Front Page Titles (by Subject) CLASS VI.: OF THE INSTRUMENTS OF CLINICAL PRACTICE. a - The Writings of Hippocrates and Galen
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CLASS VI.: OF THE INSTRUMENTS OF CLINICAL PRACTICE. a - 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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OF THE INSTRUMENTS OF CLINICAL PRACTICE.a
Galeni librorum sexta classis de Cucurbitulis, Scarificationibus, Hirudinibus, et Phlebotomia præcipuo artis remedio tradit.—Ven. Ed. 1609.
This sixth class, although the shortest, is yet, all things considered, one of, if not the most interesting of Galen’s works, whether as tending to show his great promptitude in bloodletting, his excellent judgment, in relation thereto, or in connexion with his admirable defence of it against Erasistratus and his followers. In most instances his rules are excellent, and some particulars may afford us instruction in several cases of a doubtful nature. If we admit that Galen did not fully comprehend the circulation as now (yet imperfectly) taught, we cannot doubt that the existence of such a function was strongly and uniformly present in his mind, and that he comprehended its necessity, and acknowledged its importance, in his regulations for derivation and revulsion! A man who judges so correctly of venesection, and points out so minutely all its details and its practical utility, surely cannot be deemed ignorant of its existence universally; and in acknowledging the possibility of death from loss of blood from a single vessel, from the anastomosis of them in every part; surely, no great superiority over this information, can be strictly or justly ascribed to the assumed discoveries awarded to Harvey.
GALENI, DE HIRUDINIBUS, REVULSIONE, CUCURBITULA ET SCARIFICATIONE.
of leeches, revulsion, cups and scarification.
Bas. Ed., p. 1053.
In the first chapter of this book, he briefly notices the multiplied uses of leeches, with the means of insuring their biting, in which ablution of the part is particularly insisted on; and even preparing the leech for the operation, by putting it in warm water, and removing the sordes from their surface by soft sponge, &c.—if applied to the hands or feet, those parts are to be immersed in the water with them. Snipping off their tail, to keep up the flow of the blood, is mentioned; and the subsequent application of cups, if necessary to continue it. Several measures are given for stopping the bleeding when it continues beyond our wishes, amongst which are burnt galls, and heated pitch. He regards the action of this species of bloodletting as confined to the blood of the superficial skin and flesh, and that they are simple substitutes for cupping, and are to be removed when half the amount is abstracted, in order (it is to be presumed) to give place to the cups.
In treating of revulsion in the second chapter, some useful practical facts are afforded, even if dissatisfied with his doctrines. Thus, in promoting revulsion from the chest or belly, the application is to be made to the hand; and to the lower parts, when the revulsion is to be made from the stomach to arrest vomition; acrid glysters are recommended for a like intent. The application of cups to the breasts (mammas) is spoken of; and to the præcordia, in epistaxis, or in uterine hæmorrhage, and other particulars are laid down.
In respect to cups, (third chapter,) evacuations are previously recommended; and plethora seems to be regarded as opposed to their employment; for which cause they are not to be used in the beginning of inflammation of the brain and membranes, or other parts; but rather after all due evacuations are had recourse to. The effects of cupping are to abstract matter, allay pain, diminish inflammation, discuss swellings, induce appetite, restore energy to a weakened stomach, to cut short deliquium, translate morbid afflux from parts deep seated, restrain hæmorrhage, and benefit menstruation.
The subject of scarification is then taken up, and “multum in parvo” may be said of it; the when, and the where, are briefly pointed out to the reader.
Immediately following this book is a short one, in the Venice edition, called a discourse (sermo), by Oribasius; it is on nearly the same subjects, and taken from his seventh and eighth books, as by him abstracted from Galen, Antyllus, Herodotus, Apollonius, and Menamachus; and in so far as epitomizing several preceding writers, it is by no means devoid of interest. Not belonging to my subject, I, however, pass it by, merely stating that different kinds of cups are mentioned, such as glass, horn, and brass:—this last being most commonly employed; and the glass is commended from its enabling us to see the amount of blood discharged. The operation is effected with the glass or brass cups, by aid of heat; with the horn, by forcible suction through an aperture. On the subject of phlebotomy, Apollonius, who is very favourable to scarification, says, however, that no one will suspect him of thereby exploding it, for he never omits it in the most dangerous diseases; in which it is requisite to employ it speedily and largely, in proportion to their violence.
GALENI, DE VENÆSECTIONE ADVERSUS ERASISTRATUM LIBER.
of venæsection, in opposition to erasistratus.
Bas. Ed., p. 1057.
Erasistratus appears to have been the prototype of old Van Helmont in his enmity to bloodletting; and severely has Galen animadverted on him and his disciples. He commences this book by saying he deemed it worthy of inquiry, why, whilst Erasistratus had in relation to many trifling remedies, written most minutely, even as to their most insignificant points, as in the manipulations of a poultice, he had been altogether silent respecting bloodletting; even studiously so, whilst many celebrated ancient writers had fully treated of it before his time; and he tells us, that in all his writings, the word venæsection only once is to be found. This anomaly Galen attempts to elucidate, and gives us the opinions of Erasistratus in respect to the origin of fever and inflammation, and their conjunction; and then inquires, why he preferred abstinence to bloodletting, seeing it was so tardy in its effects, when the latter was prompt and immediate. Galen remarks on the universal evacuation from bloodletting, its rapid influence, and even the example of nature herself, who was so much esteemed by Erasistratus. The whole book is a satirical review of his opinions and conduct. Neither Dogmatist nor Empiric rejected phlebotomy; and physicians themselves uniting in its employment, only differed as to the amount, the precise period, and the part from which its abstraction was to be made; which points, he briefly treats on. He adverts to the facility of stopping the discharge at pleasure, and of the judgment that may be formed as to the amount from the change of colour in the blood as it flows.—Other remedies, after being taken, are no longer under our control, whether they work for good or evil; and this remark extends even to the aliment employed. He ridicules those who call themselves after Erasistratus, and tells them, they did not comprehend him. That their master had only three modes of evacuation,—baths, exercise, and the negative one of diminished diet; which last, he adds, is longer in promoting its effects, and is more injurious to the whole system than venæsection; which is more prompt, and safer, and not unfrequently prevents a rupture of some vessel. On these and other points, much is said, and he repeats that Erasistratus makes no reference to venæsection.
GALENI, DE VENÆSECTIONE ADVERSUS ERASISTRATÆOS QUI ROMÆ DEGEBANT.
of venæsection, in opposition to the erasistrateans of rome.
Bas. Ed., p. 1074.
It is probable that the preceding book had called down the indignation of the followers of Erasistratus; and that Galen wrote this, in reply to their affirmations in behalf of their master. He tells us that at first settling at Rome, he found many physicians who so totally repugned venæsection, that they would not bleed in cases of the greatest emergency; some of which cases he mentions, and their fatal issue. He affirms that they even mistook the opinions of their master, and fell into subterfuges on the subject. In evidence of this, he analyses in a masterly manner, several of these cases, which had evidently proved fatal, from a neglect of this evacuation; their errors are largely dwelt on, and combatted; and the practice pursued by them, is justly censured! The reasons assigned by them and their masters, for the omission, are considered; and some judicious remarks are made as to the use of this evacuation, or its omission. In one part of the book we find the unacceptable remark, that “Desiderantur hoc loco non pauca.”
GALENI, DE CURANDI RATIONE PER SANGUINIS MISSIONEM LIBER.
of the rationale of bloodletting.
Bas. Ed., p. 1099.
This book may be considered as a full account of every thing connected with bloodletting; such as the mode of operating, and the preliminary considerations leading thereto; what affections chiefly require it, and wherefore; the locality to be selected, whether of an artery or vein, the amount, and other particulars. It is as a whole an admirable book, and deserves to be studied for its merits as practically elucidating the benefits of venæsection. Unquestionably much useless speculation exists, but this ought not to preclude us from the information to be derived from other parts. The boldness of his practice is conspicuous throughout; his judgment not less so; neither of which are reconcilable to an ignorance or doubt of a circulation, even if some error may be ascribed to his demonstrations, so repeatedly enforced in order to enhance the merits of Harvey. No one has a right to judge in this, who has neglected or omitted to read the writings of both Galen and Harvey; and yet deems himself adequate, on mere second-hand authority, (too often itself removed alike from actual investigation,) to call in question the knowledge of the former, and to crown with laurel the head of the latter! If Harvey has actually discovered any individual parts of the circulation or its structural adaptations, unknown to Galen, or to any anterior to the period of his own elucidations, let them be clearly advanced in his behalf; but that such can be done by his warmest admirers, we have great doubts! for even now, all the mysteries of that wonderful contrivance are far from being fully comprehended, or universally admitted.
In this book, Galen again animadverts on the falsehoods of the Erasistrateans as to venæsection, telling them very plainly, that subtile as they are in their wicked sophistry, they well knew that they were lying at the time (mentiri se sciant), in striving to prove it a novelty. Whereas, many ancient writers, some of whom he mentions, had extolled it as first on the list of remedial agents. He affirms that on every question, reason or experience, or both united, must decide; and refers the reader to his treatise “de plenitudine” as a proper subject, previously to reading this book. He points out some of the circumstances that indicate the propriety of bloodletting, and others forbidding it; together with the general views to be considered when about to prescribe it, and the indications by which its propriety may be judged of. He speaks of its use in gout, and of his cures by it in the spring, as well as by purging; both of which are usually injurious in cases of intemperance, whether in eating or in drinking. He makes a remark of importance to show the conjectural character of medicine, as deduced from the different doses of medicine required; and points out, what cannot be too often repeated, as a guard to presumption in our doses, that such exhibition if erroneous, admits not of correction; whilst venæsection is superior in this respect, since we can at once arrest it; its efficacy is immediate, when from plethora, &c., a violent and acute fever requires to be arrested, by bleeding ad deliquium, yet at the same time with proper caution.a He says he remembers thus having drawn off six cotylab (about one lb. troy each) at once; with other instances of a like kind, being at the same time governed by the indications drawn from the pulse, the spissitude or tenuity of the blood, and its improved hue from a dark colour; which last, he tells us, was Hippocrates’ rule for bleeding in pleurisy, and he gives various cautions for our benefit. The pulse, he tells us, he particularly attended to, as the blood was flowing, lest, when least expected, death might ensue instead of syncope, as happened in the practice of three physicians. He inculcates what practically we find erroneous, not to bleed (with some exceptions) under fourteen years of age, nor beyond seventy, to which he seems to have been led by some of his speculations on the subject of plethora. A case is recorded of ophthalmia, in the steward of a rich Roman, attended by a physician of the sect of Erasistratus; that is, one who was an enemy to bloodletting; and who had been under his hands for twenty days. By a little finesse, Galen obtained the chance of prescribing for him at his own (Galen’s) house for three days, at which he was directed to call. “Venit autem, (says Galen,) circiter horam quintam: ac prima protinus detractione, tres sanguinis libras exhausi, deinde, hora nona, aliam,”—and by this treatment, and some topical application, on the third day, he sent him back to his master, nearly or quite restored. The other physician seems finally to have received from the master, the appellative or nickname of αιμαφοβον or sanguifugus.
Galen speaks very decidedly as to bleeding in inflammation of the throat and windpipe; and reprobates those physicians who limit blood-letting to the first days of the disease; some, he says, not daring to extend it beyond the third, and others the fourth as the extreme; but he adds, we must bleed even on the twentieth day, if strength permits, and forbear even on the second, should prostration ensue. He laughs equally at the presumed hour of the day, on which some fixed the operation, as at five or six in the morning, &c. Night or day, says he, makes no odds;—giving at the same time some cautions on the subject; and concluding this interesting book with some remarks on arteriotomy, its dangers and advantages; the danger of aneurism, and even death from not being acquainted with the vessels by dissection; and declaring the necessity of tying up the artery with a ligature, when unhappily wounded, (necesse enim hic est laqueo vasculum constringere). He seems not to have omitted arteriotomy in different parts, on many occasions; and notices the circumstance of the ancients having called arteries by the name of veins, as being elsewhere treated of by him.
With this book the sixth class is brought to a termination.
[a ]Οργανα εις ϰλινιϰην.
[a ]It may be here added, the carelessness of physicians too often in writing their prescriptions so illegibly that mistakes are not unfrequent; committed, as they not uncommonly are, to some ignorant assistant. We have heard of death from the mistake of aqua fortis for aqua fontis, and others of a similar description; and we have lately seen a “Correction” publicly given, calling on the proprietors of a medical formulary to correct a typographical error as respected the symbol of quantity in so highly dangerous an article as prussic acid, in which an ounce (Ʒi.) is prescribed instead of a drachm (Ʒi.) Typographical or not, the proof reader and the printer are both reprehensible, and should not have the charge of a publication, in which the lives of the community may be said to be hazarded.
[b ]“Cotyla Attica, pendet uncias novem, ut Hemina Italica. Cotyla Italica vero est libra mensuralis unciafum xii.” Blancard’s Lexicon.