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CLASS IV.: SEMEIOTICS. - 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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Galeni, librorum quarta classis, signa quibus tum dignoscere morbos, et locos affectos, tum præscire futura possimus, docet. Eighth Ven. Ed. Title, 1609.
GALENI, DE LOCIS AFFECTIS, LIBRI SEX.
six books on the parts affected by disease.
Bas. Ed., tom. iv., p. 5.
This treatise, taken generally, is of much interest, and of great importance. The very name may be considered as indicating this character. It consists of a general explanation of those various modes that had been adopted, in order to become acquainted with the parts affected by disease; after which the subject is taken up more in detail, that is, as to the affections of individual parts. The whole is deserving of attention, but that is incompatible with our present object: a few particulars from each book are all that can be expected.
This first book sets off with affirming the importance of a knowledge of the parts diseased, and of the necessity of anatomy in attaining that information. Examples are afforded in proof of this; among which is to be found a reference to the discharge, by coughing, of the bronchial cells, or portions of them in pulmonary ulcerations, and of the intestinal coats in dysentery, &c.—No action or function of a part, it is asserted, can be injured, unless from an affection of that part, although it may be scarcely discriminated at times, from its slightness, but is only different in degree from that of the highest character. The different subjects adverted to are numerous; in that of retention of urine, the catheter is noticed, and some general divisions are given, in order to facilitate the distinction of affections, and of their causes; thus the obstructed actions of a part, lead to the notice of the excreta, position, species of pain, and the appropriate symptoms. A distinction is made between idiopathic diseases and those from sympathy; and an interesting case is related of distant affections removed by applications made to the spine; and notice is taken of the occasional loss of motion, without the loss of sensation, and of the reverse of this; with other circumstances of much interest.
Three modes are stated as leading to a knowledge of the parts affected; one has reference to each individual part; a second, to the causes and affections or disposition of the parts; and a third, to the difference in the accompanying symptoms. Many of the remarks in relation to the different kinds of pain, are directed against Archigenes and his observations, and an explanation of that diversity is attempted; a great number are mentioned under a specific nomenclature. The mode and rationale of the means of knowing the seat of a disease and its disposition, are then pointed out, and some cases of interest are occasionally referred to.
The distinction of primary from sympathetic affections constitutes much of this book. Archigenes is again attacked, and his observations on the loss of memory are critically examined, and his mode of treatment is pronounced to be absurd. This leads to a consideration of the origin of the nerves; and many of the diseases that are dependent on their presence, as convulsions, epilepsy, and others, are cursorily noticed and explained.
The affections of the face and fauces, &c., are here taken up, and their distinctive marks; of those of the spinal marrow, in the consideration of which, the subject of angina is touched on, one species of which was supposed to arise from a luxation of the cervical spine. The vitiation of respiration, and of the voice, through the influence of spinal affections: pulmonary affections, hemorrhage from; and a case of hemorrhage from swallowing a leech, is of some interest. One also of Antipatrus, a Roman physician, who died suddenly, after a long-continued irregularity of the pulse, but without much indisposition, or difficulty of respiration, until a few days previous to that event. Some cardiac and thoracic affections are briefly noted.
In this book are considered the affections of the heart, more extensively than in the preceding; and those of the thorax, diaphragm, with somewhat on phrenitis; the affections of the throat or gullet; of the os ventriculi, and liver; with remarks on dropsy and jaundice.
The palpitation of the heart and its danger, from the connexion of that organ with every part, is particularly noticed; its other peculiar diseases, and those of the pericardium. In various parts, the etymology of sundry organs, &c., is given, and the changes thereof at different periods; stricture of the œsophagus is noticed, and its causes, &c. Some remarks allied to the pulmonary circulation may be found in this book. The diaphragm, septum transversum, phrenes vel mediastinum, is said to have had the first name given to it by Plato, from διαφραςϛω, to limit or divide, as by a septum, the irascible power of the mind, supposed to be contained in the heart, from that of appetite or desire that was located in the liver. Such are the fluctuations of language, arising from fancy or hypothesis, and by which perpetual difficulty is presented to the advance of science. The os ventriculi, by which is now meant the upper orifice of the stomach opening into the œsophagus, was formerly called cor; from whence its name of cardiac orifice; it also had the name of stomachus, or rather, this term was applied to the œsophagus itself, subsequent to the time of Aristotle; whilst in Galen’s time it had received the name of gula, from whence our gullet. It is obvious that infinite mistakes have arisen among medical writers by inattention to these changes, in investigating the works of the ancients, and thereby mistaking the accurate meaning of their terms! This ridiculous propensity for coining new names in every branch of science, in place of those well known and long employed, and more especially in medicine and its collateral branches, was never more extensive, (nor more absurdly conducted,) than at the present period, when the “march of mind” seems even to out-herod Herod himself.—A few interesting cases are to be found in this book.
Here we have the consideration of affections of the spleen, intestines, kidneys, bladder, uterus, and penis;—among those mentioned, we find nephritis and its various symptoms; diabetes, apparently a rare disease, since Galen seems to have met with but two cases of it, (“eum equidem ante hac, bis duntaxat videre potui.”) In speaking of uterine affections, much is said respecting seminal and menstrual retention; and the question “num uterus animal,” is duly considered and its absurdity pointed out. The subject of Hysteria, and its connexion with that organ is mentioned, especially as appearing in widowhood; and a curious trait in Diogenes is related; some reference is made to rabies, which is affirmed to be confined to dogs, though extended to man by means of their saliva. In speaking of the diseases of the penis, &c., various passages present an analogy to some of those diseases that are now considered to be venereal. From this brief account of these books, some slight idea of their importance may be had.
GALENI, DE PULSIBUS LIBELLUS, AD TYRONES.
a concise treatise on the pulse, for students.
Bas. Ed., p. 166.
At No. xviii. of the prima classis of Galen’s writings, (p. 491,) we have the treatise “de pulsuum usu;” and which, had I not fixed on the arrangement of the Venice and Basil editions, I should have rather connected with the present and succeeding books, as a more appropriate location. It is deserving attention, from having so much in it, of close connexion with the subject of the circulation of the blood; the few extracts given from it will perhaps serve to satisfy most persons, desirous of truth, rather than of being considered “addicti jurare in verba magistri.” Before perusing the present treatise, it may not be useless to refer back to the book above-mentioned.
The outline of the present book is here presented, more in proof of Galen’s ever active mind, than from any estimate of its absolute correctness, or of its practical utility; yet it contains much interesting mat ter for reflection.
The heart and arteries have a uniform pulsation, though not equally sensible in all the arteries; wherever it is capable of being felt, it is equally adapted for observation; but some parts are superior to others, and of these the carpus is best. The arteries are extended in every dimension, viz., in length, breadth, and depth. The quality of the motion; the interval or time of rest; equality and inequality of. Of a common and inordinate pulse; inequality of one pulsation; of a compound inequality of pulsation; vermicans, fluctuosus, formicans, magnus, longus, latus, altus, vehemens, mollis, celer, frequens, æqualis, ordinatus.—A threefold difference in the mutation of the pulse, viz., natural, non-natural, and præteronatural. Each one may learn his own pulse by experience.—Of the pulse in men and women in infancy, and in age, and at intermediate periods. Modification of pulse according to season, country, &c. Pulse in pregnancy; in sleep; on waking;—changes of, from habits, natural or acquired; differences in, from different exercises, or baths, or food; influence of wine, water, &c., on; all which, immoderately used, are præternatural; their action is explained by the vital power, and the character of the pulse induced. Of the pulse of syncopal affections; of anger, pleasure, grief, fear, pain, and its varieties; of the pulse of inflammation; its locality and character, as of the diaphragm, in pleurisy, and its varieties; in empyema, marasmus, the hectic pulse in it, and in phthisis; pulse of peripneumony; of lethargy; phrenitis; catalepsy; catochos; convulsions; palsy; epilepsy; angina; orthopnœa; hysteria;—the pulse, and its diversity in various affections of the stomach; in dropsy, and its varieties; in elephantiasis, jaundice, and in those who have taken hellebore, &c.
We see by this brief exposé, to what an extent Galen carried his observations on the pulse; can it be possible he never dreamed of, or elucidated the route of the circulation!
In the succeeding books, the subject is very minutely entered upon. These books, are thus denominated.
Making sixteen separate treatises, and all of greater or less interest.
GALENI DE PULSUUM DIFFERENTIIS. LIB. QÚATUOR.
of the difference of pulses.
in four books.
Galen begins with some good remarks as to the use of names. In themselves, they only facilitate the attainment of, but add nothing to the art. He animadverts on the perpetual changes made in them, and on the useless commentaries and disputes on the subject. These seem to have been as numerous as in our times; and to have no less retarded the progress of the science. He then notices the name of pulse, on which numerous commentaries appear to have been written, (omnes qui de pulsibus instituerunt commentari,” Ven. ed.) Hippocrates seems first to have employed the term, whilst others called it palpitation; and this was a common name both by physicians and the public. He then notices the intention of this book, and proceeds to consider the different genera, species, qualities, or difference of pulses, by all which names they have been called. This leads him on to the consideration of them more in detail; and he gives, in a tabular form, no less than twenty-seven varieties, dependent on the threefold distinction of quick, slow, and moderate; he next considers the quality of the stroke.—The difference of sects, some of whom judge of the variety of pulse by the distention of the artery, others by its contraction;—its state of quiescence, and the difference of it, and of the rhythm, which he explains;—also the different inequalities of motion; with tables, &c., he speaks here of various pulses, such as the undulating, vermicular, formicans, vibrating, and convulsive, &c., and gives an explanation of them, and of several others.
This second book begins with an explanation of its use. Of the use of names, and of definitions, in opposition to the sophists; some of whom he severely animadverts on, and calls one of them atrocious. This is a highly amusing chapter; and his description of his arguing with them, and turning them into ridicule, would form an admirable appendage to some of the writings of La Sage or Quevedo. He takes occasion to dwell on the opposition of Archigenes to himself (Archigenes) in his nomenclature. He then states how he discovered the differences of pulses, with reasons for distinguishing the common genera; and alternately lashes his opponents for their opinions, and their nomenclature.
In this book Galen takes notice of several varieties of pulse; the vehement and languid, &c., refers many of the difficulties and contrarieties on the subject, to the intermixture of terms, and improper definitions. Archigenes, who is again the subject of his attack, errs greatly in even his definition of a vehement pulse; and the perpetual disputation about names, he tells us, had been more than useless, and that they have filled immense volumes with such follies as are undeserving of pardon; for since the subjects are obscure, if man’s life was tripled, even then we should have but imperfect acquaintance with them.—Much more to this effect he says, that is deserving of consideration; and calls up for castigation various authors besides Archigenes, as Magnus, Herophilus, Athenæus, Asclepiades, &c., and points out their contradictions and intricacies; he especially speaks of Archigenes and his followers, as “imperitissimi et pertinacissimi,” and of their entire ignorance, abuse, and obscurity in their names, when they speak of heavy, light, impeded, and repressed pulses. He gives a laughable interview and conversation with an old man of ninety years; and shows himself a deep critic in nomenclature and etymology, in adverting to the word ϱοιζωδης as improperly employed by Archigenes, meaning as it does, poetically, stridulus, which will not apply to the pulse in question.
It may be a question at present, whether this same term stridulus is properly applied to discriminate the peculiar sound in croup, as in different writers.—Objections are made to other definitions of Archigenes; and the host of hard names employed by him to explain the different pulses, are considered by Galen as being both obscure and useless. In this he was unquestionably right, if we may judge from those he has adduced, of which the following few are samples, as difficult of pronunciation as any Polish or Indian words, in the softly-flowing Greek: apokekroumnismenos, extethamboumenos, apopepougos, engkaluptomenos, ukopleptomenos, &c., &c. The Latin translations are not a jot behind, either in obscurity or in utility, as applied to the pulse, and which they could scarcely be divested of, in an English dress, though possibly they might befit the unpronounceable dialects of Wales or Poland. Galen has well bestowed on this wretched host the epithet “id genus nominum immensus numerus.” Alone, and separate, adds Galen, these words have some meaning, but they have no appropriate connexion with the pulse. He affords some idea of his own views of a vehement pulse; opposes the Pneumatists in their explanation of a full and empty pulse, and gives some reasons for changing those names. He states what he thinks to be the proper signification of a hard and soft pulse, and the deception of the Pneumatists in respect to them.a
In this book, we find Galen still sedulous in repelling the ancient definitions, by which each partisan thought fit to transmit the notions of the pulse peculiar to his sect. He assigns some reasons whereby he was compelled to combat the shadows of the Pneumatists; and explains his opinion of what the pulse properly is; and from what he says, it appears that young physicians, then, as now, gave publicity to their lucubrations, (“non requirunt multa verba, quibus scatent juniorum medicorum libri.”) He speaks of the various definitions of the pulse by the ancients, and the disputes thereon, apparently, as numerous as in later periods. It is a curious chapter, (ii.) and quite as well deserving of attention as any of the speculative treatises of Parry, Hillier, and others. Some defined the pulse, as the motion of the arteries; to this, some superadded that of the heart; others say it is that of only the arterial part of the heart, or ventricle. Further disputes sprung up, as to whether the arteries pulsated by their own accord (sponte sua,) or by that of the heart, &c., and although he freely criticises, he yet seems to admire Aristotle. He notices the different structure of an artery and vein, and regards the pulse as a peculiar motion or action, especially (præcipue) of the heart, and then of the arteries, which, by a vital faculty are excited to distension and contraction, and whereby a degree of native heat is maintained. From Galen’s statement, it would seem that the labour would be immense, and useless, to pursue all that had been said on the subject. That it was a favourite one, we cannot doubt; for he tells us, the pupils of Herophilus were the principal leaders of this curiosity, (hujus curiositatis), to whom several of the family of Erasistratus succeeded; and to these, many Pneumatists and Methodists.
In the succeeding chapter, (iii.) he gives the description of the pulse, by Heraclides of Tarentum, Alexander, Demosthenes, Bacchius, Aristoxenes, Chryserneus, another Heraclides of Erythrea, Agathimus, Archigenes, Magnus, Athenæus, Asclepiades and his followers, Moschion, Erasistratus and his followers; many of whom may be recognised as writers quoted by authors of the present day. We must suppose, therefore, that the pulse has always been a subject of great interest, and that among so many learned men, and anatomists, had their writings and observations reached us, in full, we should probably find more than mere conjecture and distant probabilities, of a well understood and acknowledged circulation. As to Erasistratus and his followers, since they disagreed amongst themselves, as much as they did with other sects, we are led to wonder, says Galen, not so much at the diversity of medical sects, as that they differed the most, who were the disciples of the same master!
GALENI, DE DIGNOSCENDI PULSIBUS. LIBRI QUATUOR.
on the knowledge of the pulse, four books.
In this book, Galen remarks on the difficulty of attaining a knowledge of the pulse; and previously recapitulates his division of his books on the pulse, pointing out which are most connected with medicine, and which with philosophy. The first he considers common to both, (de differentiis.) The second and fourth (de diagnoscendis et præsagitione,) to the physician, and the third to the philosopher, (de causis.) Of particulars to be considered in the distension and contraction of the pulse, and in various other points; how to feel the pulse. He lays down four principles for knowing the pulse. Investigates the disputes as to whether the contraction of the pulse is felt;—how to apply the hand to the artery, to perceive the contraction; prognosticating by the pulse, and some cautions, &c.
Here, he notices the quick and slow pulse, and compares them with the moderate pulse, to which reference is always to be made in becoming acquainted with any other variety. He animadverts on Herophilus and his followers, for being so careless and negligent respecting the pulse.
Galen defines a quick and slow pulse, and points out how they are to be known; referring to his previous remarks respecting the intervals of motion, and the force of strength, and, keeping in view the moderate pulse, the state of distension, &c. He points out the attainment of the difference of the pulse in regard to length, breadth, and depth, (longitudo, latitudo, profunditas), or the quality of the motion; he then notices the mode of acquiring a knowledge of the rhythmus,a (interval of stroke, &c., Qu.?) giving a tabular view of his ideas, in two columns, representing the states of distension and contraction of the pulse;—the commencement of this scale is that of quick (celer) in both, and the ending of it is (tarda) slow in both; moderata in both, constitutes the mean of the scale, and the intervening degrees are filled with varieties in combination of these three terms.
Here we have the hard and full pulse; and his opposition to Archigenes and other ancients, as to their knowledge of the pulse. He describes how we are to know the stroke (ictus) of the pulse. A great (magnus) pulse, by some judged of, from its vehemence; by others, from its hardness. Of a full and empty (vacuo) pulse; some did not distinguish a vehement from a full pulse; and Herophilus and his followers did not know it; whilst Archigenes has written obscurely and erroneously respecting it, and others equally so. Galen then explains a full pulse; full, being first considered as of three kinds. Much interesting and useful matter may be found interspersed through these four books.
GALENI DE CAUSIS PULSUUM. LIBRI QUATUOR.
on the causes of the pulse.
in four books.
The causes giving rise to the pulse, are here generally adverted to, and are very ingeniously treated of under three heads or genera;—some arising from the nature of the instruments or organs; others generated, as it were. He then speaks of these separately; the instrument or artery, and foreign agencies, as heat, emotions, passions of the mind, eating, drinking, exercise, and so forth. The influence of age, as in infancy, &c. The inequality and other changes of pulse, from these and other causes, are noticed.
As the causes of the pulse generally constitute the principal intention of the former book, so those inductive of inequality in the pulse, are here considered. Of the causes of inequality in a single pulse,—of the vibratory, and many other varieties of pulse;—all, probably, as fully and as well explained as by any later writer.
This may be in a measure considered as explaining the operation of the so-called non-naturals, in promoting the action and changes of the pulse:—of the pulses of man and woman,—of those of warm temperament,—of thin persons;—of its changes by age, season, climate, and state of air,—of pregnancy,—in sleep, and waking,—from artificial habits or temperaments,—exercise,—hot baths and cold,—food and wine. It is a book replete with interest, independent of its more immediate connexion with the pulse.
Preternatural causes are here noticed as productive of modifications of the pulse;—anger, joy, sorrow, fear, grief, pain;—the pulse of inflammation, of pleurisy, suppuration, decay, consumption, peripneumony, and a host of other diseases, are here noted; and, assuredly, in many, with a precision not inferior to any writer on the pulse of the present period.
GALENI, DE PRÆSAGATIONE EX PULSIBUS, LIBRI QUATUOR.
of prediction from the pulse, in four books.
Some general remarks on prognostication;—on that from a large and small pulse; from a quick and slow one; strong and weak, hard and soft pulse. In this consideration, the state of the pulse is to be connected with the particular disease, and not simply estimated from itself. The previous books on the pulse should be consulted before reading this. Various pulses noticed, and their changes; privation of pulse; of the long, short, broad, narrow, low and high pulses, from whose varied combinations twenty-seven different pulses originate, &c. Four general differences in distention; causes increasing and oppressing strength; what external causes produce a hard pulse, and a soft one, &c.
After noticing four differences of pulse according to the contraction of the arteries, similar to those derived from distention, he proceeds to note the prognosis from a frequent and rare (raritate) pulse, by the rhythm, from inequality in, from intermission, &c. Signification of rhythm, and inequality, &c. What pulse affords two strokes in one distention. Signification of certain pulses, as caprizans, dicrotus, and others. What is presaged by order in the pulse, and what by its disturbance. An intermitting pulse in age and in childhood less to be dreaded than in youth.—Many of these terms have maintained their standing in some of the treatises on the pulse in later times.
In this book, the peculiar pulse in the different diseases of the heart is noticed, and the appropriate pulses of different fevers. He is very precise in defining his terms; thus he says, that he is about to treat of those pulses that are peculiar to affections (affectionibus) or diseases; and he calls that an affection that is preternatural, (præter naturam), and the pulse peculiar to each one, that which perpetually attends it, or most frequently. He then proceeds to the different cardiac and other affections arising from heat or cold; with some observations as to the pulse in pestilential fevers, and on other sources of prognosticating, in which he seems to have observed the heat about the præcordia greatly increased, whilst other parts were cold;—of the pulse in such states.—A very useful chapter follows, on the proper signification of names and metaphors, and its connexion in regard to the pulse is pointed out. The general character of the pulse in fever, and the individual character in some particular kinds, explained. Changes in the pulse, from certain causes acting on the heart and arteries.
Presages drawn from the pulse, as modified by affections of other parts, especially those of respiration, nutrition, the head, &c. He notices the pulse, thus created by affections of the lungs, thorax, liver, diaphragm, pleura, stomach, and other digestive organs; and those of various other parts, as inducing sympathetic action.
Thus, then, the sixteen books on the pulse are concluded; but we find, immediately succeeding to them, one entitled, (at least in the Ven. edit.), Synopsis librorum sexdecim de pulsibus, or Synopsis of the sixteen books on the pulse.
GALENI, SYNOPSIS LIBRORUM SUORUM, SEXDECIM, DE PULSIBUS.
Ven. Ed., p. 123.
The following preliminary remarks to this book, under the name of “Censura,” may not be unacceptable to the reader, as showing that Galen had been induced to write such an epitome of his sixteen books on the pulse, that it might be more correct than if committed to another person; and he commences by a recommendation to read his larger work first, as then, a few words of the synopsis, by association, would recal much to mind.
Galen, at the close of his book “de arte medicinali,” thus writes “It is my intention to write another book, in form of Epitome of all my sixteen books on the pulse, which I shall entitle Isagoge, Synopsis, or Epitome!” But in his book, “de libris propriis,” chapter five, he says, “I have written one other book, a synopsis of the abovementioned sixteen books on the pulse.” Now this must be that book abovementioned by Galen, for both the doctrine, and the reasons assigned for writing it evidently prove it. The author refers the reader frequently to the treatise on the pulse addressed to beginners, (Tyrones), and which he sometimes calls Isogogic; also to the larger work in sixteen books, and not unfrequently to the books “de Crisibus,” and some others. Now as all those are declared by him to be his, this is found conformable to them; and he often declares that much will be gained by a previous acquaintance with the larger work, which he inculcates in the eleventh chapter of the present tract.
He then reminds the reader of the fourfold division of the work, viz.,
1. Of the difference of pulse, and mode of distinction.
2. Of the knowledge of the pulse, and how the distinction is made.
3. Of the causes, &c., of different pulses.
4. Of the prognosis of the pulse, and which he considers as the manifest point for which the whole was written. The danger of attending to names, rather than to facts, is strongly re-enforced. “Often,” says Galen, “one word has various significations, and very often the same thing has different appellations, not always or equally appropriate, or of indiscriminate application. There is, therefore, a great chance of some equivocal meaning being bestowed by those who are not fully masters of a language, or of its various idioms,” &c., and he therefore strongly urges the absolute necessity of giving to things their correct appellation.
The diastole (dilatation) and systole (contraction) of the arteries have received the name of pulse, to which two things or circumstances have relation, viz., the space through which the artery moves, and the time of that motion. He then assumes the position that four generic differences are to be considered in the diastole of the artery, viz., as to quantity, time, tenor, and the body of the vessel itself. He hereby distinguishes twenty-seven special varieties in the pulse, though limited by others to a smaller number. Varieties further arise, in relation to the length, breadth, and depth of motion, &c. He attempts to prove, that no other than the above four named generic differences can be found in the diastole, by impugning the opinions of those who have explained a diversity of pulse, from the nature or character of the article conveyed (re infusa) through the artery; it being a question, if arteries were devoid of blood, or contained both it and spirits; also, as to the blood, whether it be serous and thin, thick and viscid, or intermediate between both.
He adverts to many absurdities advanced respecting the pulse; as of the full pulse, making three varieties, and confounding names, &c. He then proceeds to notice the different speculations on the systole of the artery; considered by some as sensible, by others, as insensible, and states the division of pulses founded thereon. After this he adverts to the hypothesis respecting the rhythmus, or interval between the diastole and systole, as to the equality or inequality of time, inductive of variation in the pulse with respect to strength, continuity, or interruption, &c.; then points out the mode of estimating the quantity of the diastole and systole; and says that the volume or smallness of the pulse, with its other variations, should be attended to in the systole. This is followed by noticing a triple genus of causes of the pulse, designated by the terms continent, antecedent, and procatarctic. This being explained, he points out the uses of diastole and systole; and remarks, that when those are augmented, such and such pulses are induced. He now proceeds to a consideration of the pulse in health, as leading to the knowledge of that which is preternatural or unhealthy; and examines the propositions of Herophilus on the subjects of diastole, systole and rhythmus; says that systole can scarcely be known in new-born children; but that as age advances, the four times or differences augment; and he then directs the reader to the mode of acquantance with the systole and diastole, both in febrile invasion, and in putrescence of the humours. Diastole, he says, relates to inspiration, systole to expiration; and by comparing these, the extent of lesion may be judged of. He then notices some pulses, in which the rhythmus varies; the difference of natural pulses, as induced by sex, age, season, &c., and takes a glance at those natural things or circumstances in sickness (symptoms) by which accurate information of the affection may be attained; next speaks of the signs of febrile invasion, and of those which Themison regarded as absolute and certain. He now proceeds to consider the causes of inequality in the pulse, and reckons up nine orders of such inequality in one pulse; says that the inequality in one pulsation is not in the softness or hardness of the artery; and that if it be in several pulsations, it will generally be in frequency or in slowness. He observes that a conjunction of inequalities in one pulse, will enable us to judge which concur in promoting a good or bad crisis; mentions what pulses should be considered in the diastole of the artery; what affection is peculiar to each, and what prognosis may be drawn from them. He then describes a great variety of pulses, under the names of vibrating, waving, undulating, vermicular, formicans, &c., and proceeds to notice some, that in one diastole, have an inequality in different parts of the artery; explains sundry occasional phenomena apparent in the pulse; speaks of the knowledge attained of fever, by means of the pulse; of the different forms of fever, and of the pulse peculiar to each, and of the indications of crises to be derived from it. He now proceeds to speak of the pulse peculiar to various diseased states, as pulmonic and thoracic affections, of the diaphragm, liver, spleen, stomach, bladder, uterus and its membranes, muscles, testes, &c., and then takes notice of the diagnostics of those causes (external) by which the pulse is altered in magnitude or diminution, such as baths, frictions, exercise, &c.,—what indications are deducible from slow, frequent, intermitting, intercurrent and other pulses; and speaks of inequality as consisting either in the situation or the motion of the parts. In a synoptic view of the whole subject in his last chapter, Galen collects what has been said, and teaches how to prognosticate the termination of disease in health or in death; the time of recovery or death, and the mode of each; embracing in this consideration the rules for knowing whether the vis vitalis is weakened by its own exertions, or is overpowered by a host of foreign agencies; and concludes with some remarks on the termination of future crises in various modes.
This hasty summary of the different books on the pulse, occupying nearly two hundred folio pages, imperfect as it is, is sufficient, I should judge, to impress on every medical man, an opinion highly favourable to the illustrious author of these ancient views, had even nothing further of his writings reached us. Upon the whole, on reviewing the sixteen books of Galen, on the pulse at large, or his condensed synopsis, and other treatises on the subject; I apprehend we may safely conclude that there is full as much good sense and reason in his speculations, as in any of those that have since his time been promulgated by Solano, Bordeau, Nihill, Falconer, and others, down to the later period of Hillier, Parry, and many more in Great Britain, and elsewhere. A comparison of his statements will establish the correctness of many of his propositions; and we may be inclined to doubt, whether a man, who here so fully proves his powers, and the resources of his art, could possibly have drawn his explanations and deductions on the pulse, from dissections and observations of the monkey alone; or that one who observed so cautiously and extensively, could be deficient in a knowledge of the circulation in most, or all of those particulars, which have been so pertinaciously awarded to Harvey! The loss of some of his writings has unquestionably thrown difficulties in the way of knowing the full extent of his information on this, and some other subjects; but enough is here said, in connexion with other parts of his works, to render such opinion not even tenable. I have largely discussed this subject elsewhere,a and shall only add, that so many authors are alluded to, whose works and opinions are known to us through Galen alone, as to give a high character to his extensive research and erudition; and our regret must be strengthened, that so much actual information of ancient science, especially that of medicine, should have been lost, in the conflagration of the Alexandrine and other libraries, before the general extension of printing had rendered such an event of comparative insignificance.
GALENI, DE URINIS, LIBER SPURIUS.
Bas. Ed., p. 474.
It seems doubtful whether this be the production of Galen, although he did write one on the urines, as he mentions in his first commentary on the humours. That the ancients generally thought more on the subject of this discharge, and attended to it more uniformly and critically than is now done, cannot be doubted; and that many indications, &c., framed on the discharge, either as to colour, density, or tenuity, and other points, were well founded. It must be admitted that we fail greatly, by our almost total relinquishment of its inspection, whilst we sedulously attend to the discharges from the bowels, the stomach, lungs, &c. If these are required,a why not also, in a greater degree the inspection of that fluid, which comes freighted with so large an amount of saline and other matters secreted from the blood, and freeing that important fluid from some of its most injurious contents. Why has this occurred? And from what period may this solecism be dated? It may be difficult to respond to these questions. Possibly, the dignity of the Profession was humbled, by the empiric extension of this subject of inquiry, in the hands of the so-called water doctors, who regarded the urine as the sole register to be examined in respect to the patient! In laughing those rogueish medicasters out of countenance, the regular members have occasionally received some rubs, which seem to have caused a perfect obliviscence that the urine was a secretion from the blood; and an excrement whose discharge from the system was of infinite consequence. Its saturation and super-saturation with saline matter, that could find no exit from the circulation except through the kidneys; and the evil to be apprehended from its retention, to the system at large, or to particular parts; conspire to prove that it was deservedly considered of the highest importance by our patient and indefatigable forefathers in medicine! and that, although they may have overdrawn the subject, it is not the less deserving of our favour and protection.b
The author of this treatise, whoever he may be, has presented in successive chapters, all that apparently was then known on the subject; and no doubt, accurate observation on our part, would fully substantiate the truth of many particulars laid down in this and other writings connected with the subject. The treatise scarcely admits of abridgment. The importance of urine, as a critical discharge, is considered in the following treatise.
GALENI, DE CRISIBUS, LIBRI TRES.
of crises:—in three books.
Bas. Ed., p. 482.
The doctrine of crises, it is well known, has at all times been a favourite and plausible one among the most learned members of our science, until within a short period; but even now, when it is considered as having been greatly exaggerated and overdone, in bygone times, there is not a doubt, that we still look, (with half assurance of its truth) for the same events, under equal circumstances, as are detailed in the pages of Hippocrates and Galen.
By the term crisis, the ancients understood a sudden and rapid change in disease, tending to recovery or to death. In this struggle of Nature, if she prevailed, the patient was saved; but if she succumbed, the tendency was to death. In a more limited application, the term was sometimes used to signify a secretion of some of the humours, through which the semina morbi might be evacuated, and health restored.
Great allowance is to be made for the difference to be perceived, as to the facts themselves of the doctrine of crises, as abundantly set forth by former observers, when we consider the numerous alterations in the habits of life in almost every particular, from those of former times; each in its turn, no doubt, exercising some influence on the regular operations of the living system. Thus, the introduction of many articles of immense consumption, employed primarily perhaps as merely luxuries, but subsequently becoming of absolute and universal necessity. Is it possible such an entire change of habits should be unaccompanied by modifications in the human constitution, and thereby greatly tend to alter the natural actions of foreign agencies, whether of an healthy or morbid influence? Need we mention the articles of tea, coffee, punch, spirituous liquors of every description! the narcotic influence of tobacco amongst the nations of Europe and America, and of opium among the Eastern population, where wine is altogether prohibited! May we not to these superadd the extension of commerce, and the gradual increase of, and facilities in travelling, alike productive of infinite changes in the long established customs and habits of former ages? Changes, moreover, among a large proportion of mankind, arising out of the numerous modifications of religious and sectarian pursuits, that have sprung into existence since the reformation; by which those salutary habits of restriction in diet, by temperance and fasting, have been nearly abolished, or at least most imperfectly conformed to!—and latterly, the powerful influence of liberty, both of mind and body; which, originating principally through our revolutionary struggles, is still advancing, and must continue to advance, until the whole human race shall taste of that (to many, still forbidden) fruit! Consider the invigorated operations of the mind since printing shed its influence abroad; and which was in truth, the principal agency in advancing into broader day, what had before been merely dim and feeble glimmerings, amidst the Cimmerian darkness of the middle ages! Let us, I repeat, advert to these and other circumstances which will present themselves to the mind; and we shall probably discover sufficient causes for those discrepancies that are to be found in the critical observations of the ancients and moderns.
Physicians formerly regarded themselves as merely the ministers of nature,—and acting under this impression, seldom interfered to restrain her operations. In the rapid advance of science, and the march of mind, fancy has not been idle! and the former humble follower of nature, has ventured to take the lead; and amid the revolutions of the world, the physician has assumed the privilege of enforcing, or of counteracting the laws of nature, by means of the adventitious and partial knowledge, that he has (or thinks he has) acquired! But, as the poet says of this mighty power,
“Natura si furca expellas, tamen usque recurrit.”
And hence she strives continually to maintain that supremacy, to which she is so justly entitled! Shackled and enchained however by her ruthless tyrants, what can she, for the most part, effect, save abortive attempts; by which too frequently injury is produced, rather than the benefit that might have otherwise been anticipated! Under all the circumstances thus presented for reflection, it will be readily perceived that it would be unnecessary to enter further into the subject; and yet, very much of a practical nature might be attained from a correct translation of the books in question, and many acknowledged truths would be admitted by the reader.
GALENI, DE DIEBUS DECRETORIIS, LIBRI TRES.
of critical days: in three books.
Bas. Ed., p. 558.
In the commencement of the first of these three books, Galen explains what is intended by crisis, and critical days, in a very satisfactory manner; and opposes those who deny the existence of the latter. He then enters on the consideration of the doctrine of these days, and that of each in particular; and minutely considers the subject under all its bearings.
In the second book the subject is continued, and that of astral influence is taken up, especially of the sun and moon. Hippocrates is largely referred to, and, indeed, the whole may be regarded as in a great measure a commentary on that great physician. The comparison is made between the sun and the moon, the changes of the atmosphere from the influence of the latter in its occultation, &c., together with much of a meteorological nature. This is further extended in the third book, the beginning of which is chiefly a recapitulation of the preceding. The sol-lunar influence is as fully unfolded as by Balfour and others of later date. The changes of weather and of the winds, &c., as derived from the appearance of the moon, are given, in the quotation of some Latin hexameters from Aratus, which Galen says are correct; and he gives us his reason for writing this third book on the subject of critical days; which was, a vehement call on him from many friends, to carry it into effect, and he concludes by affording an explanation of what is meant by an acute and chronic, a short and a prolonged disease, &c.
And here we may ask, why the heavenly bodies, or planets, should not possess some influence on the living system both of animals and vegetables, when that influence is admitted on mere brute matter. The production of the tides is attributed to the influence of the moon, although the quo modo is not uniformly established. How far it is really true, is hard to say. Our highly-gifted Franklin doubts its correctness in an interesting essay or letter on the subject! Much may be urged on either side, and whether it be possible to arrive at a perfect solution, may well be doubted.
GALENI, IN PRIMUM PRORRHETICI LIBRUM HIPPOC. COMMENT. TRES.
three commentaries on the first book of the prorrhetics of hippocrates.
Bas. Ed., p. 616.
There have been doubts as to the first book of Prorrhetics having been written by Hippocrates. However this be, the predictions, (170 in number,) with the commentaries upon them, are not undeserving of attention. They can scarcely be abbreviated: all that need be stated, is, that after pointing out, why predictions are necessary to the physician, we have several of the symptoms or signs, by which predictions are deduced; such as those derived from the eyes, tongue, mode of lying in bed, and all such as are enumerated in the book of prognostics; and, as it seems to me, they should be conjointly studied, as affording mutual and great assistance. Like all the brief sentences or aphorisms of Hippocrates, they require the able comments of Galen, fully to appreciate them. Like isolated texts, without an explanation, they are very unimportant and incomprehensible, if not inconsistent; a position admitted by Galen himself, who, in the beginning of the second commentary, says, “Multa quidem in libro toto carent perspicuitate.”—I may here remark, that this is one of the Hippocratic writings that has been translated by Moffatt, and printed 1788, with “large annotations, critical and explanatory.” They serve, however, rather to whet the appetite, and thereby prepare it for the far more extended commentaries of Galen.
GALENI, IN PROGNOSTICA HIPPOCRATIS, COMMENT. TRES.
three commentaries on the prognostics of hippocrates.
Bas. Ed., p. 726.
This book of Prognostics is likewise translated by Moffatt, but it is of the text alone of Hippocrates, and unattended by any notes or commentaries, save a few at the foot of a page. Galen has been diffuse in his commentaries. This, like the preceding, can scarcely be abridged; and I could but repeat, what is there remarked. Certainly the comments of Galen in a good translation, would be well calculated to promote reflection; for they are on subjects of much interest and importance. In the Venice edition there appear to be one hundred and fifty-eight sections or texts, whilst in that of Basil, they are made to amount to one hundred and sixty-four.
GALENI, DE DIGNOTIONE EX INSOMNIIS LIBELLUS.
of indication from dreams.
Bas. Ed., p. 820.
In this short treatise of scarcely a page, Galen has given us much on the indications derivable from dreams; and undoubtedly the state of the body must, and does influence that of the mind on many occasions; so that a judicious physician will be enabled occasionally to call to his assistance even the “visions of the night” in aid of his opinion. His speculations as to the state or location of the mind (anima,) during dreams, and sundry speculations as to the causes, &c., are plausible at least as any that can be now advanced; and although this production is of no great importance, it yet affords additional proof of the indefatigable attention paid by Galen, to investigate his patient’s complaints by every means that would afford him a probable assistance in attempting his cure!
GALENI, DE PRÆCOGNITIONE LIBER.
Bas. Ed., p. 822.
This book, addressed to Posthumus, maintains the capability of the physician to predict what is about to happen to each patient. In doing this, the writer informs his friend that he had offended many physicians on his first settling at Rome by the predictions he made on several occasions. He depicts the habits of the medical men, at that period residing in Rome; by which it appears that professional animosity was as high then in that city, as it has been elsewhere, at any time; and he comes to the following conclusion in relation to them, “Ergo, ut apud nos sibi latrones parcunt, et in facienda injuria, mutuo conveniunt, ita medici Romæ nunc habitantes faciunt, hocque solo a latronibus differunt, quod in urbibus, non in montibus scelera perpetrant.”—In animadverting on the ignorance and malice of these men, he speaks of patients cured by himself after they had been deserted by them;—of his detecting by the pulse the love and anxiety of a female for a man; together with other cases of considerable interest; and finally mentions his retreat from Rome to his native country; and his recall by the Emperors Antoninus and Commodus;—then recurring to the subject of predictions, he states other instances of much merit, finishing thus the book;—and with it terminates the fourth class.
[a ]It may be here remarked, as of some interest, that in this book, Galen evidences his acquaintance with the writings of both the Old and the New Testament. He is speaking of the difficulty of divesting one’self of sectarianism in medicine, and repeats from some writer,
[a ]Rhythmus—ρυθμος—proportio pulsuum prioris cum subsequentibus. Castelli, Lexicon.
[a ]Refutation of Harvey’s claims.
[a ]Which are chiefly the mere excrementitious parts of the food taken in; is it possible that the urine coming by secretion from the interior of the system, can be justly neglected?
[b ]Water doctors.—It is well known that within a very few years, some European practitioners acquired large sums by prescribing after simply inspecting the urine of their patient, by which they became fully acquainted with his disorder;—hence their common appellation was that of water doctors. At present our intention in adverting to the fact is merely to introduce a jeu d’esprit, applied, it would seem, to the celebrated Doctors Mead and Sloane. Whether either of those gentlemen, in their examination of the urine, went further than mere inspection, as was mostly the case, we know not. It is, however, a good hit—and ought not to be lost;—we can join in a laugh on the profession, although members of it; for we well know it is often well deserved. It does not, however, at all diminish our respect for the science, nor for those great and able members who have helped to rescue it from that general ridicule bestowed on it by Le Sage, Quevedo and others, but which might have been legitimately and advantageously administered in particular cases. “an old woman’s fun; or, the doctors outwitted.