmaceutical, and surgical treatment.
Chap. IX. Of the causes and cure of three kinds of angina. Inhalation for, well described.
Chap. X. Of uva; in which the excision of the lower part of the uvula is ordered;b of tonsillitis; of tubercle of the tongue; of inflammation of the palate; and of the treatment.
Chap. XI. Of five kinds of polypus; the pendulous, oblong, soft, fleshy, and callous, which occupy the nostrils; and their treatment by excision, cautery, &c.
Chap. XII. Of jaundice, with, and without fever; and their treatment.
Chap. XIII. Of the treatment of three kinds of fever arising from bile.
Chap. XIV. Of the treatment of quartan fever.
Chap. XV. Of the signs and treatment of three kinds of pleurisy.
Chap. XVI. Of peripneumony; its origin, symptoms, and cure; of suppuration from peripneumony, and of incision therefor, and evacuation of the pus. Auscultationc is here clearly adverted to, and incision ordered for the removal of the pus.
Chap. XVII. Of consumption from pulmonary affections; signs of, and dangerous symptoms; falling off of the hair, with fetid expectoration, &c.; its treatment.
Sec. III.—Chap. XVIII. Of consumption of the lungs; of ulceration of the trachea; their diagnosis, prognosis, and treatment.
Chap. XIX. Of dorsal phthisis; its rise, causes, signs, and cure; of a disease of the lungs, somewhat differing from common phthisis.
Chap. XX. Of wounded trachea, and pulmonary lesion; convulsive twitching of the fibres of the lungs; their signs, prognosis, and remedies.
Chap. XXI. Of erysipelas of the lungs, its causes, signs, and treatment.
Chap. XXII. Of the signs and treatment of a dorsal affection, and tubercle of the lungs.
Chap. XXIII. Of engorgement of the lungs, and their lateral gravitation; their signs and cure.
Chap. XXIV. Of tubercle in the side; dropsy of the lungs; rupture of the breast or back; their signs and treatment. Incision between the ribs in dropsy of the lungs is here recommended.
Chap. XXV. Of ardent fever; of fever with singultus; their signs and cure.
Chap. XXVI. Of lethargy; marasmus; of a variety of fever, (called φονωδης, mortifera;) their signs and cure.
Chap. XXVII. Of the livid disease; and of one accompanied with eructation.
Chap. XXVIII. Of a pituitous disease affecting chiefly women; of leuco-phlegmasia; their signs and cure.
Chap. XXIX. Of melancholy; and of three varieties of (Μελαινα νȣσος) black disease; their signs and treatment.
Gardeil, in seventy-two paragraphs, gives the following outline of this second book.
I. From excessive heat of the head, the pituita is melted, and conveyed to all parts. This paragraph, and up to x. inclusive, is taken up with concise notices of some diseases of the head, the treatment of which follows, from xi. to xxxiv.a
XI. to XIII. Of diseases which arise from the head. Here, says Gardeil, (up to No. xix.,) the author appears to return to the diseases already mentioned, for the purpose of giving their treatment. At the same time, he adds, the order of the matters, in all the four books, is very difficult to attain, if, in fact, any order has been pursued. It may be remarked, that the use of the cautery is very frequent.
XIV. Refers to hydrocephalus, or water on the brain; the strabismus is noticed; and in the last resource an opening of the cranium is recommended, as in trepanning, in order to discharge the fluid.a
XV. Seems to refer to No. v. The pulsation of the vessels is here noticed. Some part omitted by Gardeil.
XVI. A singular treatment here recommended, for some vertiginous affection, by incision of the forehead near the hair, and sprinkling salt in it, and closing the wound, &c.
XVII. to XX. All referring to some of the previous numbers.
XXI., XXII. Refer to sphacelus and caries of the bones of the head, &c., in which scraping the bone to the diploe is recommended.b
XXIV. Quinsy, and its treatment, is here noticed, and continued in No. xxv. and xxvi. Inhalation is here recommended and described.
XXVII. Tumid uvula, (ϛταφυλη, uva.) Its excision recommended. Long prior to some assumed modern discoverers, passing down through the whole train of medical writers from Hippocrates to the present period; although apparently unknown to a late professor, or to some contemporaries, who ascribe the discovery of this operation to him.
XXVIII. Swelled tonsils; ranula; inflamed, swelled, and suppurated palate.
XXIX to XXXIII. Polypi of the nares, five species, and their treatment.
XXXIV. The chain is here broken. Icterus is treated of in this and the next paragraph.
XXXVI. Bilious fever.
XXXVII., XXXVIII. A variety of fever, approximating to yellow fever.
XXXIX. Quartan fever, treatment; sorbets, large doses of hellebore.
XL., XLI., XLII. Pleurisy, varieties of, and treatment.
XLIII. to XLVI. Peripneumony; empyema; something like auscultation noticed; fumigating; opening the cavity of the thorax to discharge the pus; the process described.
XLVII., XLVIII. Phthisis; affection of the trachea, leading to phthisis.
L. Tabes dorsalis, common to young married people, and libertines. This is rather a seminal weakness.
LI., LII. An affection of the lungs, in which fumigation is commended. Ulcerated trachea.
LIII. Twitchings or convulsion of the fibres of the lungs, commonly fatal.
LIV. Erysipelas of the lungs, chiefly excited by excess in eating and drinking. It seems to be of a chronic character, and requires a chronic treatment.
LV. A dorsal affection, with bloody urine, on the third or fourth day; mostly fatal.
LVI. Tumours or tubercles of the lungs, to be treated as empyema.
LVII. Engorged lungs [Qu.? peripneumonia notha.—Ed.] very fatal.
LVIII. The lungs falling on the pleura, [Qu.?] It arises sometimes from a wound, or from the operation for empyema; singular treatment for, by introducing air into the cavity.
LIX. Tumour of the pleura; incision recommended, or cautery, and introduce after the tenth day a mixture of warm wine and oil, retaining, and renewing it, &c.
LX. Of dropsy of the chest, hydrothorax, slower than empyema in progress.a Rupture of the breast or back.
LXI., LXII. Of burning fever (ϰαυσως), often ending in peripneumony; fever, with hiccup.
LXIII. Of lethargy. [Not that now so denominated. It seems to be rather coma, in the latter stage of some disease.—Ed.]
LXIV. A disease called αυαντη, Gr., resiccatorius, Fœs., of a chronic character. [I should think it connected with dyspepsia or marasmus.—Ed.]
LXV. Fever, (φονωδης, mortifera,) deadly.
LXVI. Morbus lividus. Qu.?
LXVII. Disease with much flatulence upwards.
LXVIII. Pituitous disease. Qu.? Asthma.
LXIX. Leuco-phlegmasia, or anasarca.
LXXI., LXXII. The morbus niger. Qu.? Of two kinds (Μελαινα νȣσος). The gangrenous disease.
The following diseases, says Haller, are noticed in this book, viz.: tumour of the brain, and its painful repletion, apoplexy (Qu. βλητοι, Hipp.; sydere icti, Fœs.a ), lethargy, ardent fever, tumour of the lungs, headache, phrenitis, angina, jaundice, tetanus, opisthotonos, convolvulus, peripneumonia, pleurisy. Also of the drinks, &c., to be used in ardent fever.
Chap. I. Of tumour of the brain from infiammation; diagnosis, prognosis, and cure.
Chap. II. Of intense headache, from fulness of the brain; its symptoms and cure.
Chap. III. Of (Qu. apoplexy?) attoniti, Hal., vel sidere icti; its signs and cure. In the next chapter, the sideratio cerebri (ϛφαϰελισμος ενϰεφελȣ, Hipp.,) is considered.
Chap. V. Of the signs and cure of lethargy, and of suppuration from. It seems different from ours.
Chap. VI. Of ardent fever; diagnosis, prognosis, and cure.
Chap. VII. Of the lungs enlarging from heat; diagnosis, prognosis, and cure.
Chap. VIII. Acute headache, with aphonia; diagnosis, &c.
Chap. IX. Diagnosis and cure of phrenitis.
Chap. X. Angina, twofold, cynanche, and paracynanche; the signs and cure of each.
Chap. XI. Of icterus; its signs and treatment.
Chap. XII. Tetanus, opisthotonos; diagnosis, prognosis, and cure of each. In the latter, cold affusions recommended.
Chap. XIII. Volvulus; diagnosis and cure. Blowing up the intestines with a bellows is here recommended.a
Chap. XIV. Peripneumony; diagnosis, &c.
Chap. XV. Pleurisy; humid, bilious, bloody, dry; dorsal; their diagnostics, prognostics, pharmaceutic, dietetic, and chirurgical treatment, largely laid down. Something like auscultation alluded to; and paracentesis of the thorax to discharge the pus when formed.
Chap. XVI. Of a variety of cooling drinks in ardent fever.
Gardeil divides this book into forty-six paragraphs; from No. 26 of which, to the end, is a large variety of different kinds of drinks for sick people, especially in fevers, and which he calls “appropriate ptisans.”
1. Hippocrates tells us, that having heretofore treated of fevers, he now proceeds to other diseases.
2. Turgescence of the brain, with headache; here, in the treatment, after shaving the head, cooling applications, confined in a bladder, are recommended.
3. Headache from plenitude of the brain, accompanied with delirium.
4. Les Frappés, Gard.; sydere icti, Fœs.; βλητοι, Hipp.; [Qu. what is this? Gardeil refers us to sentence xxxi., chap. xvi., book ii., Coacæ, where it has connexion with peripneumony.]
5. Sphacelus of the brain—cerebri sideratio, Fœsius, p. 488.
6. Lethargy. [Certainly not that now so called, since it is closely connected with peripneumony. It seems to me merely a comatose symptom in peripneumonia notha.—Ed.]
7. Of ardent fever. This is said oftentimes to degenerate into peripneumony. Hot ablutions frequently employed, except to the head, are recommended.
8. Tumour of the lungs, from heat. This appears to be also peripneumonic.
9. Headache. Refers chiefly to that arising from drunkenness.
10. Phrenitis. Gardeil thinks this refers to inflammation of the diaphragm or paraphrenitis; and the symptoms warrant this opinion.—Ed.
11, 12. Of quinsy or angina, true and false. In the treatment of the latter it is recommended to introduce a tube, to assist respiration.
13. Of icterus (morbus regius, Fœs.) It is said to be an acute disease, which kills in a short time. Doubtful if our common jaundice.
14. Of tetanus.
15. Of opisthotonos. Cold water dashed on the patient is among the recommendations for this.
16. Of volvulus, or the iliac passion. Here, among other recommendations, is that of forcing up wind into the intestines by means of a bellows.
17. Of peripneumony. About the eighteenth day, if the expectoration is sweetish, the lungs are said to be in a state of suppuration, and may continue for a long time.
18, 19, 20. Of pleurisy. Of dry pleurisy. Of dorsal pleurisy.
21, 22. Of the examination of the tongue in pleurisy. Pain of pleurisy worse at night.
23. Treatment of pleurisy. [Bleeding seems but little attended to, and probably hence, apparently, the frequency of empyema; purging is more commended.—Ed.]
24. Suppuration being established, and having passed into the thorax, at a proper period, incision or cautery is recommended; and auscultation is obviously spoken of, to determine the presence and situation of the pus, which is slowly evacuated for several successive days.
25. The same treatment is recommended in suppuration from wounds.a
26. to the end, taken up with an enumeration of formulæ for ptisans and drinks.
This book, says Haller, is very different from the preceding ones, and is replete with acute and ingenious reasoning. The origin of disease is deduced from four humours, bile, blood, pituita, and water, arising from the aliment taken in. If received beyond a just amount, on the third day, the body is disturbed, and if the excess is not removed, disease ensues. Of the judgment as to diseases. This should be made on the uneven days, in which the humour should pass out. Other matters are minutely treated of. Towards the close, something is said respecting worms, which are discovered even in the fœtus; of calculus, from hardened pituitous milk; of dropsy of the belly, uterus, and the whole body; its origin. Here too we find refuted, the descent of drink into the lungs, which in other books, Hippocrates maintains. The author cites the book he had written on female diseases. (De morbis muliebribus.)
The argument of this book, (divided into two sections and nineteen chapters, by Haller,) is, that there are four species of humours, bile, pituita, blood, and water; their origin, generation, causes, receptacles, sources, and effects; of food and drinks; of excretions, and their ducts. Fever is considered; the principles of diseases, and their causes; of pains, worms, calculi, and dropsy.
Sec. I. Chap. I. Of the origin of man. The seminal fluid of both parents is essential to generation, and is derived from every part. There are four humours in the body, bile, blood, pituita, and water, or atrabilis, which are formed from the food and drinks taken in. Their sources are fivefold, viz., the stomach, the head, the heart, spleen, and gall-bladder. Analogy of plants and births (partium). Every part attracts its congenerous humour to itself.
Chap. II. Excess or deficiency of assimilating humour, induces disease both in plants and in man. Plants spring up and grow, only where they can obtain an appropriate nourishment. All plants will not indiscriminately grow and flourish in all places. Cultivation has caused these difficulties to cease.
Chap. III. Pituita (φλεγμα), originating from pituitous food and drinks, is attracted to the head, and if in excess, it induces headache; and if conveyed away by the stomach and bladder, benefit ensues.
Chap. IV. Bile is more copiously produced from bilious food and drinks. It is drawn to the liver from the gall-bladder, and there retarded, proves the cause of pain. Food and drinks of different kinds often prove remedial.
Chap. V. Of the more copious flow of water, its causes, seats, affections; from whence pains of the spleen and of the lower parts of the body arise.
Chap. VI. Of blood, its origin, causes, affections. The heart is not affected with pain from its increased presence; although from it many diseases of the body arise.
Chap. VII. Four streams are continually supplying the body, as its parts are emptied by a mutual co-operation: numerous vessels exist in the body;—from whence arise the savour or disagreeableness of food and drinks; appetite and its cessation explained.
Chap. VIII. Bile is secreted from food and drinks, in the gallbladder; and there induces cardiogmus (cordis morsum), but does not produce disease of the heart. The head and spleen are more liable to disease. When, and how, humours noxious to man, become reduced. Four places from whence the system is purged, viz., the mouth, nose, rectum, and urethra.
Chap. IX. How man preserves his health, by proper attention to diet; this appropriately digested, distributed, and excreted; otherwise sickness ensues, followed by emaciation and weakness, together with repletion, heat, pain, and fever.
Chap. X. When discharges exceed what is received, men grow thin. Of the operation of indolence, and activity, on appetite and health; the importance of good habits; of fever from repletion, and of the termination of diseases on certain days.
Chap. XI. Why fever terminates; and why fevers and diseases remit, terminate, or diminish on uneven days; vitiated humours are disturbed and evacuated, horror ensues, and crises follow.
Chap. XII. Why death ensues on uneven days; the humours are disturbed, pains ensue; medicine improperly given, often injurious; ulcers become more inflamed; why swelling of the glands arises from ulcers; heat and pain of ulcers, and their influence in the subsequent uneven days, &c.
Sec. II. Chap. XIII. Why men sicken; necessity of purgation; fever from repletion; watery humour is most opposed to fever, but a bilious humour is its pabulum. Why water exhales more readily than oil; what, and how many, are the principles of disease,—and of their grade of violence.
Chap. XIV. Of the effects of violence, wounds, ulcers, contusion, tumour, pain, fever, disturbed humours. Comparison between milk and blood, and their parts. What effects arise from a disturbance, excess, and evacuation of humours; of the aliment of man, and the causes of putrefaction and death.
Chap. XV. How diseases arise from the air; by the solution, concretion, secretion, mixture, agitation, and situation of a single humour, various diseases may arise, such as disturbed bowels, griping, rigor, chill, inflammation, and fever.
Chap. XVI. Of worms; lumbricus latus, and teres; the latter procreate, the former do not, but break into pieces resembling gourd-seeds; of their origin, species, diagnosis, and prognosis. The existence of worms in children, even in utero, is here asserted.
Chap. XVII. Of calculus; its origin from milk; its causes; five signs of; its symptoms; its mode of increase and location.
Chap. XVIII. Drink is conveyed into the stomach, and not into the lungs; and from the stomach it is conveyed to every part, as shown by eight arguments.
Chap. XIX. Of three species of disease from dropsy or watery effusion; their origin, locality, causes, signs, symptoms, and prognostics.
Gardeil divides this book into twenty-five paragraphs, to the following effect.
1. Of the principles of the composition of the body, and the sources of diseases, from four humours,—pituita, blood, bile, and water.
2. Physiological explanation of the origin of the four humours, with a digression, in a parallel between the nutrition of vegetables and animals; and that from an improper soil, plants cannot always be naturalized; reference is even made to the difference of contiguous soils, in the culture of the vine.
3, 4, 5, 6. The above four humours considered; their sources, &c.; defect of, and superabundance.
7. The general theory of diseases, founded on the four humours, being in excess or defect. The intercommunication of vessels throughout the body. Four fountains in the body, supplied through the agency of the stomach. Importance and utility of the doctrine to dietetics.
8. Some principles as to the secretions and excretions. Four passages by which the above-mentioned humours are principally evacuated,—the mouth, nose, anus, and urethra.
9, 10. Wherein health consists; regularity, progress of the aliment, &c.; excess or defect in diet, &c.; humours evacuated the third day; fæcal matters on the second.
11. Theory of the diseased state arising from the excess or defect mentioned.
12. The cessation of fever explained; on the third, fifth, seventh, or ninth day.
13. Why fever finishes on uneven days, and of the disturbance of the humours on such days, by improper treatment. Ancient physicians are here adverted to.
15. Theory of diseases, from superabundance of humours, or from defect of excretions; seven signs of.
16. Two other sources of disease; external, and violence done to the body.
17. The effects of external things, acting violently; tumours, contusions, fatigues.
18. The effects of atmospheric agency; how the humours are affected; death from disorganization. Health, in what it consists. Engorgement of vessels, &c., illustrated.
19, 20. Coldness in disease, explained; brief recapitulation.
21. Of worms. Tænia; formed even in the fœtal state; their great length; curious account of their generation, &c.; symptoms; the cucurbitinæ illustrated.
22. Of calculus of the bladder; of its origin from impure milk sucked in early life (see treatise on Nature of Man), explained; five signs of calculus.
23. An article respecting the passage of drinks to the lungs, which is here denied, though elsewhere insisted on, and seven arguments against it. Of the voice and its formation, &c.; the epiglottis, its use.
24. Of the origin of dropsy. Varieties of ascites.
25. Of dropsies in general; of the womb, belly, legs, &c.; danger of, when acute disease attacks, &c.
In his preface to this treatise, Haller speaks favourably of it, as having in it little reasoning, but much good observation. It is, he adds, commonly ascribed to Polybius, but this is mere conjecture. The arguments are of a mixed character, a fault, by the by, common to the Hippocratic authors. It begins with some histories of diseases, which differ from those in the books “De Morbis.” Scarcely does the author notice any remedies, but he refers to a book now lost, περι φαρμαϰων. The conclusion relates to things appertaining to diet; and what is here given differs from that which appears in the books “De Dieta,” and seems to me very useful, especially in what relates to the qualities and powers of aliment. Some short and by no means absurd things are stated as to the reason of causes. Man is stated to consist of four humours,—blood, pituita, bile, and melancholy or black bile.
The argument of this book, divided into two sections and sixteen chapters, is, that it consists of many diseases of different parts; fevers, ulcers; their causes, signs, and treatment; of food, both for the sick and convalescent; and an explanation of the powers and differences of several kinds of aliment.
Sec. I. Chap. I. Of what is requisite to be known in consulting for the treatment of diseases. The beginning and source of all diseases are bile and pituita; elucidation of.
Chap. II. Of diseases arising from pituita of the head; pains of head and ears; inflammation of the fauces and uvula; toothache, polypus, and the cure of these.
Chap. III. Of acute diseases of the belly; most violent in winter. Of pleurisy, peripneumony, ardent fever, phrenitis, with others of a lighter description, but becoming acute in winter; their changes, causes, signs, and cure.
Chap. IV. Of summer complaints; pains, fevers, ardent fevers, tertian, quartan; their symptoms, causes, signs, crises, and cure.
Chap. V. Of white pituita, with large, hard, and suppurated spleen; their causes, conversion to dropsy, symptoms, and cure.
Chap. VI. Of volvulus, dropsy; their causes, prognosis, and cure; surgical treatment of dropsy; inflating the intestines in volvulus.a
Chap. VII. Of dysentery, lientery, diarrhœa, tenesmus, cholera; their causes, signs, and treatment.
Sec. II. Chap. VIII. Of strangury, sciatica, arthritis, podagra; causes, signs, and cure; flax.b
Chap. IX. Of icterus and tubercles (φυματα); their causes and cure; of some unsightly affections; lepra, prurigo, itch, impetigo, vitiligo, alopecia, favo, panis, furunculus, and carbuncle.
Chap. X. Of what the physician must inquire, when visiting his patient; and of the proper remedies in wounds, both dietetic and pharmaceutic.
Chap. XI. The food proper in health, is to be changed in sickness; drinks are chiefly to be employed, (sorbitiones, ptisana, &c.) What food and drinks loosen or bind the belly, and renew the strength; what kinds are proper when purgatives are given; in fever, which foods moisten, or dry the body.
Chap. XII. Treatment of convalescents. In disease, attention requisite as to what dries or moistens. Articles desired by the sick to be allowed if not injurious; food is to be slowly added or abstracted; more solid food to be given as convalescence advances, and liquids to be diminished. Aliments and medicines, that are employed in practice, should be well understood; and which are appropriate in debility.
Chap. XIII. How to appreciate the powers of different food; which are light, which heavy. What food and drinks most conducive to health, and strength of body; which cause acid eructations, tormina, and flatulence; which promote evacuation by stool or urine.
Chap. XIV. Of the proper and improper use of food and drinks; of such as are drying, moistening, strengthening, &c.; of weak and strong, light and heavy food; and of the diversity of bread, flesh, and fish.
Chap. XV. Of baths; of some pot-herbs, as to their hot, cold, moist, and dry powers; and exciting the urine, stools, and menses; of astringent, stomachic, drying, and attenuating herbs.
Chap. XVI. Of the various grains and wines; of strong and weak food; the bread most proper in disease; vomition from food or drink; apples and nuts after food; what wine is useful in obviating the ill effects of food and drinks; why the belly is disordered, bound, or loosened; what food is weakening; when food is to be given to febrile patients; when wine and honey are most appropriate; food adapted to health is more powerful in sickness.
This treatise, says Gardeil, is merely an abridged domestic medicine, the conclusion of which is particularly devoted to regimen, both in health and sickness. As it treats only of diseases generally known, practitioners will there find the means of recognising those that are elsewhere spoken of under numerous different denominations. He divides it into sixty-four paragraphs.
I. Of the importance of domestic medicine, and the means of attaining a knowledge of it.
II. to XIII. Of diseases of the head, ear, throat, gums, palate, teeth; of nasal polypi; of diseases of the trunk of the body; pleurisy, peripneumony, phrenitis, ardent fever; (in x. is defined the meaning of judicatus, as applied to diseases, and in xi. a treatise on pharmacy is referred to, which seems to be lost;) change of the two last to peripneumony.
XIV. These four diseases are called acute; great care required in acute diseases; the slightest fault is hazardous; febrile diseases of winter, their treatment.
XV. Of fevers in the summer.
XVI. General remarks on fever and their treatment.
XVII., XVIII. Evidence of presence of bile. Of pains in the belly, and erratic throughout.
XIX. General remarks on summer diseases.
XX., XXI. Of tertians and quartans.
XXII. Enlarged spleen.
XXIII. Iliac passion.
XXIV. Œdematous affections.
XXVII. Chronic diarrhœa.
XXIX. Cholera morbus.
XXXI. Sciatica. Flax used as moxa.
XXXIV. Of regimen in the preceding diseases. Cautions as to remedies.
XXXV. Of tumours.
XXXVI. Cutaneous affections, &c.
XXXVII. Purgatives, not indifferent remedies; opiates.
XXXVIII. Precepts for conduct, previous to prescribing for the sick.
XXXIX. How to act in case of wounds.
XL. Of the nourishment of the sick.
XLI. Substitution of oil and wine as frictions, for baths.
XLII. Regimen in certain cases.
XLII.bis. Of the means of attaining a knowledge of the most expedient remedies.
XLIII. Of the preparation and quality of food. Of good and bad digestion.
XLIV. Of drinks, &c.
XLV. Of a drying regimen.
XLVI. Effects of bread and cakes.
XLVII. to LV. Of wines and various foods, &c.
LVI. Influence of soils on, &c.
LVII. General observations on regimen continued, and use of vomits in its improper employment.
LXII. Rules for diet in intermittents.
LXIII. Of wine and honey.
LXIV. Of the necessary modification of regimen on account of the state of disease.
OF INTERNAL AFFECTIONS.
This treatise, says Haller, is among the most confused, manifestly consisting of the Gnidian sentences; for diseases are here subdivided ad infinitum, and species constituted from a solitary case. Thus a nomenclature of diseases sprung up, distinguished by no connexion of characteristic symptoms; such as the great varieties of morbus crassus, of typhus, nephritis, hepatitis, and splenitis. In scarcely any of these, are the diseases to be distinguished by the accompanying symptoms; what credit can be given to one of the varieties of the morbus crassus (4th pachysmus, Hal.), in which the patients were injured by the smell arising from rain falling on the earth? The extreme violence of the Gnidian remedies is offensive, such as the grana gnidia, succus hypophæs, and lapis magnesiæ. The hellebore here mentioned, purges up and down. Many symptoms of diseases differ from those mentioned in other Hippocratic books, with the exception of tetanus, whose description and treatment agree with the third book, “De Morbis.” Drinks, moreover, are here stated to pass into the lungs.
The argument of this book is stated by Haller as pointing out the internal diseases of different parts, as of the windpipe, the vessels, heart, lungs, back, breast, side, spinal marrow, kidneys, of the vessels of the right and left side, of the abdomen, intestines, joints, skin, and of the whole body, together with their causes, signs, and cure.
Sec. I. Chap. I. Of ulcerated or wounded windpipe, or of any of the vessels of the lungs, their causes, signs, prediction, cure, and precautions in convalescence.
Chap. II. Of rupture of the pulmonary arteries or veins; symptoms, signs, and cure.
Chap. III. Of suppuration of the chest, and ruptured lungs.
Chap. IV. Of the causes, signs, and treatment, of pneumonic affection.
Chap. V. Of varix of the lungs, its causes, signs, and treatment.
Chap. VI. Of sanguineous or bilious repletion of the lungs.
Chap. VII. Of the causes, signs, and treatment, of inflammation of the lungs.
Chap. VIII. Of erysipelas of the lungs, its signs, and treatment.
Chap. IX. Of rupture of the breast and back, its causes, signs, and treatment.
Chap. X. Of tubercle of the side, its signs, and cure.
Chap. XI., XII., XIII., XIV. Of four species of consumption; from a defluxion of pituita from the head, upon the lungs; from spitting of blood; from a ruptured vessel from labour; and from a defluxion on the spinal marrow; their signs and cure. The fourth, from dryness of the spinal marrow, owing to an obstruction of the vessels going to the spine, or of the passage from the brain to the spine, or from venery; its signs, and treatment.
Chap. XV., XVI., XVII., XVIII. Of four affections of the kidneys, viz.:—1. Calculus of those glands. 2. Of diseases arising from violent labour, inducing rupture of the vessels and suppuration, in which an incision at the lumbar region is recommended; which, if unsuccessful, the complaint terminates in tabes renalis. 3. Of ulcer of the kidneys. 4. Arises from obstruction, and from venery, ending in suppuration; some singular advice as to exercise in this complaint; origin, signs, cure, &c.
Chap. XIX. Of a violent disease of the venæ cavæ, succeeding nephritis; its causes, signs, and cure.
Chap. XX. Of another of a like nature.
Sec. II. Chap. XXI., XXII. Of several species of pituita, viz.: common or recent, of the white, chronic, or leucophlegmatic pituita.
Chap. XXIII. Of dropsy from cacochymia, or a thin pituita.
Chap. XXIV. Of dropsy of the lungs or thorax from drinking copiously of water, or from a rupture of tubercles; operation for; auscultation apparently adverted to.
Chap. XXV. Of dropsy, subsequent to an œdematous phlegmon of the liver; signs, &c.; surgical treatment.
Chap. XXVI. Of dropsy, arising from watery effusion from the liver into the belly; its treatment.
Chap. XXVII. Of inflammation of the spleen, and subsequent dropsy; its causes, signs, and treatment.
Chap. XXVIII. Of universal dropsy, arising from drinking stagnant water in long journeys, &c.
Chap. XXIX. Of hepatitis, and scirrhous inflammation of the liver; its causes, signs, and treatment.
Chap. XXX. Of hepatic erysipelas, or erysipelatous phlegmon; causes, &c.
Chap. XXXI. Of hepatic affection, with metastasis to the brain; causes, &c.
Chap. XXXII. to XXXVI., inclusive. Of various affections of the spleen,—phlegmonous, erysipelatous, scirrhous, plethoric, and pituitous; their symptoms, signs, and treatment.
Chap. XXXVII. to XL., inclusive. Of jaundice, from bile in summer; and in winter, from drink and cold, as well as bile; of epidemic jaundice, from obstruction induced by over-eating and drinking; and of jaundice from pituita; their origin, signs, and treatment.
Sec. III. Chap. XLI. to XLV., inclusive.—Of five different sorts of typhus; from bile; superfluous moisture; putrid bile mixed with the blood, and falling on the joints; from superfluous moisture from the use of fruit and cakes, and from a putrid moisture of the body generated from black bile; their causes, signs, and cure.
Chap. XLVI., XLVII., XLVIII. Of three varieties of ileus; their causes, various signs, distinction, and cure.
Chap. XLIX to LII., inclusive. (De pachysmo, Hal.; Morbi crassi, Fœs.; Grossissement, Gardeil.; παχυς, Hipp.) Of enlargements of the belly, legs, &c., from a defluxion or collection of pituita and bile. [Qu.? If these are not connected with rickets, &c., as mention is made of incurvation of the spine. It is in Chap. lii., that the influence of the odour of the earth from rain is mentioned. Some of the symptoms resemble those of chlorosis; it would be difficult to say what they are.—Ed.]
Chap. LIII. Of sciatica, four kinds of; ankylosis from, &c.
Chap. LIV., LV., LVI. Tetanus, opisthotonos, from wounds, cold, or other causes; wine copiously recommended in the first.
The preceding treatise (4th De Morbis), says Gardeil, is a choice piece of hygiene. The present one, which is similar in many things to the three last books of the treatise on diseases, gives us a pathology and therapeusis of various diseases, in which more precision is desirable. Many details of curative proceedings are to be found, which might be usefully employed at the present time.
Gardeil divides this treatise under the following paragraphs.—Ed.
I. Of affections of the breast caused by violence.
II. Of rupture or lesions in the chest; milk diet.
III. Of consumption (pulmonic), tubercles, suppuration.
IV. Varices of lungs.
V. Of black bile in the lungs.
VI. Of inflammation of the lungs, from excess in drink, &c.; vomiting in; its chronic state, &c.
VII. Of erysipelas of the lungs from congestion.
VIII. Of (déchirures, Gardeil; pectus et dorsum dirupta, Fœsius,) irritation of the back or breast from great fatigue; cure of, and danger of relapse.
IX. to XIII. Of tumours and suppuration of the pleura; of foura species of phthisis; the first, from pituita, its treatment and rare recovery from; the second, caused by great fatigue, is less hazardous, but very fatal. The third, from the spinal marrow becoming filled with blood; exercise in, at a certain period, from one to six leagues a-day; receipt for a drink of various roots and flowers; fumigations. The fourth, or dorsal phthisis, from a drying of the spinal marrow, chiefly caused by excess of venery. Immense quantity of asses’ milk employed in, mixed with honey, nine pounds; or fourteen pounds of cow or goat milk, (tres semicongios,) continued daily for forty-five days.
XIV. to XVII. Of four affections of the kidneys. In the first, sand sometimes is seen, leading the physician to imagine a stone in the bladder, when it is in the kidneys. A laxative of two gallons of weak broth; nephrotomy recommended in certain cases. In the second variety, from excessive fatigue, followed by rupture of the small veins going to the kidneys, causing blood to be passed with the urine, and subsequently pus, in which case nephrotomy is also recommended. Hippocrates remarks that many considered this last stage as nephritic phthisis. The third species, produced from black bile passing to the kidneys, and remaining, it lacerates the small vessels and substance of the gland; it is rarely cured, but becomes chronic. The fourth is the product of pituita and bile, and also arises from venery. Here again, if suppuration ensues, the pus is to be discharged by incision on the most prominent part; its treatment by regimen and exercise.
XVIII., XIX. Of a great disease of the venæ cavæ? Whatever may be intended by this, Gardeil is inclined to consider it a disease no longer known. In its treatment the actual cautery is freely advised, viz., three near the joint of the femur and pelvis; two below the trochanter; two at the middle of the thigh; one below the knee, and one above the ankle, besides four on the right shoulder. The same treatment is recommended, when the left vein is affected.
XX. Some speculations as to pituita and bile, with the treatment of the symptoms arising from those humours, and the mode of inducing vomiting in cases of an excess of recent pituita.
XXI. Of leucophlegmasia; cupping on the lumbar region; opening the scrotal veins.
XXII. Of anasarca following the above.
XXIII. Of hydrothorax, from drinking water profusely in summer; from tubercles. Tubercles very common in oxen, dogs, and sheep, as evinced by dissection; still more so in man; treatment by paracentesis above the third false rib, by incision, and trocar, draining off the water for twelve days.
XXIV., XXV. Of dropsy of the liver, and of the spleen; this last is ascribed to eating too freely of fresh figs or apples, &c.
XXVI. Dropsy (anasarca) from the use of bad water in long journeys; among other remedies, the same water is prescribed in the treatment. A very free use of nitre (Qu.?) as a glyster, is ordered, viz., Ʒx., with other articles.
XXVII., XXVIII., XXIX. Of hepatitis, three varieties noticed; in one, glysters of asses’ milk to four and a half pounds, or of mare’s milk; all these varieties said to be very dangerous, most of the patients dying on the fourth day.
XXX. to XXXIV. Of five species of affections of the spleen, all very similar, both in causes, symptoms, and treatment. Sawing wood for thirty days is one of the remedial means. One of these (second) varieties, Gardeil thinks very analogous to scurvy.
XXXV. to XXXVIII. Of four species of jaundice. Little variety is here found; cantharides used internally, infused in wine. One variety of jaundice is called epidemic (επιδημιος, quod omni tempore prehendat, Fœsius).
XXXIX. to XLIII. Of typhus; five kinds noticed, which Gardeil thinks we would rather call inflammatory fever. It is surprising what quantity of drink is ordered. In one of these, the prescription is ten pounds of goat’s milk whey with salt in one vessel, and ten with honey, in another, which is to be all drank by glassfuls, alternately, apparently in one day. A number of remarkable symptoms mentioned in a species of typhus; among them is that of a particular inclination to the odour of extinguished lamps, &c.
XLIV. to XLVI. Of three varieties of iliac passion.
XLVII. to L. Of enlargements; (Qu.? Grossissement, &c.) What these are is problematical; four kinds are mentioned; in one, the smell of the earth when it rains, is said to induce syncope.
LI. to LVI. Of sciatica; four varieties; frequent moving to prevent ankylosis.
LVII. to the end. Of three species of tetanus, in which epilepsy and hysteria seem implicated.
OF DISEASES OF VIRGINS.
This treatise, says Haller, is a short one. It ascribes menstruation to plethora, which is to be treated by venesection, or by coition. This book is quoted by the author of the books on female diseases, and he would seem to be the author of this also.
After contending for the difficulty of knowing the nature of diseases, without certain preliminary attainments, and mentioning several, as epilepsy, apoplexy, &c., and their not unfrequent ascription to demons, the author proceeds to state the sufferings of females approximating to maturity, and who had not previously been affected, as arising from the arrestation of the menstrual flow. The symptoms attending this state of things are detailed, and the hysteric feelings thence arising, together with the inadequate and deceptive recommendations of the priests. It is added, that venesection is to be employed, if not contra-indicated, and that marriage as early as possible is to be adopted, for if pregnancy ensues, health follows. Barren women are most afflicted with these complaints.
Gardeil thinks it probable, that what we possess of this short treatise, is merely a fragment, for the author of the treatise on female complaints quotes this, as having therein already mentioned things, which we do not here find. The doctrine of this treatise, and of those of the nature of woman, and of the diseases of women, he adds, is found abridged in the Predictions, and in the treatise, “Des Lieux dans l’Homme.”
I. General remarks on the difficulty of knowing diseases, especially of some that are more peculiar to women than men.
II. An explanation of the derangements of health which females experience at the age of puberty; hysteria, melancholia, mania, &c.; the cure consists principally in sexual intercourse.
OF THE NATURE OF WOMAN.
Haller says this treatise is nearly the same with the books entitled “De Morbis Muliebribus.” Numerous diseases are stated in the Gnidian manner. A detail of an infinite number of cases of change of situation of the os uteri, its obliquity and induration, &c.; as in the second of the books referred to. The farrago of remedies, from the three kingdoms of nature, is not at all diminished.
It is divided into three sections by Haller, but not into chapters.
In reading this treatise, it will be seen, says Gardeil, that it might be remodelled with great advantage, and reduced at least one-third. Had its author revised it, undoubtedly he would have erased the many repetitions of the same cases, that are spread throughout. He would likewise have located it after the treatise of the diseases of females, of which it is a mere abridgment, augmented with some formulæ of remedies, of little importance. Gardeil makes no less than one hundred and seventy-five paragraphs.
I. Some general remarks as to what constitutes that disposition in females which renders them liable to certain complaints that are peculiarly their own.
Here the author commences, by stating, that, as to what appertains to the nature of women and their diseases, he thinks, in the first place, that all human affairs are in the hands of the Deity; and, secondly, that such and such circumstances contribute to their particular ills; and, therefore, that in discussing this subject, it is essential, primarily, to look up to heaven, and then to study the subordinate causes, such as the temperaments and the ages of women, the seasons, and the places in which they reside.
II. Treats of the moisture of females, and of its influence on menstruation, in diminishing or suppressing the discharge. The symptoms ensuing are noticed, and the treatment pointed out; among the remedies is a pessary of cantharides, or into which it enters.
III. Here, and in several following paragraphs, are noticed the cases in which the uterus is presumed to move its situation.
1. Where it rises towards the liver; a state said to be more common in virgins in advanced life, or in young widows. The treatment is given, and a recommendation of marriage for virgins.
2. When the uterus descends, and appears externally, which is not uncommon after delivery, if the sexual intercourse is too much permitted. In the cure, this, therefore, as well as bathing, is strictly prohibited. 3. In case of complete external descent or prolapsus, which is said to occur from coition after lying-in, and during the discharge of the lochiæ; various measures are mentioned for its reduction and retention. If unsuccessful in replacing it, it is recommended to employ “la sacade de l’échelle la téte en bas,” p. 14.a A large (dry) cupping-glass (σιϰυην) to the upper part of the thigh is also commended.
VI. In case of adhesions between the uterus and other parts, indurations, suppuration of the womb, and ulcers, sometimes arise, or discharges which prove fatal if not attended to; fomentations of urine are among the measures recommended. The usual effect of this state is said to be sterility.
VII. In case of the mouth of the uterus doubling or being inverted on itself, the menses are impeded; here, we find fomentations of the urine of a man commended. This is also stated as a cause of sterility.
VIII. When the uterus falls upon the ischium, menstruation is impeded; here we have a drink recommended, formed with different articles, among them are four cantharides, from which the feet, the wings, and the head are removed.
IX. If the lochia do not flow after delivery, after other measures, tar-water is ordered as a drink, (forestalling Bishop Berkeley,) and copious unction of the mouth of the uterus.
X. When fluor albus occurs (menses albi pituitosi), the treatment varies, as there is, or is not, accompanying sharpness and excoriation; in the latter case the fluxion is from the head, in the former from the stomach.
XI. Inflammation of the womb; its symptoms, sometimes similating pregnancy, and followed by dropsy.
XII. Erysipelas of the uterus, its symptoms, &c.; these resemble in a great degree those accompanying the milk-leg. When occurring in pregnancy, it is said to be fatal, and at all times difficult of cure.
XIII. Too great dilatation of the os uteri, its symptoms, &c.; it is said to be fatal.
XIV. The womb retiring towards the middle of the loins; here, syncope is mentioned among the symptoms, in which state it is directed to introduce into the uterus a tube, through which to inflate it. Sterility and lameness are said to result.
XV. Fluor albus; resembling the urine of an ass; among other means, the use of asses’ milk for forty days is ordered, with some singular directions in its employment.
XVI., XVII. Of cases in which the female is subject to abortion; means of obviating.
XVIII. Of difficult menstruation, symptoms and treatment; among which the pessary containing cantharides is employed, and also the drink with cantharides.
XIX. Of abortion at the end of the first or second month; one case of which is said to depend on the pressure of an enlarged omentum on the womb.
XX. Induration of the orifice of the uterus, and its displacement.
XXI. Incapacity to conception; singular process previous to purging, in order to ascertain whether the patient is bilious or pituitous.
XXII. Total suppression; a too humid state of the os uteri, and treatment of.
XXIII. Falling of the uterus on the ischium (see viii.); a different treatment.
XXIV. Pressure or suffocation (πνιγωσιν) of the womb; probably hysteria, as fetids are profusely ordered.
XXV. to XXX. inclusive. Of apprehended inflammation of the womb at delivery; of debility of the uterus; of apprehended cancer, &c. In one of the cases (resembling viii. and xxiii.), we are directed to employ a large suppository of sulphur, bitumen, and honey; a pessary of the same is also ordered.
Here follow, from XXXI. to LXXIII., a vast assortment of pessaries and other remedies, appropriate to female complaints. A drink, having in its composition five cantharides; a pessary of cantharides and elder juice; an infusion of the root of the croton; pessaries to excite a discharge of blood, formed of five cantharides and other articles; others with large amount of elaterium; sections of the squill, &c. In short, pessaries of every presumed character, emollient, astringent, &c.
LXXIV. to LXXXV. are taken up with the statement of lotions, fumigations, and fomentations of various kinds, including some ointments for various intentions.
LXXXVI. to CI. Here the author returns to the consideration of cases already noticed, and gives others of analogous character. Dropsy of the uterus, its causes and treatment, in which the introduction of a tin sound (specillum stanneum, speculum uteri?) is mentioned. Induration of the womb, its neck and orifice; displacement of the uterus;—a milk diet largely used for forty days. Entire closure of the os uteri, in which again the sound is recommended; obliquity of the os uteri; inflated uterus; grumous and clotted blood in the womb, for which, among other means, something to scrape out the clots is recommended; frequent change of its situation;—a pomegranate filled with pitch softened with wine, is here employed as a pessary; a too great enlargement of the os uteri; a softened state of the womb; its tending towards the belly, or the head, or when it acts upon the legs and feet, or from pain, induces loss of appetite, &c.: in all these cases irregular menstruation exists, and inability to conception.
CII., CIII. The author here adverts to several evils subsequent to delivery,—as diarrhœa, vomiting of blood; in this last, asses’ milk for five days, and to be succeeded by that of a black cow, fasting, for forty days.
CIV. Retardation of the menses;—of purgation of the uterus.
CVI. Constipation from the uterus tending towards the anus; inflammation or ulceration of its mouth; retention of the afterbirth; inflamed uterus, &c.; the catamenia not appearing at their regular period; excoriation of the pudenda; difficulty of making water; choking or difficulty of breathing; chills subsequent to delivery or abortion; flatulence; fetor, and carnosities of the pudenda, ulcers and pruritus;—all these, and more, are noticed, and remedies pointed out for them.
CXIX. Inaptitude to conception, from not menstruating naturally; either from the obstruction of a membrane, [supposed to be a modern discovery!] or other cause, discoverable by the finger.
CXX. to CXLV. Abridgment in a great measure of the preceding numbers, at least as to the measures prescribed.
CXLVI. Various recommendations when the woman loses her milk.
CXLVII. Directions as to the measures to promote conception.
CXLIX. A medicine employed as a pessary, to ascertain if conception will ensue. Various other means are scattered through this book, as to this and other particulars relating to conception, and perhaps equal to those now in vogue among nurses and other old women of both sexes. Fomentations, cataplasms, fumigations, &c., all connected with the female and her uterine affections, follow in rapid succession,—some of a character of great violence, and requiring much courage or hardihood in their prescription; thus, thirty grains of the cucumis agrestis, with other active ingredients, made up and applied to the os uteri five times daily, as a pessary; that formed with cantharides, is repeatedly mentioned as an emmenagogue pessary;—some are singular enough, such as fumigations with two pounds of bull’s urine, with other articles. It would seem that almost every substance employed as a medicine, internally, is also here to be found in some or other form of pessary.
OF FEMALE DISEASES.
This book, says Haller, is the production of an unknown author, not of Hippocrates, although he transiently quotes from the treatise “De Natura Pueri,” in which this book is in like manner referred to. It contains an infinitely too great a farrago of remedies, and they of too compound a character. The very face of the book seems to stamp it as of a date less ancient. It is plentifully stocked with female diseases, even more so than any of later date. They are on the subject of suppressed, diminished, or vitiated catamenia; of moles, abortion, difficult parturition, suppressed lochia, inflammation of the womb, and barrenness. The most acrid remedies are usually prescribed, such as drastic purges, suppositories and pessaries; and numerous vegetable and fossil remedies mentioned in the other writings of Hippocrates, to which virtues are ascribed, often differing from those that are commonly attributed to them. He mentions the παρθενια, or matricaria. Some things are added, which appear to be of the same author, referring chiefly to the diseases of infants, and of the eyes, and enemata. This is one of the most extensive of the Hippocratic books. Haller divides it into four sections.
“The author of this book, (says Gardeil,) is certainly the same with that of the treatise we possess, under the title of ‘The Nature of the Child,’ to which it refers more than once. Besides other faults to be found herein, and which are similar in doctrine to those in the treatise ‘Of the Nature of Woman,’ we find here many tiresome repetitions and endless distinctions of the different diseased states of the uterus and its neck. This multiplication of diseases fundamentally the same, has led to the opinion that this work, as well as that On the Nature of Woman, were productions of the Gnidian school. I think, nevertheless, that we here find many very interesting passages; and that both this and the preceding treatise may be advantageously read, by noticing that the ancient physicians, in the cure of most of those diseases here referred to, depended on the use of external remedies, which are now no longer distinguished. I can, however, affirm, that I have seen effects from them that appeared almost miraculous.” He divides it under two hundred and three numbers, the outline of which is here given.
I. The author set soff with his opinion, that with respect to female diseases, if they have never been pregnant, the deranged state of menstruation is more common and more dangerous than when they have borne children. His reasons for this, if not satisfactory, are at least as much so as any of present notoriety. Here, he adds, that he had explained all this, in the treatise ‘De Natura Pueri,” (περι φυσις παιδιου). It consists chiefly in the general enlargement of the vessels of all the body, but especially of those of the uterus, during gestation, &c., which renders the menstrual discharge a more ready exit, after delivery, and which is not the case with those who have never borne children. The catamenia consequently are more readily intercepted. This is illustrated by some curious analogies,—and an explanation is given, why the same plenitude of the vessels is not found in the male sex, although a monthly purgation does not occur.
II. The author next proceeds to mention the inconveniences and diseases most common to females, who not being pregnant are deprived of menstruation, from the closure of the os uteri, or its being in any way displaced from its natural position, or from any displacement of the parts of generation; which state of things he attempts to elucidate. If after three months the menses appear, and thus relieve the plethora, the symptoms are mitigated; but if not, very soon ensue fever, shivering, lumbar pains, &c., all which augment, if they do not still appear, and especially at the period at which they might be expected; although, after that period, they (the symptoms) sometimes diminish. Other symptoms follow after the fourth month of non-appearance. If properly treated, health follows. If the menses still are absent, the evil augments, and after the sixth month the cure is very difficult. All the symptoms increase, and others supervene.
III. From these more general symptoms, the author passes to the different affections of the uterus, arising from defective menstruation. The elevation of the womb towards the stomach, and its agitation in the abdomen, is accompanied by numerous distressing symptoms, and death sometimes ensues. A suppression of even two months causes sometimes a determination to the lungs, and induces a fatal phthisis. Suppurations are sometimes the result of two or three months’ retention of the menses, which, if care be not taken, may terminate in ulceration of a bad character and of difficult removal, and discharging by the groin a fetid pus; death generally follows; at all events perpetual barrenness. Sometimes the catamenia flow by such an inguinal suppuration, but the danger is not diminished.
VI. Sometimes the menses are vicariously discharged by vomiting or stool; more commonly is this the case with virgins than with married women, as he had stated in the treatise “De Morbis Virginum.”
VII. Of the suppression of the menses in general and of its treatment, by vomiting and purging, and by remedies at intervals to evacuate the uterus. Should these not succeed, there may be reason to suspect pregnancy, from the symptoms if present, which are enumerated. The menses sometimes suddenly appear abundantly at the end of three months, in clots of black blood, resembling flesh; sometimes ulcers of the uterus ensue, requiring much attention. Other circumstances are mentioned also; should the menses be suspended for six months, the symptoms are in due degree; and if neglected to the eighth month, death is often the result. Sometimes the menses are for a long time pituitous, and small in amount; but if well attended to, the patient may recover perfect health. The diminution of the discharge is next considered, arising from a deflexion of the os uteri from its proper position, or from its bending on itself, preventing the full discharge; the symptoms are narrated, and its dangers stated; being less in those who have borne children.
X. Of menstruation, when too abundant or too frequent, and why? relaxation of uterus; too frequent coitus; high living;—the influence of these on the female. If disease attacks under these circumstances, it readily falls on the weakened part; the symptoms succeeding thereto, and ultimate danger.
XI. The menstrual blood is thicker, redder, and flows more copiously about the middle period of the discharge than either at its commencement or termination. Its amount in health, about twenty ounces in two or three days (duarum atticarum heminarum mensuram, Fœs.), the usual period; although great diversity exists in this respect, depending on the constitution of the individual. The blood which is discharged, is red like that of victims (ιερειȣ), and it coagulates promptly, if the woman is in health, &c.
XII. When sudden suffocations affect the female, which more especially occur from non-cohabitation, and at a more advanced age, (Qu. hysteric paroxysms?) from the uterine vessels being deficient in their contents; and after uncommon fatigue, the uterus being too dry, tends towards the liver, the consequences of which are detailed by the author.
XIII. When in a diseased state, the menses are of a bilious character; they have a black and shining appearance, in small amount, and coagulate freely; and are accompanied with an erratic fever, with chills, nausea, and heartburn.a These symptoms are readily removed by proper attention; otherwise they are much augmented, and others supervene, which are benefited by bilious vomiting or stool, or by the discharge of bilious catamenia, provided none of these are too abundant, which would be dangerous.
XV. If the menses are pituitous, they are of a whitish appearance, and exhibit a membranous or web-like character. This state of things is enlarged upon by the author, and their pernicious effects, if not attended to. The discharge is said to become at length of so acrid a nature as to act on the earth like vinegar.
XVI. The author here treats of the different causes of a defect of conception, and of the mode of distinguishing the species of vitiation of the menstrual discharge, some of which are very singular. He then mentions the mode of cure of pituitous menstruation, by which sterility is removed; viz., by means of general fumigations, frequent vomits, and other measures, such as pessaries, as preparatory to coition. A hollow leaden tube introduced into the os uteri, is a means recommended to convey the fumigation to the uterus, just anterior to receiving the embraces of her husband; and much detail is given of the subsequent attention of the female to insure success. The measures for a like intent, when sterility arises from a dryness of the womb, is next adverted to, such as emollient injections, both per anum et vaginam. In both the cases, coitus, pendente menstruatione is advised.
XIX. The author next considers sterility, as arising from debility of the female, either from deficient nutriment, or from an abuse of the numerous remedies and fumigations employed, or from a bad situation of the orifice or neck of the uterus, &c., all which are particularly treated of. In the case of the os uteri being strongly closed, bougies and leaden sounds are recommended to open it; and when the direction of the uterus is wrong, after redressing it by the finger, and using aromatic fumigations, it is to be maintained in its place by the bougies and sound above-mentioned. Pessaries of various kinds are recommended in those cases of inaptitude to conceive, which arise from the orifice of the uterus being very fat and thick. And the case of sterility arising from the semen remaining and putrefying in the uterus, with the means of obviating it, are then considered, together with the causes productive of this state. In this place, the author states conception to be more certain, when the semen of both the man and woman reach the womb at the same time, the non-occurrence of which he considers as a frequent cause of failure.
XXI. He here treats of non-conception, although still at a proper age and having previously borne children. The menses being suppressed, a pessary is ordered every three or four days, of alum in powder, mixed with ointment, which is incorporated with wool, and is to be retained for three days, when it is replaced by one of ox-gall and oil, on wool as above, and also retained for three days, previous to coition. Sometimes, when conception does not occur, although menstruation is regular, the author states it as arising from a membrane, whose extension from the uterus may be discovered by the finger; when a pessary of flores cupri (ανϑος χαλϰȣ) incorporated with honey, is ordered to be introduced as far as possible, or, if possible, to remove the whole by incision. He indicates certain cases of abortion, either from the inner coat of the uterus being too smooth, either naturally or from ulceration, causing the placenta to adhere less strongly. In this case an examination is recommended, which, he adds, should be done by a woman, as being more decent than by the physician. Other cases of abortion are also adverted to, from too much eating or drinking, &c.
XXV. The author now adverts to the diseases accompanying pregnancy and delivery: the sudden occurrence of menstruation at the period of two or three months, and recurring every month; its danger to the mother and child; and he adds, that in certain cases, much care and precaution are required to conduct pregnancy to a happy termination.
XXVI. The author, then, in reference to the fœtus, considers it as unquestionable, that it participates in the ill or good state of health of the mother, and that its constitution is in conformity thereto. The state also of the lochial discharges depends thereon, and are less abundant and unhealthy. When they are suppressed, he says death commonly ensues on the thirty-first day. When the breasts and belly of the pregnant female, about the seventh or eighth month, suddenly subside; the former shrinking and the milk not appearing, the embryo is either dead, or in a state of great debility. The appearance of the menses during pregnancy, is a source of apprehension of abortion; should they be abundant, and of an ill odour, the child is certainly sick. This is followed by observations on pituitous and aqueous lochia; the characteristic symptoms are detailed, and their results, together with the treatment; and further remarks are made respecting the hysteric paroxysms at times occurring during pregnancy.
XXXVI. At the time of parturition, and labour pains come on, continuing long, without delivery; this arises, we are told, from an unnatural position, in which the feet presentation is included, and its explanation is a most singular one. It is, says our author, as if an olive had fallen into a narrow-necked bottle, &c. The case is dangerous, and both mother and child have frequently lost their lives. In speaking of the various inconveniences of pregnancy, an explanation is attempted of the extraordinary diseased appetites that often occur in it, and of the frequent respiration, especially at the latter period of gestation; notice is taken of the ailments after delivery, as flatus (which is stated as filling the womb), lumbar pain, and oppression, &c. Some of the dangerous results of delivery are also mentioned, such as excessive flooding, injury done to the uterus, bladder, or rectum, so that the urine and fæces cannot be retained; and some trivial recommendations follow for the same, and also for aiding delivery. A reference is next made to tumours, during or after delivery, of the uterus or the pudenda, in which, says the author, we must not employ astringents, like many medical men, but rather use internal remedies, a host of which are mentioned. In excoriation of the pudenda, a very good ointment of well-triturated almonds and marrow is recommended.
XLVI. He goes on now to consider the discharges and results from delivery; the causes, symptoms, and treatment, under their total arrestation; or if too small, or too abundant in amount; and of their character and the danger respectively. Some of the symptoms enumerated seem to be in a degree allied to the milk-leg, and puerperal fever, arising from an insufficient lochial discharge. The treatment consists at first of light nutriment and of purgative drinks, under some circumstances of irritation; of chologogues if bile predominates, or phlegmagogues should pituita prevail. This is all well enough; but we are then told to fumigate the uterus with aromatics, and employ fomentations, and if the uterus continues hard, then to use, in addition, lotions, and introduce a sound (fistula plumbea) of lead, and afterwards a pessary of salt and myrrh with pitch, on wool, of the size of a gall-nut! to be left for twenty-four hours; after three days, other varieties of pessary are employed, of a powerful nature, such as grains of Gnidos and pepper of cucumis sylvestris, &c. A digression then follows as to cases of difficult menstruation, in which pessaries are abundantly used, and tarwater is to be largely drank. Ulceration and inflammation of the womb succeed, and their danger is pointed out; and if by the measures adopted, the lochia do not flow, death soon follows, unless bleeding is promptly recurred to. The treatment of suppressed lochia from a union of the parts by injury sustained in delivery, is next considered; and in a case which the author himself saw; by an appropriate attention, health was restored, and the woman subsequently bore children. Unless great care is bestowed, there is danger of the ulceration becoming cancerous.
LVII. A metastasis of the lochia to the head, the breast, and lungs is noticed, and its danger, should a diversion not take place, by a discharge from the mouth or nose;—a long duration of the disease sometimes produces delirium, passing even to mania. Some other cases are adverted to,—as vomiting of blood, &c., ascribed to a rupture of an hepatic vessel, and regarded as dangerous. Asses’ milk is ordered for five or seven days, succeeded by that of a black cow, and the interdiction of solid food for forty days.
LX. In case of losing the milk, in order to restore it, various measures are directed;—and the author proceeds to state the measures to be adopted for discharging the afterbirth, if retained; which, if successful, the woman is saved. It frequently putrefies and is discharged on the seventh or eighth day, or later; a variety of articles is enumerated to promote it,—and an attempt is made to explain the cause of its retention;—a slight notice is also given of the fœtus dying in utero, at an early period of gestation.
LXV. The repeated recurrence to circumstances already noticed, renders the whole of this treatise extremely tiresome, although something of interest is to be found in the mass of rubbish. Again, he refers to injury sustained in delivery, by the womb or its orifice; of its inflammation subsequently, and of afterpains; of pituita oppressing the uterus, and giving rise to fluor albus, and derangement of menstruation, sometimes recurring three times in a month. Under circumstances of excoriation of the parts, among other prescriptions, we find an ointment made with flores argenti [Qu.? αργυρεω ανϑος].
LXXII. When the cotyledons (ϰοτυληδονες, Hipp.; acetabula uteri, Fœs., Hal.; les cornes de la matrice, Gard.), are surcharged with pituita, the menses are diminished, and if pregnancy should ensue, the fœtus will not live, even if vigorous at first. The signs and treatment of this are then stated; as are likewise those of dropsy of the uterus. This disease is sometimes of long continuance, and if pregnancy take place, abortion will ensue, with a discharge of water. Various baths, fomentations, and pessaries, are here directed; cantharides among them, and the metallic sound, &c. Dropsy, from a moist and enlarged spleen, is next considered and an explanation attempted; the fluids are carried to that viscus, and from thence by the vessels to the omentum and other viscera, &c. The menses are at times copious, at others in small amount, and irregular, resembling the washings of flesh, sometimes thicker, and not coagulating. A suspicion of pregnancy, and even a presumed motion of the fœtus, is at times credited. It is troublesome, dangerous, and of long duration, and more common with those who have not borne children, and at an advanced life, when menstruation is about to terminate. The misapprehension of the female is highly injurious, since the physician is not informed in time of the state of things. Modesty sometimes, or a want of confidence, prevents his being informed, even when known to the female. The physician is sometimes deceived also, from not being fully informed of the state of affairs, in consequence of the female being herself ignorant of the cause, but ascribing it to other sources; and he, not fully investigating the disease, frequently loses the patient, as the author says he had often seen. It is absolutely necessary, therefore, promptly and fully to question the patient, in order to attain the necessary information.
LXXV. The author renews the subject of suppuration of the womb; states the symptoms and treatment; its occurrence from abortion, and from acrid and bilious menstruation; fumigations, purging, milk diet, followed by a tonic regimen of animal food, &c., with particular restrictions. Some physicians, it is stated, order milk when the headache is severe, with a view to its removal; but he thinks water is better in this case, and milk in that of acrimony. Lotions to the womb are now directed, of different kinds, and ointments; among which is again mentioned that formed of flowers of silver (argenti flores), and a variety of other ingredients. A vast number of remedies follow; but it is a fatal and slow disease, from which few escape. Wounds of the uterus, and ulcers from any cause, are then adverted to, and with much particularity and repetition of what had been previously given. Wounds arising from abortion, or from acrid pessaries, or from a bad presentation, are specified; and the management to be pursued, when delivery is prevented by the enlarged state of the fœtus, or from a cross presentation, the treatment is very minutely laid down. Sternutatories are ordered; and in order to render their effects more powerful, the nostrils and mouth are closed,—the woman is to be well shaken, and the very extraordinary process is detailed, resembling greatly that described in the treatise on the joints and elsewhere:—The woman is to be fixed on a solid firm bed, on her back, by a bandage across the breast, under the arms, and attached to the bed; the arms are also secured; and the legs, separated, are tied at the ankles. The bed is then to be raised vertically, and apparently to be shaken against the floor, or rather, against two large pieces of wood that are placed below the legs of the bedstead, and thus support it in its upright position. The bedstead, with the woman attached, is then raised from these pieces by two men, one on each side, and allowed to fall upon them equably when the pains come on;—this is done at intervals, until the child is born. Such is the mode, says the author, of inducing the birth of the child, in a natural presentation, the parts being previously well anointed, and bathed with decoction of mallows or fœnugrec, and frequently renewing them during labour. Nothing more is to be done, except that it seems the accoucheur was busy in gently enlarging the passages with emollients, and attending to the navel-string. When the presentation is crosswise, whether alive or dead, the infant is to be pushed back, to endeavour to turn it, and give it a natural head presentation. In order to accomplish this, the woman is placed so as to raise her thighs above the head, by which the intention is facilitated, when the woman is replaced as before, and delivery is pursued in the usual way. It would appear that a foot presentation was regarded as very unfavourable, and placed on a footing with that of the arm. When, says the author, the feet or arms present, they should be immediately returned, and the presentation of the head should be facilitated by turning the fœtus;—so likewise in other cases of unnatural presentation, previously placing the woman over a bath of hot water, in order to relax the parts. If the fœtus be already dead, and a foot or arm presents, a similar turning should be adopted. If this is not to be effected, and the female parts become tumefied, the head is to be opened by a bistoury, and crushed, the bones brought away, and the delivery completed by the forceps or hook; the application of all which is described. When the delivery has advanced to the shoulders and there arrested, the arms are to be detached at the shoulder joints. If the trunk is impeded, the thorax is opened and the ribs crushed, carefully avoiding the belly, to prevent the intestines and their contents from escaping; which yet, if however too enlarged, may be slightly opened, allowing any flatus to escape, and no further difficulty will ensue.—The author now proceeds to consider the cause of the formation of moles, and their signs. In this state the woman will continue sometimes for two or three years,—and it occasionally induces death from its magnitude, or from an excessive hemorrhage. The magnitude of the belly and want of motion are means of recognition, for a male fœtus moves at three months, and a female at four; after which period, should the woman feel no motion, and the milk not appear, the case is plain, and it requires great care and attention; this consists in fumigations, glysters, lotions to the uterus, pessaries of the most powerful character, various vinous drinks, cups applied to the loins, and letting them bleed copiously. In fine, says our author, we must act carefully according to circumstances.
LXXXV. A brief recapitulation respecting the state of pregnancy, and its accompanying diseases, not devoid of interest, ensues, and may be said to terminate the treatise; for the residue consists almost entirely of a long enumeration of the remedies employed in the treatment of female diseases, and the formula of the prescriptions, &c.; thus they are such as are intended to induce or restrain menstruation, as pessaries, purgatives, &c., and are chiefly repetitions of those before given. Among the articles are cantharides and the rubigo or rust of wheat.a Others for promoting conception. Among these are fumigation, with at least ten pints of stale urine, into which, when heated, scoria of iron heated red hot are thrown, and after the fumigation, the head is to be bathed with it, and then washed; this is repeated for seven days;—fumigations likewise of the hair of a white ass, and the dung of a wolf. Uterine injections of the milk of a female the nurse of a boy, mixed with the juice of pomegranate, and the calcined powder of the perineum of the sea-tortoise. A pessary formed of the chorion, and of the heads of worms that breed in flesh, with Egyptian alum, all bruised together with goose-grease. Others, as drinks, to accelerate delivery; to prevent conception; and pessaries to enlarge the os uteri. Among the means to promote the lochia, we find the recent liver of the sea-tortoise, triturated with the milk of a woman, and oil of iris and wine, to be injected into the uterus. Remedies to expel the afterbirth, containing cantharides. To ascertain if pregnancy has taken place, a boiled clove of garlic is placed in the vagina for an hour, and the breath is then examined to ascertain if the odour is perceived in the mouth. Ærugo or verdigris is also recommended, with honey and liquor of Smyrnab [qu.?] as a drink to discharge the fœtus and the uterine immundities. For a similar purpose a pessary of fine flax is employed, sprinkled with copper-dust (æris limatum scobem). Among the injections ordered, it is mentioned that they should be eighteen ounces at most, and that is the extent of quantity in all injections. Many other singular prescriptions and directions are given, which it would be loss of time to repeat. The above samples may suffice; but it must be mentioned, that at the close of this first book, are given an additional variety of prescriptions (called by Fœsius notha quædam), of about an equal description, and of which I shall notice only two or three. They are supposed by some to be of great antiquity, and evince the use of emetics in the coughs of children. The inner part of an onion triturated with honey is recommended as a good suppository to open the bowels of children. Others are noticed for a like intention, in one of which cinnabar forms a part. Various escharotics are given, containing scoriæ of copper or brass calcined, of different strength; remedies for burns and for ophthalmia; various plasters; depilatories, &c. When it is wished merely to promote the discharge of fæces, it is useless to take internal purgatives; other means should be pursued; different forms of glysters are given for dysentery.
This treatise, according to Haller, may be ascribed to the writer of the preceding, for it is of the same character throughout, with much repetition, and in many places with scarcely any alteration. In conformity with the Gnidian doctrines, we find a great variety of fluor albus, of white and ropy discharges, uterine flatus, ulcers, callosities, cancer, hysteric affections, prolapsus uteri, and a closure of its orifice, inducing sterility. It treats of the diseases of the breasts and of the vagina, of freckles, toothache, and of several not peculiar to females. Many extraordinary cures are here mentioned, very different from our present views. The uterus is regarded as connected with almost every viscus; and a bridle or columella is described as growing in the uterus, which is ordered to be cut off.
Persons of advanced life are more subject than the young, to the fluor albus; in both, the discharge is usually yellowish, but redder with the last. The causes and symptoms are enumerated, some of which are singular, and some cases are said to terminate in death. In the treatment, among a variety of means, both pharmaceutic and dietetic, it is directed to bandage the hands and forearm to above the elbows, and the legs to above the knees; cupsa are then applied to the elevated breasts alternately, but not to draw blood. Emetics in some cases are directed; and in all, it is directed to attend carefully to the temperament of the female, her complexion and age, to the season of the year, the situation in which she lives, and the direction of the wind, on which much depends in the cure.
In floodings, grumous clots usually accompany. The symptoms of pain in the back and hips, fever, and tenderness of hypogastric region, &c., are noticed, and the vessels are said to beat strongly. Pessaries are almost invariably ordered, differing according to circumstances; and cold applications to the belly, guarding against chills. In the copious flooding after delivery, from somthing retained, which irritates and putrefies, the continual application of cloths with cold water is directed, the elevation of the feet above the head, and such medicines as are appropriate to female diseases, are given, in form of drink; other means are pursued, as milk diet, &c. The danger of death is great, however, and few recover.
A species of flooding is ascribed to the efforts in delivery, or to any severe work, by which injury is sustained in the uterine attachments; and is distinguished from a menstrual discharge or rather menorrhage, as so considered by some physicians, and the difference pointed out. To notice the variety of the discharges mentioned, so far exceeding what are now looked for, would be superfluous, particularly since the whole book appears to consist chiefly of the same materials as are to be found in the preceding, and differing therefrom only as we might expect from two individuals epitomising one common treatise. All these variously described discharges are, however, noticed as different diseases, and as requiring different treatment. We have a yellow discharge, of fetid odour, abundant, and resembling rotten eggs; another, which resembles the urine of a female ass, or sheep, &c., wherein cows’ milk is given warm from the animal for forty days, to aid convalescence, in amount of nearly two quarts per day. In one of the discharges, reference is made to feeling the pulse at the wrist. The causticity of some of them is assimilated to brine, explaining thereby the erosion of the soft parts adjoining. The varied attacks of hysteric paroxysms are described as different affections, and attributed to the displacement of the uterus. Fumigations, baths, and pessaries, seem the chief means of cure; and the best pessary in some cases, is said to be that made with cantharides. A sound or bougie of lead is employed to enlarge the os uteri, sometimes as preparing the female for more ready conception; for pregnancy is considered in many cases as advantageous, and hence virgins are to be recommended to marry. The peripatetic character of the uterus is constantly insisted on. It seems, like the owners of that organ, to have been always gadding! No wonder it was continually out of sorts! Its diseases are, however, ascribed at times to affections of the general system, and remedies to purify the blood are recommended; among these the long-continued use of cows’ milk is greatly urged. This displacement of the uterus or its orifice, is stated as an obstacle to menstruation, followed by sterility; the appropriate treatment in each case respectively, is laid down with precision, especially that of the manipulations, by pessaries, sounds, and fumigations. Tar-water,a fasting, and again on coming out of the bath, with many particulars directed as to eating and drinking. The chief remedy for all these diseases, seems to be, however, considered that of pregnancy. Cantharides infused in wine, as a drink, or used in pessaries, &c., are frequent prescriptions. Dry cupping, long continued, to different parts, the thighs, below the breasts, in the groin, &c. Falling down of the womb, and its full procidentia, are noticed, and their treatment detailed. Its inflammation, scirrhosity, induration, and vitiated orifice are also mentioned, and how to meet the different symptoms. Erysipelas, dropsy, and some other complaints of the organ, are finally noticed, and a profusion of prescriptions for pessaries, &c., close the treatise.
Much of this treatise on sterility seems to be transcribed verbatim from the books “De Morbis Muliebribus.” Some few novelties and singularities are introduced, and some unimportant experiments relating to the certainty of conception.
The treatise consists of an attempt to explain why sterility is sometimes absolute; and occasionally is removed by the power of medicine. Five different causes are assigned. The os uteri wrongly situated, and firmly closed; the lubricity of the uterus preventing the retention of the seed; ulceration of the body of the uterus, consequent to some of the diseases that have been mentioned; retention of the menses partially, productive of effects opposed to conception; and too great laxity of the orifice of the uterus, precluding the retention of the seed. All these causes are considered and explained; and the writer then proceeds to state, that when menstruation is altogether defective, or not sufficiently abundant, conception cannot ensue. That superabundant menstruation is equally unpropitious; as is a prolapsus of the uterus; and a metastasis of the menses to the hemorrhoidal vessels. Until the causes producing these effects are remedied, conception is impossible, and as they are so numerous, the sterile state of so many females is by no means surprising.
To these succeed an account of the means by which may be ascertained, whether a female will become pregnant. Means of ascertaining the state of actual pregnancy, and of what sex is the embryo. Approved means for procuring conception, and of the remedies to be used in the cases of sterility noticed in the beginning. Circumstances favourable to conception and the preservation of the germ. Among the means prescribed for remedying sterility, one consists of fumigating (after some previous measures) the uterus for two days, with putrid female urine mixed with nitre, and substituting that of the cow on the third day; after some further measures, the os uteri is to be opened by means of five leaden sounds, of eight fingers’ breadth long, and each successively larger than the preceding, to be introduced after bathing, beginning with the smallest, each being retained one day. After the mouth of the uterus is hereby enlarged, a pessary is passed up to cleanse it, made of five cantharides, powdered, and mixed with other ingredients, and incorporated by means of honey, with wool! In one case the cause is affirmed to be a membrane that occasionally forms at the mouth of the uterus. Its treatment by a pessary containing rust of copper is mentioned. In a form of the disease stated, we are told that if we think proper, we can use in fumigation, the rust of wheat, and the tar-water daily; and towards the conclusion, when speaking of the complete protrusion of the uterus, when other mentioned means have failed, the bottom of the uterus is to be incised, to disgorge its vessels; and after bathing it with decoction of the pine, the woman is to be suspended, head downwards, and to be shaken, whilst the uterus is pushed back!
Haller tells us that this treatise has been altogether rejected by Mercurialis, and thrown into his fourth class or division. It is, however, considered as by no means an ill-written one. Gardeil even affirms that it ought to be attentively read by every oculist who feels an attachment to his profession. It is very concise, and recommends many acrid and severe applications in diseases of the eyes. Of these, cauterization constitutes the chief means.
Cataract is first noticed;—neither extraction, nor depression of the lens, seem to have been then practised. Early attention to evacuate the head, and cauterize the vessels, is said to arrest and check the progress of the disease. Near-sighted people are mentioned;—this state would appear to have been considered as morbid, and cauterization, &c., are recommended; bleeding is said to be injurious in it, and in some other affections. The treatment seems to have been deferred until full growth was attained, when cauterizing in different places was freely pursued, and scarification of the lids. The principal object, in most cases, seems to have been to evacuate or purge the head; and, in some instances, some of the flesh of the lids appears to have been cut away, and then slightly cauterizing,—carefully guarding the cartilage and the roots of the eyelashes. Itching of the lids, nyctalopia, gutta serena, and ophthalmia, are all mentioned, and some singular treatment recommended, that may possibly have been found beneficial. Thus in gutta serena, we are told to trepan near the fontanelle, to remove water that is below it, &c. Some useful remarks in ophthalmic cases are given.
[a ]“Sanguis, qui inest homini, plurimum ad prudentiam confert; quidam vero dicunt, totum.”—Haller.
[a ]In which, as an ultimate resort, the skull is perforated. “Demum inciso juxta sinciput capite; ad cerebrum usque perforato, et velut sectionem per terebram curato.”—Haller, iii. p. 48.
[b ]“Extrema parte præcidito.”—Haller, iii. 57.
[c ]“Tu vero agitato humero, quonam in latere (affectio) strepitum edat, auscultato,” &c.—Haller, iii. p. 69.
[a ]In No. vii., we have the caries of the bones of the cranium, which has some analogy with that arising from syphilis.—Ed.
[a ]“On ouvre le crâne à l’endroit de la fontenelle jusqu’au cerveau, et l’ou soigne comme dans l’operation du trepan,” iii. 202.
[b ]It is not clear to me, that this affection is not allied to some syphilitic taint.—Ed.
[a ]“Quod si infusum, aut fomentum, aut suffitum adhibeas, pus non sequitur, indeque cognoscas, non pus, sed aquam intus esse.”—Fœs. Qu.? If this implies a prior incision, and injection, as in empyema? Paracentesis is, at all events, recommended.
[a ]Ictus, attonitus, apoplecticus, Gr. Lex.
[a ]“Folle fabrili indito, in ventrem flatus immittendus, ut tum ventrem, tum intestinum contractum distendas.”—Hal. iii. p. 105.
[a ]The reader, remarks Gardeil, cannot fail of observing, when reading the works of Hippocrates, how frequently the operation for empyema was performed, doubtless with more facility and success than now, in the treatment of suppuration in the thorax from internal causes.—It appears to me (Ed.) that the principal cause of this arose from the dread of bleeding in the early stage of disease, lest concoction of the humours should be thereby prevented.
[a ]This treatise seems a kind of brief of the preceding, and of the nature of a treatise on Domestic Medicine for general use.—Ed.
[a ]“Quod si clysterem non admittat, fistula propendulo utriculi petiolo alligata et inflata, multus flatus immittendus; quumque intestinum et venter a flatu elevata fuerint, exempta fistula, statim clyster injiciendus.”—Haller, ii. p. 379.
[b ]Used as moxa. “Ustio autem per linum crudum fiat.”—Haller, ii. 385.
[a ]Hippocrates says three species.
[a ]“Et si quidem sic intro redierint, satis est, sin minus, summis uteris derasis et calefactis, ablutis et illitis, alligataque ad scalam muliere, scalam ad caput concutito, et manu uteros intro trudito, postea ejus cruribus alternatim simul colligatis, sic per diem et noctem sinito, et paucum ptisanæ succum frigidum, nihilque aliud exhibeto.” See, also, treatises “De Articulis,” “De Morbis Mulierum,” and “De l’Extrait du Fœtus Mort.”
[a ]These uterine discharges appear to have been closely examined by the physician, equally as those by the other emunctories! and why should this not be the case?—Ed.
[a ]Qu. If this can have any reference to our secale cornutum?
[b ]Syrmœa, Hal. et Fœs.
[a ]Σιϰυης, Hipp,; cucurbitula, Fœs., Hal.—It is remarkable that Gardeil, here, p. 203, translates this word, by sangsues, leeches, which were not employed in the days of Hippocrates; yet every where else, where the word is used, he properly has translated it Ventouses or cups. Aliquando dormitat.
[a ]Tar-water, or some infusion of the pine, seems to have been no uncommon drink, thus forestalling the Bishop of Cloyne.