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eration; the fifteenth also treats of diseases mostly surgical, tumors, ganglia, strumous affections, aneurisms; and enters fully into the preparation and employment of plasters. The last discourse of all is occupied with diseases peculiar to women. The portions of the work assigned to the management of young children, are full, and well considered, as are also those on fevers. The following observations on eruptive fevers, which he derives from Herodotus, a practitioner at Rome prior to the time of Galen, are worthy of notice:
In certain acute fevers, says he, there will be an eruption of pustules about the lips and nose towards the close of the attack. In fevers which are not simple, but rather from a depraved condition of the humors, there will appear vibices like flea-bites, over every part of the body. In malignant and pestilential fevers, these may ulcerate and sometimes assume the appearance of carbuncles [a term here applied to minute and highly inflamed pustules, and to furuncles, as well as to what is now understood by carbuncle]. These eruptions are all indicative of a multitude of corrupt and erosive humors. Those which appear on the face are the most malignant ; their danger being in proportion to their num ber and dimensions. Those which rapidly disappear, or go through their changes quickly, aré worse than those of longer duration. The highly inflamed are more dangerous than such as are attended with pruritus. Those following constipation or moderate evacuation, are of little danger; but those succeeding a looseness or vomiting are bad.
Pustules are often followed by malignant fevers, or by deliquium animi.*
The allusions in the foregoing paragraph will be seen to have some bearing upon the eruption and fever of small pox; and their bearing upon this diséase will be more clearly seen by comparing them with a similar passage hereafter to be introduced from Ahrun, the earliest author known to have written expressly upon that disease,
Many surgical topics are well handled by Aëtius. He was a strenuous advocate for the actual cautery. He is the first to mention uterine calculus He recommends the perineal operation for vesical calculus; and describes a scabrous affection of the bladder, which, however, is also spoken of by Oribasius! He excises hæmorrhoidal tumors; he operates on brachial aneurism by a double ligature upon the artery on the cardiac side of the tumor, and subsequently opening the sac and emptying it; and secures the vessel at the points of its communication with the tumor. But he pays his deference to the superstition of his times, in recommending the use of amulets, and in resorting to charms and incantations. For removing a foreign substance from the pharynx, he tells us to touch the patient's neck and repeat the following: "As Jesus Christ raised Lazarus from the dead, and Jonas from the whale's belly, so do thou, whether shell or bone, make thy escape;" or thus: "The martyr St. Blaisius and the Saviour Jesus Christ, command thee to move either upwards
*Tetr. ii. serm. i. cap. cxxix.
or downwards." In like manner he resorts to incantations and Scriptural expressions in the preparation of his medicaments, for imparting to them greater efficacy. In compiling from other writers, Aëtius is careful to give the name of the author at the head of each chapter. He has thus preserved the names and given valuable extracts from the works of several writers not elsewhere mentioned; among these may be noticed Aspasia, an able and original writer on obstetrics and the diseases of women and children, from whom many distinct chapters have been borrowed by him, and in this way preserved from oblivion.
Alexander, surnamed Trallianus, from his native city, Tralles in Lydia, flourished shortly after Aëtius, whom he takes occasion to mention. He was of a talented family; his father Stephen, and his brother Dioscurus, were of his own profession; his brother. Olympius, was distinguished in jurisprudence; his brother Metrodorus was known as a grammarian; and a fourth, Anthemias, was employed as an architect by Justinian, A. D. 532, in building the cathedral of St. Sophia, which still stands among the principal ornaments of Constantinople. Alexander had traveled extensively in Italy, Gaul, and Spain, and had resided long in Tuscany, before ultimately settling in Rome, where he rose to great distinction. His work on the art of medicine,* dedicated to his friend Cosmas, the son of his preceptor, was written
* Alexandri Tralliani de Arte Medica libri duodecim. Joanne Guinterio Andernaco interprete. See Collection of Stephanus, Venice, 1567.
after the infirmities of age had disabled him from the more active duties of the profession. This work is worthy of notice no less for the discriminating judgment and original observations of its author, than, for the order and perspicuity of his descriptions of disease, or for the simplicity, force, and elegance of his style. In point of originality, Alexander ranks next after Hippocrates and Aretæus. He speaks of Galen in higher terms than any previous writer, calling him the "most divine," and placing him even above Hippocrates, Nevertheless, he does not hesitate to dispute the authority of this great master when at variance with his own experience. His work consists of twelve books'; of which, in their present numerical order, the first eleven treat of diseases, from the head downwards. The last is mostly occupied with fevers.. But the dedication or introduction to the whole work, is at the opening. chapter of this twelfth book; where the author speaks as if at the commencement of his literary labors. It is, therefore, reasonable to infer that the twelfth book, as at present arranged, must have been originally the first; and that it was the author's object to speak of constitutional or general ailments first, and of local diseases afterwards. The work is occupied almost exclusively with the description and treatment of diseases; with little allusion to anatomy, to topics strictly surgical, or even to the materia medica, except in direct relation of remedies to the diseases in which they are employed. Under the head of each ailment, he lays down the characteristic appearances and symptoms; points out the
divisions and subdivisions; notes the diagnostic symptoms when necessary; enters occasionally into the exciting causes and the actual conditions of disease, in accordance with the humoral pathology of Galen, or sometimes with the theory of the methodists; and finally proceeds to the treatment, whether by diet and regimen, or the administration of medicines. In the management of acute diseases, he pays great attention to the influence of age, temperament, mode of life, atmospheric changes, season of the year, and above all to the effects of nature. He enjoins caution in the use of opium for the cure of diarrhoea, in consequence of its severe effects upon the brain. He is opposed to the use of astringents in dysentery, which he treats in accordance with the rational indications. His favorite remedy for dropsy was venesection, which he adopted from having seen oedema in a limb, where the movement of the blood through the part had been arrested by tight pressure above the tumefied portion, entirely overcome by removing the pressure. In chronic ailments he preferred mild aperients to drastic purgatives. He has been often commended for his skill in, diagnosis. The passage usually referred to in proof of this, is that in which he lays down the distinctive signs of pleurisy and inflammation of the liver; a passage which the modern pathologist would hardly select for the purpose; and in which, from what is stated, he appears to have confounded pleurisy with inflammation of the lung. Like Aëtius and Marcellus, this author also recognizes the use of charms. and amulets. But on the whole, considering the 'age in