Front Page Titles (by Subject) SECTION VI. a: ON THE SHOP OR OFFICE OF THE PHYSICIAN. - The Writings of Hippocrates and Galen
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SECTION VI. a: ON THE SHOP OR OFFICE OF THE PHYSICIAN. - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
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ON THE SHOP OR OFFICE OF THE PHYSICIAN.
Fœsius has a sufficiently interesting preface to the section now to be considered; but it is not adapted to my plan, independently of its extent. Of the ten treatises here noticed in the arrangement of Fœsius, five are esteemed to be genuine by Haller. Other commentators and translators have thought differently, and have separated them in conformity to their views, and arranged them elsewhere. The subject is briefly adverted to, in a preliminary address to the reader, by a friend of Haller, in the first volume of his translation. Be they or not the offspring of Hippocrates, there is not one from which we cannot gain information, and at the same time enjoy both the “utile and the dulce.”—Ed.
Although, says Haller, Galen doubted if this were of the genuine writings of Hippocrates; yet that it is so, is easily detected by its raciness (ex ipso sapore). Brief, profound, and even in the less important parts, not less informed attention is bestowed on the minutest concerns, and precepts given as to the best situation for the surgeon or physician, and mode of standing or sitting in his operations, &c. The subject of bandages is by no means uninteresting, and is pretty copiously treated of. Gardeil, speaking of the title of this treatise, says it has undergone alterations among the ancients, and been the object of dispute to the learned. I have, adds he, given in French, the name that seemed to me to be best adapted to the matters treated of, as well as to the Latin translations, by which it is quoted, de Officina Chirurgi. His title is “Du Laboratoire du Chirurgien.” Le Clerc thinks that the term is inappropriate, inasmuch as surgery did not then constitute a distinct branch of medicine, and that the term Ιηϛϱειον implies “La Boutique du Médecin,” and not “du Chirurgien;” the title of surgery appearing no where in the writings of Hippocrates, although the art constituted a large part of his medical practice.
The treatise sets off by stating that the means of instruction in every case, are dependent on the senses, by which we are enabled to form comparisons, and from them deduce our judgments. In relation to the objects of the physician in his shop, they are enunciated under the heads of the patient, the operator, assistants, situation for the operation, instruments, light, as best adapted to perform it, and other necessary appurtenances; all which are briefly considered, as well as some particulars respecting the hands, nails, and the regular placing of the instruments as they may be called for, the silence and attention requisite, and other circumstances. This is followed by the subject of bandages, the making, form, and application; compresses, &c., and their various intentions explained; the natural situation of injured parts by extension, flexion, &c.; the attention constantly required to keep up the full advantages that proper bandaging affords, and obviate the injury that negligence brings with it; with many hints and suggestions of a useful nature, not irrelevant even at the present time.
An admirable production of a wise and experienced man, (says Haller,) and worthy of Hippocrates. He correctly explains the fractures of the humerus, femur, tibia, and forearm, and the luxations of the tibia, and forearm. He teaches lucidly their chirurgical administration, together with the statement of the due precautions, apparatus, and precepts. He properly directs the extension of fractured and luxated bones, to be performed on the first or second day, and not to be delayed to the third. Throughout he appeals to his own experience.
This book, although entitled “De Fracturis,” is at least equally taken up with the subject of luxations, as the succeeding one on luxations embraces much on the subject of fractures. So much is this the case, that Haller considers it as merely a continuation of the present. The author begins this with some general precepts on the subject of both these accidents, and then follows more in detail, on the fracture of the bones of the hand, in which he severely animadverts on the ignorance of some reputed able practitioners;—on that of the forearm, wherein much stress is laid on the proper application of bandages, &c., and which is highly deserving of attention. Fracture of the humerus succeeds, then luxation of the bones of the feet; of the leg at the ankle joint; fractures of the bones of the leg, and the difference of treatment in these, from the fractures of the upper extremities; of fractured femur. Fracture with wounds, considered, as well as luxations; spiculæ of fractured bones;—all these minutely described, and the treatment, both by others and himself. Extension, if not previously made, is to be sedulously avoided the third and fourth day; and reasons assigned. Luxation of the knee and elbow; reduction of; fracture of radius, of cubitus, &c.
This treatise could scarcely be read without benefit, even by surgeons of the present day. It would at least convince them, that their science was, practically, not less perfectly comprehended than it now is!—Ed.
ON THE JOINTS.
This treatise, considered by most commentators and translators, as being a manifest continuation of the preceding one, “De Fracturis,” embraces those fractures and luxations that are not therein mentioned, such as fracture of the ribs, scapula, clavicle, nose, ear, &c., and luxation of the vertebræ, maxilla, femur, &c. It is of equal value as the preceding, and equally deserves attention. Four various luxations of the femur are accurately detailed by Hippocrates, together with the appropriate manipulation and treatment of each in the reduction; and which can scarcely fail, in the perusal, to throw light upon the subject, even at this more advanced period.
Luxation of the head of the humerus begins the treatise, of which the author says, he had seen but one mode, and that downwards, in the axilla; and he gives his reasons for believing that some of the varieties mentioned by physicians, were not as stated, but that error existed on their part. He points out and explains no less than six modes of reducing this luxation, and affords some reflections on the causes of the facility or difficulty in the operation; mentions the diagnostics of the injury, and states the mode of applying the actual cautery in some cases, and to what parts, together with the results of such luxations. Luxation of the humeral extremity of the clavicle, fracture of the clavicle, and treatment of each. Luxation of the elbow, complete and imperfect, and their respective treatment. Of the fingers, hand, the lower jaw, and fracture of the latter. Fracture of the nose, crash, or fracture of the external ear; treatment of all these, with some general maxims of importance in many diseases, tending to illustrate the propriety of not doing too much. Luxation of the spine or its processes; deformity from; observation on, relative to situation, causes, and treatment. Of the structure of the spine and luxation of the vertebræ; curvature of the spine and treatment; danger from; incurable if it is inward. Fracture of the ribs, and treatment; luxation of the head of the femur in four ways, each particularly considered in their symptoms and treatment, accompanied with many judicious remarks as to the atrophy and deformity of parts caused thereby. Luxation of the femur at the knee joint, with accompanying observations on the symptoms, &c. General remarks on luxations, and on bandy legs; treatment of, in children, and of club-foot. Luxations with laceration, and projection of the bone; danger from, and treatment of various cases of; gangrene from. Of the reduction of the different kinds of luxation of the femur, and the machinery described for extension, &c., and for that of other luxations.
ON THE REDUCTION OF FRACTURES AND LUXATIONS.
Haller calls this a brief, yet not inelegant compound of the two preceding books; or, as Gardeil states it, a recapitulation of those treatises, of a summary character, for such as would not charge their memory with all that they contain. Such being the case, a few outlines will suffice.
Μοχλια, is defined to be “ossis aut ossium a loco qui præter-naturam sit, ad naturalem reductio.” It is derived from μοχλος, vectis; or the apparatus, &c., by which the reduction was effected.
It begins with a brief description of most of the bones. This is followed by the statement of the fractures and luxations of the different bones, nearly in the order as we find them in the preceding books; terminating with some general remarks on reduction, on some of the machinery employed, and on some incidental particulars, in a greater or less degree connected with the subject.
From the number and variety of remedies herein mentioned, this would appear not to be one of the genuine productions of Hippocrates. It does not add the doses, as in the books De Muliebribus. Sundry-admonitions are given against the abuse of oleaginous and relaxing applications about the ulcerated parts. The remedies themselves are sufficiently adapted to the nature of things. Arsenic, black hellebore, and cantharides are amongst them. Some plants are briefly described.—This book, according to Gardeil, is often quoted in surgical books.
Some general remarks commence this book, which are of much importance as to certain applications, rest, &c. A principal intention is to prevent inflammation, and promote suppuration; to permit fresh wounds to bleed freely, and avoid greasy applications, except in certain particular cases. Purging; bandaging, when proper; seasons, which are best for ulcers; of measures for promoting cicatrization; treatment of round and deep ulcers, and of ulcers accompanied by erysipelas. Signs of suppuration, and of difficult cicatrization. Some recommendations to accelerate it.
A variety of formulæ, simple and compound, follows, for remedial applications, as cataplasms, &c. In one of these, we find the juice of the stramonium, or solanum, where erysipelas is apprehended. Ærugo, mixed with various ingredients, as sweet wine, honey, resin, myrrh, and nitre (νιϛρον), made into a kind of ointment, for dressing ulcers when they do not discharge adequately,—and spoken of as especially useful in those of the prepuce, head, and ears;—if correctly made, I think it must be an excellent ointment, and well adapted for cleansing or deterging wounds and ulcers: it is stated as equally good in recent and in inveterate ulcers. Many other active ointments are mentioned, in some of which are to be found lead, tutty, alum, copper, arsenic, cantharides, &c.; some used in form of a lotion. Some observations are made on swellings of the feet, on varicose veins, &c.; their treatment, and a few remarks on the use of cups.
Fœsius regards this as a genuine work of Hippocrates,—to which Haller does not subscribe.—Description of fistula in ano, and its cure;—one mode consists of a twisted ligature, composed of fine flax entwined around horse haira (certainly an animal ligature), and employed as at present. Another mode is that of incision. Astringents are praised in cases of prolapsus ani. It is remarked, that in going to stool, the prolapsus is infinitely less, if the legs are extended.b Its cause is referred to pituita and bile, as stated also in the book “De Mulierum Morbis.” An abundant display of remedies follows. The book on Hemorrhoids seems closely connected with this.—Haller.
How fistula in ano is produced; of its treatment by various pharmaceutic preparations according to the nature of the case; ligature of flax, twisted around horse hair! incising the fistula; injections; attentions requisite; prolapsus, how to be treated; precautions in going to stool; various remedies noticed.—Gardeil.
ON THE HEMORRHOIDS OR PILES.
Although, says Haller, this is a spurious book, it is by no means a bad one. It cannot be a writing from the author of the Aphorisms, since there, one of the tumours is directed to be kept open; whilst here, the whole are cured. Pituita and bile are the foundation of the author’s theory. Various means of cure recommended; acrid applications, and even the cautery.
Of the formation of hemorrhoids,b and of their treatment by incision, ligature, cautery; how to distinguish hemorrhoidal tumours. A styptic composed of urine, mixed with calcined copper-filings in a copper vessel, and exposed to the sun, frequently stirring it, until dry, then powder it finely, and sprinkle slightly on each incision. Mulberry tubercles, external and internal; treatment; speculum ani (ϰατοπτηρος);—here, reference is made (in order to explain why so little discharge of blood follows the falling off of the tumours) to amputation of the legs or arms at the joints, when compared with the operation either above or below; the particular analogy would be difficult to apprehend, even with the accompanying explanation! Cauterization seems to have been employed internally, through the medium of a canula of some kind introduced. The tumours, when burning or cutting were deemed improper, were sometimes made to extrude, and were then sprinkled with a mixture of myrrh, galls, and alum, calcined. Some other analogous preparations are given.
ON WOUNDS OF THE HEAD.
This, says Haller, is one of the genuine writings of Hippocrates, and, with his other surgical works, amongst his best. His treatises on practice and on semeiotics, have many parts that require explanation and restriction. Here, all are clear and true; you perceive at once that the author is conscious of this being the case. Some anatomical observations precede, and also somewhat paradoxical in relation to the sutures. In one part we find him noticing his having been deceived by them, and taking them for fissures; thus having a manifest connexion with the case of Autonomus in the fifth Epidemics.—Affections of the head induce bad symptoms on the opposite side. The trepan noticed, and directions for.
This treatise commences with general remarks on the sutures and on the bones of the cranium. The danger of wounds of the head depends very greatly on the bones concerned therein. Of the various ways in which the bones of the head are affected by wounds. Contusion with fissure. Simple contusion. Depression, &c. Contre-coup. Cases in which perforation is required. Regard to be had in the treatment to the mode in which the blow has been given, as also to the nature of the body inflicting it. Difficulties arising from the sutures, in the diagnostics of the real state of the wound, and of its treatment. Lotions and bandages prohibited in wounds of the head. Advantages of incising the scalp, especially when the bone is denuded. Certain reservations as to this, and remarks. Of the time for perforating the bone, and cautions thereon. Indications to be derived from the state of the surrounding flesh. Requisites for a good exfoliation in certain cases. Cautions as to the diagnosis and prognosis. Prognosis in desperate cases. Necessity of hastening the operation in certain cases. Mode of trepanning; hazard of wounding the meninges; precautions in and during the operation.
ON THE EXTRACTION OF THE DEAD FŒTUS.
This short treatise, says Haller, instructs us how to bring away the fœtus by piecemeal, and how to crush the head. It details moreover, a most extraordinary concussion of the parturient female, in order that the fœtus may obtain more room for its exit. Some directions are given in relation to the replacing of the prolapsed uterus.
Gardeil properly warns us against attributing to Hippocrates all of the doctrine in this short tract; which will, says he, shock the accoucheurs of our time in more parts than one,—and which we cannot accredit to him, after having perused the treatises already given.
I am about to notice the case, (says the author, whoever he may be,) in which the woman cannot be delivered naturally, and which requires the fœtus to be extracted by piecemeal;—beginning by veiling from her the sight of such a frightful operation, &c. The operation is then pretty amply detailed; and other cases of difficult delivery are mentioned. Then succeeds the plan adverted to, of shaking the female, at least ten times,—and if not successful, she is to be turned head downwards, her feet in the air, and to be well shaken by the shoulders, so as to afford the chance of the fœtus obtaining a more favourable position for his exit!a —Of side presentation; of the cord around the neck; the head locked, and hand projecting, are adverted to; and the subject of prolapsed uterus is then noticed. If the subject is old, it is best to do nothing; if young, the skin of the orifice and neck of the uterus is to be slightly incised, and that in both directions, rubbing it with a soft towel to excite inflammation and empty the vessels. Some unctions are next applied, or astringent lotions; after its reduction, tents of sponge with wine are introduced into the vagina, and a recumbent position, with the legs crossed, is maintained.
A concise treatise, says Haller, giving some account of the lungs, heart, liver, and other abdominal viscera; correct, and derived from human dissection; [which I much doubt.—Ed.] It can be looked upon, says Gardeil, merely as a slight sketch of the anatomical knowledge of the period; and it speaks only of the most essential organs of the trunk of the body. Somewhat is said as to the names and etymology of the œsophagus, &c. This terminates the sixth section.
[a ]This section, entitled by Fœsius χειρουργουμενα, or that part of medicine called Chirurgia or Surgery, consists of ten treatises.
[a ]Pilum equinum.
[b ]“Dum autem ventrem exonerat, crura extendat: sic enim minime sedes exciderit.—Hal. iv. 120.
[b ]See different meanings among the ancients, of this term; it was used often to imply hemorrhagies of different kinds.
[a ]As this is a singular obstetrical operation of the olden times, we give it in detail from Gardeil, vol. iv. p. 365. It will be a bonne bouche for the accoucheurs of the present age.