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ON THE SACRED DISEASE.

THE ARGUMENT.

I HAVE stated, under the proper head in the Preliminary Discourse, my reasons for deciding to allow this treatise a place among the genuine works of Hippocrates. Though it must be admitted that, both in style and matter, it bears but little resemblance to the other authentic productions of our author, it would be contrary to the critical rules which I formerly laid down, were I to reject a treatise which has so respectable an amount of ancient authority on its side. I shall proceed, then, to give a brief outline of its contents, and afterwards subjoin a few remarks on certain interesting subjects connected with it.

The author enters at once upon the controverted question, whether or not epilepsy be a sacred disease; that is to say, whether or not it be an infliction from the gods. Here, as in the treatise "On Airs, Waters, Places," he decidedly maintains that there is no such thing as a sacred disease, for that all diseases arise from natural causes, and no one can be consistently ascribed to the gods more than another. He argues that the only reason for its having been regarded as divine is, that its nature is incomprehensible; but upon this principle, he justly remarks, many other diseases, the nature of which is above the level of human understanding, such as the paroxysms of intermittent fevers, might be set down as divine. He does not hesitate to dcelare it as his opinion that epilepsy had been referred to a supernatural cause by persons who pretended to cure it by spells and purifications, and who sought to screen their own want of ability to effect anything in the way of remedy under the pretext that it was an infliction from the gods. He points out very acutely the cunning of these impostors in not actually prescribing anything for the cure of it, as in this case their want of skill must have been made apparent to everybody; and in merely enjoining certain restrictions with regard to food and the modes of life, so that if any improvement should take place the credit would be theirs; whereas, if the patient got worse, the blame could be laid on the gods. One author's train of reasoning on this head is most logical and conclusive. He argues, that if these persons had the power of removing disease, they must also have the power of inducing it, and consequently they would be superior to the gods themselves. He further contends, that if magical arts could effect what they are represented as

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being capable of, that is to say, could darken the sun and pull down the moon, it would follow that these celestial objects are not of a divine nature, seeing they are mastered by human power. He then enters into a most convincing line of argument against those who pretended to cure epileptics by purifications; contending that if these persons were in reality possessed by a god, their bodies would be purified, instead of polluted, by the presence of a divine being.

He further argues against the supposition that the disease is divine, from the known fact that it is hereditary, for which he attempts to account upon physiological principles. He also contends that it particularly attacks persons of a peculiar temperament, namely, the pituitous, which he justly contends would not be the case if the disease were derived from a supernatural source.

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He goes on to state, that the disease is connected with the brain; and of the blood-vessels which connect it with the trunk he gives a description which cannot but appear to us very remarkable. It bears some resemblance to the description of the vascular system contained in the treatise 'On Human Nature," but is not quite so far removed from modern ideas on the subject. There are, also, certain points of resemblance between it and the description of them given in the Second Book of Epidemics. One of his leading doctrines regarding the veins, is that they are the spiracles of the body, and inhale the pneuma (or spirits) by the lungs, and carry it to the surface of the body, where it passes out of the system by the exhalents. The pneuma (or breath) he holds to be the vehicle of sensibility to all parts of the body, and hence, if its course be intercepted, the part beyond becomes insensible.

He goes on to enlarge upon the connection of the disease with the brain, a doctrine which he illustrates by a pretty full exposition of the humoral pathology as illustrated by various defluxions upon different parts of the body. It is important to remark that he represents eruptions of ulcers on the head and other parts of the body in infancy, as being calculated to ward off the attack of serious diseases in after life. Local diseases are accounted for as being occasioned by defluxions on particular parts, and the epileptic paroxysm is described as being a struggle between the humors and pneuma in the vessels. This hypothesis he explains very elaborately. Epileptic convulsions are represented as being generally fatal to children, because their veins are small, and cannot admit the defluxion. He gives a curious account of a natural cure which the disease sometimes undergoes, by fixing upon some member of the body, such as the mouth, the eye, the neck, or the hand. In adults this does not take place, as their vessels are large, and the blood is not choked by the influx of the phlegm. When the disease seizes old persons it is apt to induce fatal attacks of apoplexy, owing to the scantiness of the blood in their veins, which is coagulated by the cold defluxion.

The formation of the disease in children is ascribed to a melting down of the brain, owing to exposure to heat, and to an excretion from the same. In some cases it is occasioned by the south wind succeeding to cold north winds, and it is also sometimes produced by sudden fear. In old persons the disease is most commonly engendered in winter, and in that season the transitions from the one state to the other are apt to be attended with the most fatal consequences; and this may happen at any season of the year, and in spring more frequently than in summer, as in the former season the changes are more sudden than in the latter. After the twentieth year, epilepsy is not apt to take place, as the brain by that time is consistent, so that it does not readily melt down, and the blood in the veins is copious. But if the disease had become habitual from childhood, in such a case attacks are apt to occur during changes of the weather, more especially during the prevalence of the south winds, whereby the brain is rendered more humid. That the disease is produced by humidity of the brain, he shows from what is observed in the inferior animals who are subject to it; for if the brain of a goat so affected be dissected, it will be found to be watery, and to have a bad smell. This, he acutely argues, is an ocular proof that in them it is not god, but a disease, which infests their body; and he infers, from analogy, that the case is the same with

man.

Children he represents as being most liable to attacks during the prevalence of south winds, the effects of which upon all bodies exposed to it, he describes in very striking terms; and hence forms a strong argument in support of his opinion, that the south wind has a great effect upon the brain, and thereby superinduces this disease. He thereupon gives a very interesting exposition of the humoral pathology in explanation of the origin of epilepsy and catarrhs. He afterwards repeats his former declaration, that epilepsy is no more a divine disease than any other is, but has its seat in the brain, which he holds to be the organ of the senses and of the intellect, that, in a word, it is the part by which we know, feel, think, and judge what is right and what is wrong, what is foul and what is fair, that it is the seat of the passions, and the organ which is deranged in cases of insanity. These maniacal affections he holds to be connected with phlegm and bile, and the varieties of them he describes very circumstantially. The more violent of them are referred to the bile, and the opposite class to the phlegm. He argues that the pneuma (breath or spirits) passes direct to the brain, and thence is distributed to all parts of the body. He contends that the diaphragm has nothing to do with feeling and sensibility, as its name would imply, any more than the auricles of the heart have to do with the sense of hearing. He further argues against the physiological hypothesis, that the heart is the part in which thought and the mental emotions are seated. The work concludes with another repetition of his declaration, that the disease is no more divine

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than any other, and he contends that by studying the intemperaments, and administering such things as are calculated to correct each of them, the physician may hope to accomplish the cure of epilepsy, as well as of other diseases, provided he will abandon the use of spells, purifications, and other illiberal tricks of the same nature.

From this brief outline of its contents, the reader cannot fail to perceive that the work is highly interesting, and of a very original nature. The argument here directed against the vulgar belief that epilepsy is derived from a supernatural cause, is perfectly conclusive. If, as here laid down, epilepsy obey the same laws as diseases universally admitted to be sprung from natural causes,-if, like certain of them, it be hereditary, and attack peculiar temperaments, and if it be seated in a particular organ of the body, it is contrary to all sound logic to set it down as divine, and the others as natural.

There are two subjects touched upon in this treatise, which are so abstruse, and at the same time so important, that I cannot omit the present occasion of attempting to throw some light upon them,-I allude to the philosophical doctrine regarding the pneuma, and the hypothesis whereby the nature of epilepsy is explained.

From the exposition of the ancient physical doctrines given in the Third Section of the Preliminary Discourse, it will be readily understood that the higher classes of the philosophers agreed in holding that all activity, intelligence, and force, are derived from mind, that, in a word, it is the active power in all and each of the bodies which compose the universe. Hence a sententious poet of a somewhat earlier date than our author, ventured to proclaim that

""Tis Mind that sees, and Mind that hears; all other things are deaf and blind.” 1

But although the philosophers taught that mind is the only active principle in the universe, they maintained that it performs all its operations through the instrumentality of a refined material substance, which partakes of the nature of light or fire. Thus, in the animal frame they recognized the existence of a pneuma, that is to say, a breath or spirit, which they held to be a sort of ethereal matter, that serves us the vehicle of the intellectual and sentient principle, by the instrumentality of which, the latter was supposed to operate upon the organs of the body. The pneuma, in short, is not mind, but its first instrument in all living creatures. But, as we have stated in the Preliminary Discourse, the

1 Νοὺς ὁρᾷ καὶ νοῦς ἀκόνει· τ ἄλλα κωφὰ καὶ τυφλά, (Clemens Alex., tom. i., p. 442, ed. Pott., Maximus Tyrius, i.) I may mention that it is doubtful whether the last clause of the line be genuine. It does not occur in Maximus Tyrius.

2

* On this subject the reader may find it interesting to consult the notes of Mosheim on Cudworth's Intellectual System, pp. 1076, 1099, 1172; edit. 1723. The opinions of Aristotle may be learned from the third chapter of the Second Book,

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