By this term r On a sympton -h the symp se, some sugg has (37) the latter: hoa comes and (14) the e, or sympt 35, 42, 43, 54 at in confirme es the disease: nes on enlar I shall mere n as they ar at (§ 19) bone not restored: ody, becomes d rapidly in portant state st of all the tion is pro de. In $45 In § 39 the odus Præcog ics. double nature of convulsions is distinctly indicated. In § 47 it is laid down as a rule, that persons requiring bleeding or purging, should be bled or purged in spring. The last two Aphorisms relate to morbus coxarius, and are very interesting, as showing how well acquainted our author was with this disease in all its stages. SECTION VII. In this section, also, a large portion of the Aphorisms belong to the class called superventions, namely, from §§ 1-27, 29, 41, 47, 49, 70, 75, 76, 77, 78, 79, 80, 84, 85, 86. It appears, then, that nearly the half partake of this character. In this list it is generally a symptom which supervenes on a disease, as (§ 1) coldness of the extremities on an acute disease; and (§ 3) hiccup on vomiting; or (§ 7) rigor and delirium upon intoxication; and (§ 14) stupor and delirium on injury of the head; and ($15) purulent expectoration on hæmoptysis; and (§ 16) purulent expectoration on phthisis. Another class is mostly prognostic, as §§ 31, 32, 33, 37, 38, 44, 45, 52, 82. Of these, §§ 31, 32, and 33 relate to the characters of the urine in fevers, and are very interesting. Another class are diagnostic, as §§ 30, 34, 35, 36, 39, 40, 62, and 69. Other Aphorisms contained in this section are deserving of being well considered, such as §§ 66, 67, 68, 69, in which the importance of attending to the excretions is pointedly stated. In § 72, the prognosis founded on coldness of the extremities while the internal parts are warm, in intermittent fever, is distinctly pointed out. Many of the Aphorisms in the latter part of the work are probably supposititious; and, moreover, they are possessed of little value. The last, as given here, and in the editions of Foës and Littré, is memorable, from it containing a notable statement of the proportional powers of medicines, the knife, and the actual cautery as remedial means. This, then, is a brief outline of a work which, whether we regard the value of the subject-matters of which it is composed, or the influence which they have exerted on professional practice during a long lapse of ages, may be confidently pronounced to be one of the most remarkable works in the whole compass of Medical Literature. I may be permitted to say further respecting it, that whoever is possessed with any proper degree of liberal curiosity to understand the real state of professional knowledge at the time when its scattered fragments were first embodied into a regular system; and whoever would wish to have his mind thoroughly imbued with those enduring princples which have formed the groundwork of medical theory and practice during the many revolutions of professional opinions, in the course of the last twenty-four centuries, should give his days and nights to the study of these Aphorisms. But I would be entirely out of place; and that if I were to attempt it, I might be stopped short at once with the pertinent interrogatory, Quis culpavit? APHORISMS. SECTION I. 1. LIFE is short, and the Art long; the occasion fleeting; experience fallacious, and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals co-operate. The exordium of this work bespeaks at once the reflective philosopher and the practiced physician. It commences by contrasting the shortness of human life with the extent of the Medical Art, the parts of which, as Theophilus, the commentator, remarks, are diversified, and some of them require long and tedious investigation. "The occasion is fleeting," that is to say, the season during which remedies may be successfully applied is soon past; as the poet says, "fugit irreparabile tempus. Some render this clause by "the time is urgent," and this interpretation is quite apposite. The following clause might be rendered: "experiment is dangerous, and decision is difficult;" and this appears to be the meaning which Galen puts upon it. He remarks that it is evidently hazardous to experiment in a case which involves the life of a human being, and that it is difficult to catch the truth in medicine, as is evident from the circumstance of the profession being divided into so many opposite sects. The last part of the Aphorism evinces how well he had apprehended the difficulties which beset the practitioner of Medicine, who must not only be well acquainted with the part which he himself has to act, but ought also to possess the talent of making the patient, the assistants, and all around, co-operate with him in the performance thereof. The whole of Galen's Commentary on this Aphorism is replete with philosophical reflection, but is written in too diffuse a style for my limits. The same objection partly applies to those of Theophilus, Damascius, and Meletius. Compare Loc. in Hom. 1., 1; ib. lív., 1; II. Prædict. xix., 13, xxix., 8; I. Morb. iv., 1-2; I. Morb. Mul. lxvi., 13; Humor. i., 6, 7; Artic. ix., 7; I. Epid. ii., 93, 96; VI. Epid. ii., 78–82.1 2. In disorders of the bowels and vomitings, occurring spontaneously, if the matters purged be such as ought to be purged, they do good, and are well borne; but if not, the contrary. And so artificial evacuations, if they consist of such matters as should be evacuated, do good, and are well borne; but if not, the contrary. One, then, ought to look to the red scarcely re the former mas evacuat 1 The reader is requested to observe that in the Annotations on the Aphorisms the references, for convenience sake, are all made to the edition of Van der Linden, unless otherwise stated. that is to s ted the int es of which I as a precept w and ret I fe em find th De severe evac forget the The country and ants country fo 12 not bleed h 2zed to admi Coed, and that had not forgo Grant pro nat are Aphor. i. the athletæ, e they canno , they can them to get ed to an extrem Aphorism. The Hippocra Lere can scarce 44 slender and in acute d VOL. II. nted a reputati eting; exper not only be he reflective es by contras Medical Art, ta s the poet s must not c is, Damastas pontaneous do good, sai evacuations good, and are look to the the Aphoris country, the season, the age, and the diseases in which they are proper or not. I need scarcely remark, that this Aphorism consists of two divisions: in the former of these the effects of natural, that is to say, spontaneous evacuation, are described; and in the latter, those of artificial, that is to say, such as are produced by medicinal means. I have adopted the interpretation approved of by Galen, about the correctness of which I cannot entertain a doubt. The last clause of it contains a precept which is evidently of great importance in medical practise, and yet I fear it is often overlooked at the present day. We now seldom find the question mooted whether or not it be safe to practise severe evacuations in hot seasons or in hot countries; in a word, we forget the precept of Hippocrates, who directs us "to look to the country and to the season. A few years ago it was the fashion in its country for us to deride the Italian physicians because they would not bleed heroically, as was the practice with us. Now, we are obliged to admit that the Italians were not so far wrong as we supposed, and that their practice was adapted to their own climate. They had not forgot the rule laid down by their ancient countryman: "differunt pro natura locorum genera medicinæ." (Celsus, Præf.) Compare Aphor. i., 25; Humor. ii., 49; VI. Epid. iv., 30. 3. In the athletæ, embonpoint, if carried to its utmost limit, is dangerous, for they cannot remain in the same state nor be stationary; and since, then, they can neither remain stationary nor improve, it only remains for them to get worse; for these reasons the embonpoint should be reduced without delay, that the body may again have a commencement of reparation. Neither should the evacuations, in their case, be carried to an extreme, for this also is dangerous, but only to such a point as the person's constitution can endure. In like manner, medicinal evacuations, if carried to an extreme, are dangerous; and again, a restorative course, if in the extreme, is dangerous. In the Life of Hippocrates we have stated that he was initiated in medicinal gymnastics under Herodicus; in this school, then, it is to be supposed that he learned the facts which he enunciates in this Aphorism. The two following modern authors have written very learnedly on the gymnastics of the ancients: Hieron. Mercurialis (de Arte Gymnast. Veter.); Schulze (Hist. Med., and de Athletis Veterum.) Hippocrates evidently points out what happens in the case of the athletæ, as a lesson, to show the dangerous effects of repletion; he also takes occasion to state the danger of carrying depletion to an extreme. About the meaning of the different parts of this Aphorism there can scarcely be any doubt; and none of the commentaries, ancient or modern, supply much interesting information under this head. Compare IV. Morb. xi., 15, 16; Aphor. ii., 51; Vet. Med. xviii., 1; Vict. Acut. xvii., 10; and Celsus, ii., 2. 4. A slender and restricted diet is always dangerous in chronic diseases, and also in acute diseases, where it is not requisite. And again, a diet VOL. II.-13. when in the extreme, is also dangerous. As Galen, in his Commentary, remarks, our author, having pointed out the dangerous effects of too great repletion and depletion on the health, in the present Aphorism defines the effects of a slender, an extremely spare, and a full diet, in diseases. Any difficulty which the reader may meet in this Aphorism, he will find cleared up satisfactorily by Heurnius and Berends, in their very sensible Commentaries on the Aphorisms of Hippocrates. Compare Vict. Acut. xx., 6, 7; Aph. vi., 39; and Celsus, iii., 2. 5. In a restricted diet, patients who transgress are thereby more hurt (than in any other?); for every such transgression, whatever it may be, is followed by greater consequences than in a diet somewhat more generOn this account, a very slender, regulated, and restricted diet is dangerous to persons in health, because they bear transgressions of it more difficultly. For this reason, a slender and restricted diet is generally more dangerous than one a little more liberal. ous. There have been different interpretations of the first clause of this Aphorism, but I am satisfied that Galen and Theophilus are correct in explaining it as I have rendered it, namely, that a patient who is put upon too strict a regimen is apt to transgress the rules prescribed to him, and in this way he is more injured than if he had been allowed a fuller diet. Damascius also understands Hippocrates to mean that when patients are much restricted as to regimen, they are apt to deceive their physicians, and to take things that are very prejudicial to them. Lefebure, however, understands Hippocrates to mean that the physician commits a mistake by putting his patient upon too restricted a diet, whereby he suffers. As I have stated, however, I prefer the interpretation given by the old commentators, to which, I should mention, Bosquillon also inclines. With regard to the meaning of the latter part of the Aphorism, and the correctness of the opinions there stated, there can, to my mind, be no question. On the propriety of using a varied regimen, see Celsus, í., 1. Compare Vet. Med. xv., 9-14; Vict. Acut. xx., 6, 7, 11. 6. For extreme diseases, extreme methods of cure, as to restriction, are most suitable. By extreme diseases it will be readily understood is meant, extremely acute, as is explained by Galen, Theophilus, Damascius, and Stephanus. By extreme methods of cure these commentators all understood an extremely restricted regimen. Heurnius, however, gives a wider latitude to our author's rule of practice, and understands him to mean that, in very dangerous diseases, the physician is warranted in using "diæta quam tenuissima, pharmacia exquisita, et crudeli chirurgia." This mode of interpretation is ingenious, but it is unsupported by any of the ancient medical authorities, who may be supposed the best judges of our author's meaning. At the same time it must be admitted that Cicero seems to have adopted this interpretation; for it would appear to be this passage which he alludes to (de Te must form on the diet ously and no and become l This Aphoris one, indeed, mentaries of Parks, when t ant will not en ty hisduty to Led. Beren reased by our este on the dist trial one (τέκ on of his pat ng well acqua This is very pol Milligan.) 1.87. La judgment in In those case ld be enjoi Officiis, i., 24). Our earlier modern authorities in surgery also adopted this interpretation. See Angelus Bologninus, de Ulcer. Compare, further, Loc. in Homin. xxxvi., 14, lv., 7-11; Artic. i., 9. 7. When the disease is very acute, it is attended with extremely severe symptoms in its first stage; and therefore an extremely attenuating diet must be used. When this is not the case, but it is allowable to give a more generous diet, we may depart as far from the severity of regimen as the disease, by its mildness, is removed from the extreme. The meaning here seems quite obvious, and the rule of practice judiciously laid down. The ancient commentators agree in explaining "a very acute disease" to mean one that is finished in four days. As Galen remarks, inflammations and fevers are the classes of disease principally comprehended under this order. Compare Aph., iv., 10; I. Epid., iii., 29, 33; II. Epid., i., 24; Celsus, iii., 6. 8. When the disease is at its height, it will then be necessary to use the most slender diet. Theophilus, in his Commentary, remarks, that there are four stages of a disease: the beginning, the increase, the height (or acme), and the decline. That there ought to be the least food administered when the disorder of the system is at its height, and consequently when the body is in the worst possible condition to digest it, is evidently a proper rule of practice, and consistent with reason. Compare Aph. ii., 28; Vict. Acut. xvii., 11, xx., 1-6. 9. We must form a particular judgment of the patient, whether he will support the diet until the acme of the disease, and whether he will sink previously and not support the diet, or the disease will give way previously, and become less acute. This Aphorism is evidently a corollary, as it were, to the preceding one, indeed, the two are joined together by Dietz along with the commentaries of Damascius and Theophilus. As the former of these remarks, when the physician calculates that the strength of the patient will not endure through all the stages of the disease, it is evidently hisduty togive a more nourishing diet than would otherwise be allowed. Berends, in his Commentary, draws attention to the term here used by our author (ovvτεиμαipεσ0α), the meaning of which rests on the distinction between a general symptom (onupior) and a special one (Tέnμapois). The physician, then, is supposed to form (τέκμαρσις). his judgment in this case from his knowledge of the peculiar constitution of his patient. From this we see the importance of a physician being well acquainted with the habits and constitution of his patient. This is very pointedly stated by Celsus in his Preface. (See p. 16, ed. Milligan.) Compare Vict. Acut. xix., 5-10; Aph. i., 23; Humor. iii., 87. 10. In those cases, then, which attain their acme speedily, a restricted diet should be enjoined at first; but in those cases which reach their acme |