people in a district at certain times; sporadic, or maladies of different characters affecting a people at the same time; and hereditary, or those disorders which are born with us, and have been transmitted by parents.

54. Crisis and critical days are largely dwelt upon by Hippocrates. He talks of the terminations of diseases as being regulated by the concoction of humors, and of the modes which nature employs to expel these humors from the body after due preparation.

55. The critical periods of our author are formed considerably upon the Pythagorean notion of numbers, and he speaks of every fourth day as having something in it of destinating or regulating power. In disorders which he would call exceedingly acute, the coction of the humors becomes completed and the crisis perfect on the fourth day; the ordinarily acute disease may pass on to the seventh, and sometimes to the eleventh, or even to the fourteenth; occasionally he talks of acute diseases being protracted to the twentieth, or one-and-twentieth day, and at times even to the fortieth and sixtieth: after this last period the disorder is considered as justly entitled to be ranked among chronic affections.

56. After the time of critical tendency is over, in reference to days, Hippocrates supposes the seasons and other circumstances to influence the termination or protraction of disorders; some, for example, terminate about the equinoctial, others about the solsticial periods; others are regulated by the stars and constellations; and there are affections which are influenced by entire months and years; thus certain disorders, incidental to infancy, have reference to the seventh month from birth, and others to the seventh or fourteenth year.

57. Hippocrates does not argue for the absolute necessity of crisis in disorders, but he contends that the termination of acute maladies without them is not so safe and satisfactory as when they have place. He further recognises and speaks of the mutation of diseases, as when inflammation of one part or organ leaves the place originally affected, and falls upon another; or as when cancer of the breast is changed for cancer of the womb.

58. On prognosis and diagnosis the writings of Hippocrates are exceedingly full and particular. He especially speaks of the physiognomy as indicative of danger or otherwise; and his statement respecting the appearances of the countenance, in an individual who is about to sink under the violence of a disorder, has become proverbial. The Hippocratic visage is talked of even in the present day. When, he says, the nose is sharp, the eyes are sunk, the temples hollow, the ears cold and drawn back, the skin hard, extended, and dry, and the color of the face approaching to a leaden appearance, death is certainly approaching; to these signs he adds hanging, relaxed, and cold lips. He takes special notice of the appearance in the eyes. When a sick person is incapable of supporting the light, when he sheds tears involuntarily, when, during sleep, he shows part of the white of the eye, should that not be his habit, or he has no diarrhea upon him, things are for the most part in a bad state, the last being a particularly unfa

vorable symptom. A want of the usual brightness of the eye is either a sign of approaching death, or indicates extreme feebleness. A sharp, fixed, and at the same time wild look in the eyes, denotes present or approaching phrenzy. When the individual sees red sparkling or clear bodies floating before his eyes, a nasal hemorrhage may be anticipated, or some critical loss of blood.

59. The manner in which the sick lie in bed is especially marked by Hippocrates as demanding and deserving observation. If the patient lies on one of his sides with a slight curvature, as in health, we may judge favorably of his state; on the contrary, if the individual lie on his back, with the arms and the limbs generally extended, and particularly if he is found gradually to slip down towards the bottom of the bed, a motion which proves that the body is as it were acting by its own weight without any muscular resistance, approaching death may be calculated on. Lying on the abdomen, should this position not be the common one, indicates either delirium or pain in the belly.

60. When an individual who has a fever upon him is continually picking with his hands and fingers, and often putting his hands about his face and eyes, as if to remove something that is irritating him, or pulling about the sheets and coverlet of the bed, as if to take things away that are offensive to him, delirium and death may be predicted; the approach of delirium is also menaced by the circumstance of a person, naturally taciturn, becoming talkative; or, on the contrary, when a great talker becomes all at once silent and reserved.

61. Starting of the tendons (subsultus) is marked as an especially unfavorable omen.

62. Frequent or oppressed respiration is a bad sign, as are continued watchings or want of sleep.

63. The color, the odor, and the consistence of the excrements, are matters of importance to attend to: if the fæces are soft, of a reddish brown, and of due consistence, answering in quantity to the ingesta, and evacuating at accustomed times, and not of an uncommon odor; the symptoms in reference to this particular are favorable; the fæces ought also to increase in consistence as the disorder approaches a crisis. Liquid motions may indeed be considered as importing well, providing they are not discharged with much noise, and not rendered in very small quantities, and very frequently. All watery evacuations from the bowels, whether of a white, or very high color, or of a greenish cast, or frothy, or nauseous, are bad. But the worst sort of fæcal discharges are those which are black and greasy, and those which are of a verdigris color. That discharge which is actually black, and which Hippocrates considers to be black bile, invariably denotes a very high degree of danger. Indeed, bile discharged in any form unmixed with fæcal matter is always a bad symptom.

64. In respect to the urine, that is to be considered the best which readily throws down a sediment of a whitish and equable kind; the notion of Hippocrates in regard to such urine is that this regular sediment denotes a disposition to what he calls, as above intimated, the coction of the humors. When, he says, the urine is

cloudy, and does not show a tendency to become clear by throwing down a sediment, the humors are in a crude unsettled state. When it is unusually white and clear, a very considerable erudity is denoted, and sometimes a transfer of the bile to the brain. Urine which is particularly yellow or red marks a superabundance of bile. Black urine is an exceedingly unfavorable omen, especially if its odor be particularly unpleasant, or if it be either preternaturally thick, or more than commonly clear. Those urinary discharges which appear to have in them a thick meal, or bran, or small bodies like scales or shells, are unfavorable, and denote a disorder in the bladder or the kidneys. Urine, upon the surface of which oily matter is found swimming, marks a disposition to consumptive wasting of the flesh. The sudden discharge of a copious quantity of urine is for the most part critical. The correspondence of the appearances on the tongue with the urinary discharge is pointed out by Hippocrates as capable of recognition, and important to recognize; if for example the tongue is yellow and charged with bile, the urine should be of the same color and condition; on the other hand, if the tongue is red and moist, the urine will be found natural in its appearance.

65. Matters discharged by vomiting ought to be mixed with bile and phlegm; those in which only one of these matters is present are not so favorable. Black, livid, and green discharges from the stomach are bad; and if they have a particularly strong odor, they denote approaching death. Vomiting of blood is often fatal.

66. Expectorated matter, or that discharged from the chest, is favorable in proportion to the facility with which it is thrown out; and, during the early periods of pulmonary disorder, it is not amiss to see that discharge of a yellowish tinge; but if this discoloration continues, or if the matter be acrid, and occasion violent cough, it is a bad sign. If the expectoration be quite yellow, it cannot be considered good; and discharges of a white, glairy, or frothy kind do not relieve the patient. White expectoration de

notes a due coction, but then this whiteness must not be accompanied by viscosity, nor should the expectorated matter be either very thick, or very transparent. The same observations apply to discharges from the nose. Expectorated matter that is either black, or green, or red, is bad. But the worst sign in pulmonary affection is when the matter which ought to be thrown off from the chest is retained. Spitting of blood is followed by a discharge of pus, upon which follow consumption and death.

67. Perspiration is favorable when it happens on a critical day, when it is abundant and universal; but cold sweats are always unfavorable. If sweats are confined to the head and neck we may expect that the malady will be protracted and dangerous. Light partial perspirations either point out the seat of the disease, or denote topical weakness.

68. A soft equable condition of the hypochondria and the abdomen always imports well; if upon feeling over the abdomen any irregu

larities are found, or if one part is more hot than another, or painful to the touch, we may conclude that there is either external or internal inflammation.

69. With respect to the pulse, it is generally admitted that the remarks of Hippocrates do not correspond in precision on this head with those which are made in reference to other particulars. Some indeed have denied that our author recognised the pulse at all in the sense which we give to the term, that is the ordinary and natural beat of the arteries; and, with his confused ideas of the blood's flux and reflux, it is conceivable enough that the circumstance of pulsation would not by him be appreciated as it is in modern times; certain, however, it is, that in the books on Epidemics we read of frequent and strong pulses in acute fevers, and of the trembling, weak, and languishing pulse as indicative of approaching death; but it must still be allowed that on the subject even of fevers Hippocrates dwells much more upon all other symptoms, especially on the variation and degrees of heat, and on the kind of respiration (both highly important points of recognition) than he does upon the character and circumstances of pulsation.

70. We shall now consider the practice of Hippocrates, or the principles upon which he professed to treat diseases, as well as the remedies he was in the custom of employing; on these heads, however, we shall be proportionately less full than on the subjects of signs and prognosis, inasmuch as the maxims and remarks on these last are applicable to all times and all circumstances; while practical or therapeutical medicine varies with varied states of the art, and with the modifications made in disease by time and place.

71. Hippocrates gives the following general principles for regulating medical practice. We must proceed to oppose contrary to contrary; we must evacuate in cases of repletion, and supply materials where there has been too much loss. We must have recourse to heat in cases of cold; and meet superfluous heat by refrigerating measures.

72. We must recollect that there are certain juices or humors which require to be discharged or dried; others which are to be restored. We must be careful not to be very precipitate in our measures, either of depletion or repletion, either of discharge or restoration. We must not fearlessly and abruptly meet heat with cold, or cold with heat, nature being an enemy to every thing that is violent or in excess. We must sometimes contract and sometimes dilate, so as to give facility and freedom to the passage of the humors by the first operation, and restrain their too copious discharge by the second. There are occasions too in which we are called upon to sweeten, to harden, to soften, and to render parts finer or more subtle; sometimes we must give them increased thickness, at other times excite or stir them up, and occasionally it is necessary to blunt the sensibility of the body. It is expedient moreover to take good note of the natural tendency of the humors, and to follow nature as much as may be in her course, not to direct upwards what nature disposes downwards,

or to force in one direction where the natural disposition is to the opposite. We should be solicitous to choose convenient passages for discharges, and not permit matter which has been thrown out from vessels to return. Should we have attempted a course of proceeding without success, we must not be too quick in changing our plans of operation. We ought, however, to be ever watchful as to what obviously agrees or disagrees, or what the patient can and cannot support. Nothing ought to be undertaken rashly; and it is often the part of a prudent physician to stand still and merely watch, without any interference, since nature sometimes cures without the assistance of art, and, when we are doing nothing, we of course are avoiding positive mischief. In extreme disorders, Hippocrates proposes extreme remedies. What medicaments will not effect, may occasionally be effected by iron (cautery), and what this latter fails of performing may sometimes be accomplished by fire. At the same time, we must not think of uselessly interfering when the case is desperate, and beyond of medicine. powers

the

73. In the detail of his practical directions, Hippocrates considers largely the subject of purgation, and he has a notion that the several articles which are employed as cathartics have the power of attracting as it were the particular something that requires to be thrown off, and thus effecting its expulsion; that having effected this main operation, of attracting the matter to be expelled, it subsequently takes hold of others; thus, if a medicine which is given for the purpose of purging off the bile is too strong, it takes hold first of the bile, then of the phlegm, then of black bile, and finally of blood. The purgatives employed by him were many of them of the active or drastic kind, such as hellebore, elaterium, scammony, colocynth, buckthorn, &c. The doctrine of concoction of humors, Hippocrates applies to purgative operations; and in some cases this preconception must have led him to erroneous timidity in respect to purgative medicinals, and, indeed we find some inconsistencies on this point; for in one place he talks of the propriety of purging at the commencement of acute diseases, while in others he speaks of its impropriety, till the humors are sufficiently prepared by concoction. Suppositories and clysters were employed by Hippocrates.

74. Bleeding, according to our author, should be instituted under several indications; in the first place, that of evacuation, or taking off a superfluous quantity of blood; in the next place, that of recalling the impetus of the fluid from parts where it is going in too large quantities; thirdly, to procure a more free motion of the blood and spirits generally; and fourthly, to cool the system. In those maladies which appeared to have their seat above the liver, he directed that blood should be taken from the arms, or from some veins in the upper parts of the body; while, in those disorders the locality of which was lower than the liver, he ordered the discharge to be procured from a vessel in the foot, or ankle, or ham.

75. The practice of taking blood by cupping is also spoken of, and directed by Hippocrates,

both in the dry way, or without previous scarification, and also after scarifying.

76. When purging and blood-letting did not appear to avail sufficiently in diminishing the quantity of superfluous humors, our author had recourse to diuretics and sudorifics; sometimes simply ordering the bath or wine, to produce an increased flow of urine; at others, employing one or more of the diuretic species of vegetables, as garlic, onion, leek, fennel, &c.; but, when he wished for a more powerful diuretic operation, he administered cantharides, powdered and mixed with wine and honey. He scarcely mentions any particular sudorifics to be taken into the stomach, and in only one or two places alludes to the practice of provoking sweat, by pouring hot water upon the head. Ydaroç поλλв каι Oɛрμe κατα της κεφαλης καταχεόμενα.

77. In harmony with his doctrine of humors, Hippocrates talks of medicaments which increase or diminish dryness, or which resolve or dissipate humors, without actually purging; thereby indicating that class of remedies which would in the present day be called alteratives; and he speaks of drugs which procure sleep; of the mecon (uncov) he speaks in several places, which was the poppy of the Greeks; but it is curious that he ascribes to this plant generally a purgative quality. There seems in this, as in the instance of hellebore and several other drugs employed by the ancients, reason to believe that the names have not been handed down to posterity correctly. Galen informs us that some considered the peplis and spatling poppy for the same plant; and he mentions, in his commentaries on Hippocrates, that meconium and peplis were often spoken of as the same thing. In addition to medicines acting thus sensibly, or upon certain principles, Hippocrates alludes to the specific virtues of drugs, or those which produce a particular effect without their modus operandi being at all known.

78. External as well as internal medicaments were employed by our author. Fomentations were employed in various ways; the first was that in which the patient sat in a decoction of herbs, so that the part affected should be as it were soaked by them; indeed this was a kind of medicinal bath. A second form of fomentation was that of enclosing hot water in a skin or bladder, or in a copper or earthen vessel, and applying the vessel to the part affected. Sponges tco were employed for fomentation; and bran or vetches applied in linen bags. These applications were further made occasionally in the dry way, as by heated salt or millet in bags. Vaporous fomentations were also employed by Hippocrates, of which we find an example in the first book on Female Maladies. He threw bits of red hot iron into urine, and caused the patient to receive the steam from below. His intention in applying these fomentations was to warm, resolve, and dissipate; to draw out peccant humors, to assuage pain, and open or close pores, according as the materials employed were relaxant or astringent. Fumigations also were much employed by Hippocrates; and we find pitch, and sulphur, and other things, employed in this way for the purpose of bringing away phlegm from

the inference is apt to be made, that if he have not health himself he cannot give it to others.

97. A physician ought to be attentive to propriety in his habits, to possess a gravity of demeanor, to be moderate in his actions, and chaste and modest in his conversation with females; he ought not to be envious, unjust, nor a lover of dishonorable gain he should not be a great talker, but nevertheless ready to give a prompt answer with suavity to every proper question. He should be sober, patient, and ever ready to do his duty; he should be pious without being superstitious, and always conduct himself honorably both in his especial calling and in the general conduct of life. 98. It is not discreditable to a physician, when he feels a doubt about the method of treating a case, to call in the aid of another opinion.

99. As it regards remuneration, a physician ought always to act according to the ability of the patient. On some occasions pecuniary reward ought neither to be asked nor expected; on the other hand the fee may occasionally be given and received in advance, that the patient may with more confidence commit himself to the care of the physician.

100. Those who have considered medicine as having God for its author, have in my mind considered justly. Physicians and philosophers have this in common, that they have the knowledge of the Divinity forcibly impressed on their minds.

101. Such, says Le Clerc, are the principal maxims given by Hippocrates respecting medicine in general, and the duty of its professors. The reader is left to judge for himself on their merits, and physicians may make what use they please of them. It appears from these maxims that there were many physicians in existence at the time when Hippocrates wrote, and but few good ones. It is also evident that consultations were used in his time.

102. Before we quit altogether the part of our history which refers to the Coan sage,' it may be right to say a few words on the subject of his writings, and on the question respecting the genuineness or spuriousness of those productions which have been attributed to our author.

103. Under the name of Hippocrates, says Dr. Parr, we have received works of very different value. Those of his predecessors and successors are confounded with his, partly from his having appropriated some of their remarks, in part from the high character he acquired, and from several of his descendants having retained his name. The chief cause, however, of the many spurious works attributed to him, is the avarice of the collectors of Ptolemy, who, when he founded the library of Alexandria, endeavoured to obtain at the most extravagant rates the works of every author of reputation. Every thing under the name of Hippocrates was eagerly received, and it was thought of little importance whether they proceeded from the first, second, or third of that name, so that the reports were not sifted with minute discrimination. To distinguish the real works of Hippocrates has been consequently a problem of no little difficulty. At the expiration of 500 years this task was attempted by Galen, who, with an intimate knowledge of what the succes

sors of Hippocrates had written, possessed a discriminating genius and a critical discernment of the style and manner of the Coan sage, which peculiarly fitted him for the task. Mercurialis, a man of the most extensive erudition; Haller, a physician of vast information, capable of the most incredible labor; and Grumer, possessed of all the indefatigable diligence of his native place, labored in the same field. They have assumed as a principle that Hippocrates was a man of singular abilities, extensive information, consummate candor and modesty. By these tests they have tried every imputed work. Though perhaps the principles might not be readily conceded, yet, as they will certainly point out to our attention the most valuable works, we shall give the result of their labors.

104. The undisputed works of Hippocrates are said to be the first and third books of the Epidemics, two books of the Prænotiones (a different work from the Prænotiones Coacæ, published by Elzevir, in 1660, by Duretus at Paris, and with commentaries by Hollerius at Leyden, which is very certainly spurious), containing the Prognostics and the second book of the Prorrhetica; De Dietâ in Acutis, in opposition to the Cnidian sentences; the Aphorisms; De Aere, Aquis, et Locis; De Natura Hominis; De Humoribus purgandis; De Alimento; De Articulis; De Fracturis; De Capitis Vulneribus; De Officina Medici; De Locis in Homine. This is nearly the enumeration of Haller; but Galen and Haller seem to have admitted tracts among the Hippocratic works with too great facility. Grumer, who like Haller considered brevity, gravity, and the absence of theoretical reasonings, to be the true test of the genuine writings of Hippocrates, differs in the application. He admits the Oath, but rejects the treatise De Naturâ Hominis, De Locis in Homine, De Humoribus, De Alimento, and De Articulis. Whether the Oath be rejected or admitted is of little importance, since it must be considered rather as an object of curiosity than utility. The first of these rejected works was admitted with hesitation by Galen and Mercurialis, as containing many passages very distant from the manner and doctrines of Hippocrates; but it was retained as containing some facts of importance. The second, though admitted by Galen and Cælius, and though it agrees in general with the practice of Hippocrates, has been suspected on account of some passages of a very different description. Haller only asserts that it may be his work; and Mercurialis, who ascribes it to Hippocrates, thinks that he did not live to complete it.

105. Grumer and Mercurialis reject the tract De Humoribus, but add that it merits attention. It has indeed been commended in every age, and illustrated with commentaries by Galen, Duretus, and Gunzius. The tract on Aliment on the contrary imitates only the terseness of Hippocrates, but betrays the author to be of a later era by the doctrine respecting the arteries and veins. The book on the joints is evidently the work of Hippocrates, or at least of the author of the tract De Fracturis, and universally admitted. It contains also an account of the luxation of the