Front Page Titles (by Subject) THE SECOND BOOK OF EPIDEMICS. - The Writings of Hippocrates and Galen
The Online Library of Liberty
A project of Liberty Fund, Inc.
Search this Title:
Also in the Library:
THE SECOND BOOK OF EPIDEMICS. - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
About Liberty Fund:
Liberty Fund, Inc. is a private, educational foundation established to encourage the study of the ideal of a society of free and responsible individuals.
The text is in the public domain.
Fair use statement:
This material is put online to further the educational goals of Liberty Fund, Inc. Unless otherwise stated in the Copyright Information section above, this material may be used freely for educational and academic purposes. It may not be used in any way for profit.
THE SECOND BOOK OF EPIDEMICS.
Fœsius, p. 944.
It would seem from Haller’s prefatory remarks, that Galen refers to certain books, which he insists must have been formed by Thessalus, from the common-place book of Hippocrates. The first section of the present one, pays attention to the subject of crises, more carefully and better arranged than any of the Hippocratic books. The other sections are entirely promiscuous. In the second section are some imperfect histories of patients, and of diseases, such as angina, &c. Section third contains the Perinthian epidemic; and predictions are intermingled with the history of diseases. In the fourth section, we have an account of the vessels, pretty much like that in the book “De Ossibus.” The histories of diseases are introduced; among which is to be found a paralytic affection arising from the use of vitiated grain.a The two last sections contain predictions, and a mingled mass of other matters.
There appears to be here, as well as elsewhere, much useless variation in the divisions of these books, as given by Fœsius, Haller, Gardeil, and others, dependent, it may be presumed, on the individual fancy of each. Such diversity, however, renders reference more difficult, and appears to be called for by no solid reason.—Ed.
Gardeil, in some preliminary remarks on this book, says, that it is generally believed that the second, fourth, fifth, sixth, and seventh books on Epidemics, are not productions of Hippocrates; at least the same order that exists in the first and third, is here defective. We have, however, a commentary by Galen on the sixth book, which he looks upon as being the work of the Father of Medicine. In my opinion, continues Gardeil, the fifth and seventh books are quite as interesting as the sixth, in consequence of a considerable number of surgical observations. We might even be authorized, he adds, to consider all the five books above-mentioned, as the real works of Hippocrates, since we find in them the principles and facts precisely as we read them in the other treatises that are usually acknowledged to be his, such as the one “De Humoribus,” &c. This, however, by no means proves that all the seven books on Epidemics, wherein so little order is preserved, have emanated from the same author to whom we are indebted for several of those we have given, yet all are generally regarded as being nearly of the same period, and as emanating from the same school. Many general propositions are given in an aphoristic form, accompanied with numerous observations.
Clifton, in the beginning of this book, leaves out several pages, amounting to nearly the whole of the first section of Fœsius, stating in a note, that it consists of “aphorisms of various kinds that noways agree with the title of the book, and so are placed under their proper heads in other parts of this work,” &c., to which he makes reference.
I cannot commend his translation on many occasions; a better one, and more accurate to the text, is a desideratum.—Ed.
In Cranon, in the summer, were carbuncles. It rained, during the excessive heats, very much, and continually, but more with the southerly winds. Under the skin were thin sharp humours, which, being confined, grew hot, and caused an itching; after which pustules broke out, like what comes upon a burnt part, and occasioned a sense of burning underneath.
In this city inveterate pains are attended with cold; fresh ones, with heat; and most of them from the blood. Those from the hip are likewise cold.
A woman had the heartburn, and could not be easy; but upon steeping the finest flour of barley in the juice of quince, and eating but once a day, she vomited no more; as was the case of Charion.
Changes, where the change is not for the worse, are of service; as in fevers to vomit after taking a medicine. But where a vomit terminates in something simple and unmixed, there corruption is denoted, as in the case of Dexippus.
Serapis swelled after a looseness, but the exact time of the itching I know not, though it was not long. An abscess in the flank, that mortified, was her death.
Stymargus’s wife swelled too, after recovering from a short looseness designedly stopped, and a miscarriage of a female child four months old.
Moschus, who was much troubled with the stone, had a little tumour like a barley-corn upon his upper eyelid in the part next the ear, which ulcerated inwardly. The fifth and sixth day the matter that was pent in broke out, and the complaints below were taken away. He had also a swelling of the gland by the ear, and another in the neck, right against the upper swelling.
Aristæus’s wife’s brother fatigued himself upon the road when he was hot, and so brought little black swellings, or tubercles, upon his leg, with a continual fever. The next day he sweated, and after that upon the other equal days, without being quit of his fever. His spleen was a little suspected; he bled often from his left nostril, though but little at a time; and was freed. The next day a tumour appeared behind the left ear, and the day after another behind the right, but this was less and grew warm. Both of them subsided gradually, without coming to suppuration.
He that came from Alcibiades had, a little before the crisis, a swelling in his left testicle from a fever. His spleen was large too, and his crisis happened upon the twentieth day. After this he grew a little warm now and then, and his spitting was somewhat florid.
She, who brought up little or nothing to speak of with her cough, was seized with a palsy in her right arm and left leg, without any alteration in her countenance, or understanding, or any other part; and even here it was not vehement. About the twentieth she began to go better, perhaps from the breaking out of her menses, which was then the first time; for she was a young virgin.
Apemantus, and the builder’s father that broke the head, and Nicostratus, did not cough at all, but on the contrary were in pain about the kidneys. Being asked, they confessed they were always eating or drinking.
Hercules swelled the eighth day of his illness.
To one that suckled, pustules broke out all over the body, which, upon leaving off, were dispersed in the summer.
The currier’s wife, that made the leathers, after she had been brought to bed, and to appearance perfectly well delivered, had a part of the membrane, chorion, left behind, which came away the fourth day with great difficulty; a strangury being upon her. Soon after she proved with child again, and had a son. This course lasted many years, and at length her menses stopped. When she was brought to bed, her strangury gradually left her.
Another woman had a pain in her hip before conception, which was cured by conception. The twentieth day after the birth she was in pain again, and delivered of a son.
Another woman with child had little pustules upon the lower part of the right leg, and the thumb of the right hand, in the third or fourth month of her pregnancy; to which the chips of frankincense were applied. But whether she was brought to bed or not, I cannot say; for I left her in her sixth month. She lived, as I remember, at the house of Archelaus, by the precipice.
Antigenes’s wife, who lived with Nicomachus, was delivered of a child all over fleshy, but distinct in the principal parts, and about the bigness of four fingers. It had no bones, and was afterwards thick and round. The mother was asthmatic before her lying-in, and in her delivery vomited a little matter like that which comes from the boil called a felon.
She that was delivered of two daughters after a hard labour, and was not well cleansed afterwards, swelled all over, and became very big in her belly, but fell away in her other parts. The reds continued for six months, and then the whites the rest of the time, in great quantities. These evacuations hindered her conception; but her menses came again pure, unmixed, and in a proper manner.
In lienteries of long standing, an acid belching, where nothing of this kind has happened before, is a good sign; as in the case of Demænetas. Art at this time should try to imitate nature; for such disturbances make a great alteration, and perhaps acid belchings will carry off a lientery.
Lycias, who was cured by drinking hellebore, was at last attacked with a painful swelling of the spleen, and a fever; and the pain reached up to her arm. The splenic vein in the elbow was opened, and beat often. Sometimes again it was not opened, and the pain went off spontaneously, or with a sweat. Upon this going off the spleen reached to the right side; her breathing was doubled within, and not great; she grew lightheaded; was covered up; troubled with wind, but nothing passed downwards, nor by urine; and, before she was delivered, she died.
The swellings, that were produced by a great flux of humours on each side the throat, did not ulcerate, but passed off to the left; the spleen was affected with pain, and there was no crisis.
Hieron’s crisis was the fifteenth day.
Cous’s sister had a swelling upon her liver like the spleen, and died the second day.
Bion bled at the left nostril, after making a very great quantity of urine without a sediment; his spleen being hard, and gibbous. He got over it, but had a relapse.
Those who had the quinsy were thus affected. The vertebræ of the neck turned inwards, in some more, in others less, leaving a manifest cavity outwards; and here the neck upon touching was painful. It was also somewhat lower than the process called the tooth, and not altogether so acute. In some it was very evident by the greatness of the circumference; but the throat was not inflamed, except by the tooth above-mentioned, but subsided. The parts under the jaws swelled, but not as when inflamed; nor were the glands at all inflamed, but in their natural state. The tongue indeed could not easily be stirred, but seemed larger and more prominent; and the veins under it were very evident. They could not swallow, or but with great difficulty; and, if violence was used, the liquor returned by the nose; through which part the voice came likewise. The breathing was not attended with great elevation of the shoulders. In some the veins in the temples, head, and neck were tumefied; and in these, where the pains were renewed and augmented, the temples grew a little hot, though in other respects they were not feverish. The greatest part kept clear of suffocation, unless they desired to swallow their spittle or something else; nor did the eyes sink at all.
Where the tumour affected not any one side, but came directly forward, none of these, so far as I remember, became paralytic, but all recovered. Some grew easy in a very short time, but the greatest part continued forty days, and that without a fever. Many had some remains of the tumour a very long time, as appeared from their swallowing and their voice. The wasting of the uvula was a proof that the distemper was not quite gone off, though they seemed to have nothing bad about them. Where the tumour appeared sideways, there a palsy followed in the part from whence the vertebræ inclined, and they were drawn on one side. These were most evident in the face, the mouth, and the septum of the uvula. Add to this, that the lower jaws were changed in proportion. The palsies did not affect the whole body, as in other cases, but stopped at the hand of the quinsy-side. What they spit was digested, and a hoarseness followed. Where the tumour was direct, they also spit. But where a fever attended, there the difficulty of breathing was much greater, the spittle could not be contained in speaking, and the veins were more tumefied. The feet, which are coldest of all, were remarkably so at this time; and those, who died not immediately, were unable to stand upright: but those, that I was acquainted with, all died.
Coughs began the fifteenth or twentieth day about the winter solstice,a from the frequent changing of the southerly and northerly winds, and snowy weather; some of which lasted but a little time, others longer; and were succeeded by peripneumonies in abundance. Many had a return again before the equinox, forty days for the most part from the beginning. In some indeed they were very short, and went off well; in others, inflammations of the throat, quinsies, palsies, and that disorder of the eyes called nyctalopia, happened, especially among children. The peripneumonies were very short; but inflammations of the throat came at last after coughing, or else held them a little while in the room of the cough. These were of short duration, especially the disorder of the eyes now mentioned; but the quinsies and palsies were either hard and dry, or little, and seldom attended with digested spittings. Some indeed brought away a great deal. Where any took more than ordinary pains in speaking, or fell into a shivering, there a quinsy was generally the consequence. Where any used their hands much, their hands only were paralytic: but where they rode, or walked much, or exercised their legs any other way, there paralytic weaknesses fell upon the loins or legs, with a weakness and pain in the thighs and shins. The hardest and most vehement coughs were such as ended in palsies. All these things happened in the relapses, but not very much in the beginning. In many they remitted about the middle, but did not leave them entirely, and appeared again at the return. Where the voice was broke with coughing, there the greatest part escaped a fever, and some had it but a little. Add to this, that neither peripneumonies, nor palsies, nor any thing else appeared in this case, but the crisis was determined by the voice alone. The disorder of the eyes above-mentioned was as when it comes from other causes, and affected children most. The black of the eye had a great variety, where the pupils were small; but in short it was generally black. The eyes were rather large than small, and the hair straight and black. Women were not equally fatigued with coughing, but a few had fevers. Of these very few came to peripneumonies, and such as did were among the elderly sort; all of whom recovered. The reason of this was, in my opinion, their not going abroad so much, and their not being at all so liable to be seized as men. Quinsies, and those of a very mild kind, happened to two free women, but among the slaves frequently, and, where they were violent, they proved fatal very soon. Many men were also seized, some of whom recovered, others died. In a word, those who were able but to drink had a very mild and easy time; those, who could not speak distinctly besides, had a more troublesome and tedious one. Those, whose veins in the temples and neck were swelled, were somewhat bad; and those, who breathed with great elevation of the shoulders, were very bad: for these grew hot also. The disorders were thus ally’d, or determined, as here described. The first happened without the last, but the last not without the first. They died very soon, after shivering now and then as in a fever. As they were not oppressed with frequent motions or risings to stool, I tried what stimulating the belly, and what bleeding would do, but nothing was of service to speak of. I also bled them under the tongue, and some I gave a vomit to. These things happened always in the summer, as many other things did of the eruptive kind. So painful ophthalmies, when the drought was greater than ordinary, were very common.
Swellings of the glands were likewise common, because the liver was inflamed and out of order; and where they proceeded from an artery ill-disposed, as in the case of Posidonius, it was a bad sign.
We came to Perinthus much about the summer solstice. The winter had been serene and southerly; the spring and summer very dry, to the setting of the Pleiades; or, if any rain fell, it was in small drops. The Etesiæ blew but little, and that not constantly. In the summer many burning fevers raged among the people; during which they were free from vomitings, but subject to thin, watery, frothy stools in abundance, without bile, but not without a sediment now and then in that that was set by, and in that part of it which was exposed to the air. Now, where no alteration happens at any time, as to the appearance of the excrement, it is a bad sign. Many were comatose and lightheaded in their fevers, and some became so after sleeping, but recovered themselves entirely upon getting up. They elevated their shoulders in breathing, but not much. The urine was thin in most, and little in quantity, but in other respects not without colour. Bleedings at the nose were very rare; and so were swellings behind the ears; of which more notice will be taken afterwards. There was no swelling upon the spleen, nor upon the right hypochondre; neither did any great pain, or vehement distension attend it, but yet there was something of an indication, and the crisis happened for the most part upon the fourteenth day, partly by sweat, partly by shivering, with very few relapses. During the drops that fell in the summer, they began to sweat in their fevers, and some fell into them from the beginning without any injury; others about this time, and the crisis went off this way. In the summer fevers, about the seventh, the eighth, and the ninth day, little miliary roughnesses, very like the bites of gnats, appeared upon the body, without any great itching. These lasted to the crisis; but none of the men had them that I saw; nor did any of the women, that had them, die. Their appearance was foretold by a thickness of hearing, and a coma, where they were not very comatose before. These complaints did not last the whole year, but in the summer and to the setting of the Pleiades they were comatose and sleepy, but afterwards more watchful. Nor in fine did they die during this constitution or season. The purging could not be checked even by diet; but one might imagine that an irrational method of cure might be serviceable, though the discharges in some were very great, occasioned by lying on a bed in the cold; for cold ulcerates. The warming such bodies ought to be gradual, without offering any violence to nature; and as to those who are troubled with signs or complaints of this kind, whether more or less, viz., gaping, coughing, sneezing, yawning, stretching, belching, and flatus, all such tend to destruction.
Zoilus, who lived by the wall, was seized with an acute fever from a digested cough. His face was red, and his body bound, unless when loosened by art. His left side was painful, and the left ear very painful; the head not so much. Spitting continually a somewhat purulent matter, he could not get well, but in other respects had a crisis, and discharged much matter by the ear, about the eighth or ninth day. The beginning of the ninth the pain of his ear ceased; but how the crisis could be without a shivering I know not. About his head was a great sweat, and about his ear and left side a fixed burning heat. With the pain of the ear above, the other pain ceased, especially about the shoulder-blade; but first came on a great spitting, which at the beginning was florid, and so on to the seventh or eighth day, and after that difficult and painful. The belly was bound till about the ninth or tenth day; the pain was quite removed, the swelling abated, and little sweats came on, but not critical, as appeared from other circumstances, and the going off. For, when the pain of the ear began, the belly was loose; the abscess from the ear was the ninth, and the crisis the fourteenth, without any shivering the same day. Add to this, that when the ear broke, the spitting became more copious and more digested; but sweats and tetters about the head lasted long, though they dried up (in a manner) the third day.
Whatever disappears without the proper signs makes the crisis difficult, as in the erysipelas that happened to Polemarchus’s maid.
Scopus, upon an acrid, saline, bilious, distillation from the head, an inflammation of the chops, and a bad regimen, was bound in his body, and seized with a continual fever. His tongue was dry; his sleep gone from him; the rim of his belly violently, but equally, distended, the distension proceeding gradually to the bottom of the right side; his breathing, pretty frequent; his hypochondres in pain, both in breathing and turning; and he brought away, without coughing, a thickish matter. Upon taking peplium, the pain went off from the hypochondre, but nothing passed through. The next day two suppositories put up appeared no more; but the urine was thick and turbid, with a smooth and even sediment. The turbidness occasioned no stool; the belly grew softer; the spleen was swelled, pointing downwards; and his drink was mead with vinegar. The tenth, a little watery blood came from the left nostril, which gave him very little relief. In the sediment of the urine was something whitish and thin, sticking to the vessel, that was neither like, nor very unlike, seed, and continued so some little time. The next day (the eleventh), the crisis came on, and he lost his fever. His stools were somewhat viscid, and mixed with bile as they came away. His urine was a great relief to him, both as to quantity and sediment, which, before he began to drink wine, was a little like thin phlegm. Though his stools were little upon the eleventh, they were at the same time viscid, stercoraceous, and turbid.
Query? Whether such a discharge is critical, as in the case of Antigenes in Perinthus?
Hippostratus’s wife, after a quartan of a year’s standing, was taken with a swelling, and was manifestly coldish with it. It went all over her body; a sweat followed upon it, and a crisis. Her menses afterwards came down in great abundance, continued longer than usual (having been stopped before), and seemed unwilling to give over.
In hemorrhages, attended with pulsations, the figure or position of the part is to be studied; and, if they happen in very depending parts, they are always to be elevated. So moderate ligatures in blood-letting promote the evacuation, but violent ones suppress it.
Those who are of a sanguine and somewhat bilious nature are subject to sour belchings, and perhaps at last fall into the black jaundice.
In Ænus, those who lived continually upon leguminous food, whether men or women, became infirm in their legs, and remained so. And those who lived upon vetches, or tares, complained of pain in their knees.
In order to recover the colour and fuse the humours, we should study to put a man in a violent passion; and, upon other occasions, to bring on cheerfulness or timorousness, and the like.
If the whole body is out of order, the cure should be general; if otherwise, particular.
Stymargus’s servant, the Idumæan, upon a distortion of the mouth of the uterus, in her being delivered of a daughter, was seized with a pain in her hip and leg, which grew better by bleeding in the foot; but her body trembled all over. We are therefore to consider the occasion, and the beginning of that occasion, in diseases.
In the fourth section of this second book, we find that from the constant use of some kind of grain, [“ex assiduo leguminum usu, feminæ et masculi, crurum impotentes facti sunt, ac vitam degerunt.”—Fœs., Hal.] several symptoms were induced, not dissimilar to those produced from ergoted rye.—Ed.
[a ]Analogous to what has been ascribed in later times to the use of ergoted rye.—Ed.
[a ]“This is the seventh section of the sixth book of Epidemics; a section entirely independent of the rest of the book, and of a piece, in some measure, with the observations we have been just now seeing. Whether he means fifteen or twenty days before or after the winter solstice, does not appear from the text.”—Clifton.