THE 
GENUINE WORKS 
OF 
HIPPOCRATES 
k *• H 
TRANSLATED FROM THE GREEK 
WITH 
A PRELIMINARY DISCOURSE AND ANNOTATIONS 
BY 
FRANCIS ADAMS, LL.D. 
SURGEON 
IN TWO VOLUMES 
VOL. II 
NEW YORK 
WILLIAM WOOD AND COMPANY 
56 & 58 LAFAYETTE PLACE 
1886 CONTENTS OF VOL. II. 
On Things relating to the Surgery ...... 1 
The Argument ........ 3 
The Work 7 
On Fractures ......... 21 
The Argument ........ 23 
The Work ......... 35 
On the Articulations ........ 73 
The Argument . . . . . . . . 75 
The Work ......... 85 
Mochlicus ......... 175 
The Argument ......... 159 
The Work ......... 161 
Aphorisms .......... 181 
The Argument ........ 183 
The Work ......... 192 
The Oath ......... 275 
The Argument ......... 277 
The Work . > . . . . . . . .278 
The Law .......... 281 
The Argument ........ 283 
. The Work ......... 283 
On Ulcers 287 
The Argument ......... 289 
The Work ......... 293 
On Fistulje .......... 307 
The Argument ........ 309 
The Work ......... 311 
On Hemorrhoids. . 317 
The Argument .......... 319 
The Work ......... 320 
On the Sacred Disease 325 
The Argument ........ 327 
The Work ......... 334 
PAGE 
Plates IV., V., VI., VII., VIII., with Descriptions. ON THINGS RELATING TO THE 
SURGERY. THE PHYSICIAN'S ESTABLISHMENT, 
OR 
THE SURGERY. 
THE ARGUMENT. 
In the critical notice of this treatise given in the second section of the 
Preliminary Discourse, I have briefly described the nature and object of 
the Iatrium. There seems to be no doubt that it was an establishment 
belonging to the periodeutce, or traveling physicians, in which were kept 
all sorts of medicines and surgical apparatus required in the practice of 
the profession. This, then, would resemble "the surgery" spoken of 
by Pott,1 as a place in which he received his patients for consultation. In 
my younger days I have visited what I regard as having been " the surgery " 
of a famous operator in the north, a contemporary of Pott, Dr. Thomas 
Livingston, of Aberdeen. It was then in the keeping of his son, and, in 
accordance with the spirit of the times, had ceased to be "a surgery," 
and was become little more than " a cabinet of antique curiosities; " it 
consisted, in short, of a choice collection of surgical instruments and 
everything else that constituted a portion of the armamentarium chirurgi- 
cum; but I was given to understand that, in former times, medicines 
were regularly prepared and compounded in it by the apprentices and 
attendants of the physician, for the purpose, no doubt, of being used by 
him in the practice of his profession, although I can scarcely suppose that 
it was patent to the public as a laboratory. Such an establishment, then, 
would be quite akin to the Iatrium of Hippocrates and his successors. I 
have ventured then to translate Iatrium by " the surgery." Galen hesitates 
respecting the title; he says, some named it, " On the Iatrium;" and some 
" On the things relating to the Iatrium," because it treats of matters 
connected with the Iatrium.2 
1 Injuries of the Head, sect. 2, Case I. 
2 The fullest account which we possess of the ancient iatrium, is that which is 
contained in the Hippocratic treatise, De Medico. The author of the treatise, 
after giving some general directions respecting the construction of the house, 
namely, that it should be so constructed that neither the wind nor sun might prove 4 
GENUINE WORKS OF HIPPOCRATES. 
No one can read this tract attentively without being impressed with 
the truth of Galen's remark respecting it, namely, that it is merely a rough 
sketch of a work, and that it had not been finished by the author for 
publication. Indeed, Galen sometimes expresses himself in equivocal 
terms as to its authenticity, and M. Littre was at first disposed to exclude 
it from the list of genuine works, but afterwards decided upon admitting 
it. One thing, at all events, is quite clear respecting it, namely, that it 
is a compendium of the subject-matters which are discussed fully in the 
works " On Fractures," and " On the Articulations," more especially in 
the former of these. In a word, it is a succinct outline of surgical matters, 
nearly unintelligible by itself, but highly valuable for refreshing the 
memory and methodizing the information collected from the works we 
have just referred to. In execution it bears a resemblance to some of the 
esoteric works of Aristotle, which are composed in so condensed a style, 
that they would be nearly unintelligible if they were not illustrated by 
copious commentaries. The tract of Theophrastus il On Stones," is an- 
other work of the same class as the present one. 
§ 1. The work begins with a brief enumeration of the general principles 
of diagnosis, or, more properly speaking, of semeiology, and of the objects 
and means by which diseases are to be recognized. The grand rule for 
discrimination is held to be the comparison of the diseased part with the 
corresponding part on the sound side. 
§ 2. A most comprehensive statement is then given of all the matters 
and objects relating to the surgery,-the operator,-the patient,-the 
assistants,-the instruments,-the light,-the position of the patient and 
of the operator, and so forth. 
§ 3. The circumstances connected with surgical operations are then 
discussed somewhat more fully, and very sensible directions are laid down 
in regard to the conduct of the operator and of the patient. 
§ 4. Some very acute remarks are next made with regard to the opera- 
tor's hand, and the means to be used in order to acquire dexterity and 
elegant manipulation. 
§ 5. Directions are then given for the disposal of the surgical instru- 
ments, so that they may be readily got hold of when required by the 
offensive to the patient, goes on to enumerate the various articles which it should 
contain, such as scalpels, lancets, cupping-instruments, trepans, raspatories, with 
bandages and medicines. That it was " an operation-room" there can be no doubt; 
whether it was also a public laboratory for the sale of medicines is not so clear; 
but it seems probable, from what we learn respecting theiatrium which Aristotle 
inherited from his father, Nicomachus (see Suidas, under Aristoteles), for Athen- 
asus taunts Aristotle with having been a druggist (pap/z«KO7rwZw).-Deipnos, viii., 
13. I ought to have stated above, that Galen, in his Exegesis, etc., explains the 
title of this work as follows: Kar' ir]-pecov ra Kara rf/v x^i'Povpyiav.-See further, Mal- 
gaigne, Operat. Surg., Pref. Engl. Edit. THE SURGERY. 
5 
operator. This paragraph evinces much practical acquaintance with the 
business of the operation-room. 
§ 6. The duties of the assistant are distinctly laid down and prescribed. 
§ 7. General directions are given for the application of the bandages 
along with a description of the characters by which to distinguish ban- 
daging when properly applied. Names of some of the most important 
fasciae, or forms of bandages. 
§ 8. Directions are given for regulating the amount of the compression 
produced by the bandages, and for securing the bandages by a thread with 
knots. 
§ 9. Many remarks are made on the tendency of a bandage to fall off 
from particular parts of the body, and directions are given to obviate this 
tendency. 
§ 10. The general characters of the bandage are again described some- 
what more fully than before. 
§ 11. The application of several forms of bandage, especially the hypo- 
desmis and epidesmis, acccording to circumstances and the object for 
which they are used, is described with much precision and minuteness of 
detail. 
§ 12. The remainder of the directions for bandaging a fractured limb 
is given, along with the application of the splints, and the use of cerate 
for giving firmness, and of selvages or slips of cloth for giving security 
to them. The splints also are minutely described. 
§ 13. The affusion of hot water on the limb after the removal of the 
bandages is particularly enjoined. 
§ 14. The adjustment of the limb, more especially by means of canals, 
or gutters for giving greater security to the inferior extremity, is par- 
ticularly insisted upon. 
§ 15. Directions are given with regard to the natural, that is to say, 
the proper position of a fractured limb while in the acts of setting and 
adjusting it. The fore-arm is to be placed at right angles to the arm, in 
a state intermediate between pronation and supination and an inferior 
extremity is to be laid in an extended position. 
§ 16. Directions are given with regard to the force to be applied in 
adjusting fractured bones: it is to be in proportion to the size of the bone, 
and stronger in the case of young than of old persons. 
§ 17. The general effects of friction are briefly defined. 
| 18. Minute and very sensible directions are given as to the appear- 
ance which the bandaging should present during the process of treatment. 
§ 19. The general object of the surgical contrivances connected with 
the management of a fractured limb is correctly defined to be-to keep 
the limb in position. 
§ 20. The effects of rest and exercise on the condition of the limb or 
member are briefly define 1. 6 
GENUINE WORKS OF HIPPOCRATES. 
§ 21. The strength of the bandaging is directed to be made to depend 
on the number of the bandages, rather than the tightness with which they 
are applied. 
§ 22. The effects of bandaging in the treatment of ecchymosis, con- 
tusions, and swellings are described, along with other circumstances con- 
nected with the treatment of these cases. 
§ 23. The application of bandages, position, and friction, in the treat- 
ment of dislocations, sprains, separation of bones, club-feet, and other 
surgical cases, are minutely and accurately defined. 
§ 24. The treatment of limbs which have become atrophied from want 
of exercise and the compression of tight bandages during the process of 
treatment for fracture, is strikingly defined. The application of a loose 
bandage in a peculiar form, as here described, is well deserving of attention. 
§ 25. The means to be taken in order to steady the head and chest in 
injuries of the same, are briefly and distinctly defined. 
From this brief analysis of its contents the reader will readily perceive 
that the greater part of the work is devoted to the treatment of fractures 
and injuries of a similar nature. The rules for the management of this 
part of surgical practice are certainly laid down here with a degree of 
precision which bespeaks a minute and accurate acquaintance with the 
subject, and evinces a great talent for judging correctly the bearings of 
practical questions in surgery. It may well be doubted whether the same 
subject be methodized and defined with the same precision in any other 
work, ancient or modern. It must always be borne in mind, however, 
that, as stated above, the work is to be viewed in the light of a rough 
sketch, which, in order to be understood, must be taken in connection 
with the fuller exposition of the subject given in the work " On Fractures." 
At first, then, I was inclined to arrange the present treatise after the 
works " On Fractures " and " On the Articulations," believing that it would 
thus occupy its most suitable position, by serving as a remembrancer to 
the reader of the various objects which he had previously viewed in detail. 
But although it might, no doubt, prove very useful according to this ar- 
rangement (and indeed it is so arranged by Galen), I am not sure but that 
it stands more properly in its present place, as it is always of advantage 
to take at first, as it were, a coup-d'wil of a subject, so as to ascertain its 
limits, and the bearings of its particular parts upon one another, before 
proceeding to examine each of them in detail. There is also a great ad- 
vantage to a student in having a syllabus of any subject which he in- 
tends to investigate, so that his attention may be awakened and directed 
beforehand to the matters which will be presented to him in going over 
the intended field of inquiry. For the reasons now adverted to, I am of 
opinion, then, that whoever would wish to make himself thoroughly ac- 
quainted with the surgical works of Hippocrates, should commence his 
studies with the present treatise. In a word, this work may be regarded THE SURGERY. 
7 
as the prologue, and the " Mochlicus" as the epilogue, to the great work 
" On Fractures and Dislocations." 
I may mention, in conclusion, that although Galen in one place ex- 
presses himself rather undecidedly regarding its authenticity, it would ap- 
pear that, after all, this tract was a great favorite of his, for he has not 
only written an elaborate Commentary upon it, but has made frequent 
allusions to it in other parts of his works. 
ON THE SURGERY. 
1. It is the business of the physician to know, in the first place, things 
similar and things dissimilar; those connected with things most impor- 
tant, most easily known, and in anywise known;1 which are to be seen, 
touched, and heard; which are to be perceived in the sight, and the touch, 
and the hearing, and the nose, and the tongue, and the understanding;2 
which are to be known by all the means we know other things.3 
' 2. The things relating to surgery, are-the patient; the operator; the 
assistants; the instruments; the light, where and how; how many things, 
and how; where the body, and the instruments; the time; the manner; 
the place.4 
1 The meaning of the first clause of this sentence, according to Galen, is, that 
the first thing which the medical practitioner must do is to make himself well ac- 
quainted with semeiology, by comparing carefully the condition of disease with 
that of health. In all cases of accident, it was the practice of the ancient surgeons 
to compare carefully the injured part with its fellow or corresponding part on the 
opposite side. Galen, in his Commentary, relates an interesting case, which 
shows the necessity of care in making such a comparison. A patient had met 
with an accident, by which the acromion was torn from the scapula, and the 
nature of the injury was not recognized at first, owing to the appearances being- 
similar on the opposite side: but Galen, upon inquiry, found that these had been 
occasioned by a previous accident. I may mention here, by the way, that Sir 
Charles Bell, in treating of dislocations of the hip-joint, very properly inculcates 
the propriety of ascertaining the previous state of matters before deciding in a 
case of supposed luxation. 
2 It will be perceived that this clause is little else than an apparent repetition 
of the preceding one. Galen mentions several explanations which had been given 
to account for this; the most plausible of which appears to me to be, that the 
former clause relates to the senses of the physician, and the latter to those of the 
patient. 
3 The last clause is illustrated by a very elaborate Commentary of Galen, in 
which he discusses with his usual subtilty the question respecting the criteria of 
human knowledge. Galen holds that our gnostic powers may all be referred to 
these three-sensation, understanding, and memory. These questions would now 
be reckoned too metaphysical for a surgical treatise. 
4 This will be admitted even now to be a comprehensive list of everything that 
relates to the operation-room. The general meaning is quite obvious, and the 8 
GENUINE WORKS OF HIPPOCRATES. 
3. The operator is either sitting or standing, conveniently for himself, 
for the person operated upon, for the light. There are two kinds of light, 
the common and the artificial; the common is not at our disposal, the 
artificial is at our disposal. There are two modes of using each, either to 
the light, or from the light (to the side ?). There is little use of that 
which is from (or oblique to the light), and the degree of it is obvious.1 
As to opposite the light, we must turn the part to be operated upon to 
that which is most brilliant of present and convenient lights, unless those 
parts which should be concealed, and which it is a shame to look upon;2 
thus the part that is operated upon should be opposite the light, and the 
operator opposite the part operated upon, except in so far as he does not 
stand in his own light; for in this case the operator will indeed see, but 
the thing operated upon will not be seen. With regard to himself: when 
sitting, his feet should be raised to a direct line with his knees, and nearly 
in contact with one another; the knees a little higher than the groins, 
and at some distance from one another, for the elbows to rest upon them. 
The robe, in a neat and orderly manner, is to be thrown over the elbows 
and shoulders equally and proportionally.3 With regard to the part 
operated upon; we have to consider how far distant, and how near, above, 
below, on this side, on that side, or in the middle. The measure as to 
distance and proximity is, that the elbows do not press the knees before, 
nor the sides behind; that the hands be not raised higher than the breasts, 
nor lower than so as that when the breast reposes on the knees he may 
have the hands at right angles with the arm: thus it is as regards the 
medium; but as concerns this side or that, the operator must not be be- 
yond his seat, but in proportion as he may require turning he must shift 
the body, or part of the body, that is operated upon. When standing, 
only obscurity in this paragraph consists in the reading, for which see Galen's 
Commentary, and the Annotations of LittrA I shall only mention that by place, 
in the end of the sentence, was probably meant the diseased part, or seat of the 
disease. The term is thus used in the Hippocratic treatise, De Locis in Homine. 
1 By " from the light," Galen explains is meant "turned from the light," that 
is to say, oblique to the light. Galen mentions that it is applicable principally in 
operations on the eye, such as the anabrochismus, the removing of tumors from 
the eyelids, excision of the pterygium, and couching the cataract. 
2 Galen remarks, that in operations on the parts of generation, and on the 
breasts in females, it is proper that the patient should be blindfolded. He also 
recommends in certain cases, when the patient is remarkably timid, to deceive 
him by telling him that the operation had been put off until another day, and 
while in the act of making, as it were, preparations for it, to perform the neces- 
sary incision. 
3 The ancient physicians attached much importance to decorum, and studied 
effect very much in the practice of their art. In the Hippocratic treatise, On 
Elegance, the dress of the physician is not forgotten. In this passage it will be 
seen that the manner in which the surgeon's robe, or mantle, should be flung over 
him, while in the act of operating, is graphically described. THE SURGERY. 
9 
he must make his inspection, resting firmly and equally on both feet; but 
he must operate while supporting himself upon either leg, and not the 
one on the same side with the hand which he makes use of; the knee be- 
ing raised to the height of the groins as while sitting; and the other 
measures in like manner. The person operated upon should accommodate 
the operator with regard to the other parts of his body, either standing, 
sitting, or lying; so as that he may continue to preserve his figure, avoid 
sinking down, shrinking from, turning away; and may maintain the fig- 
ure and position of the part operated upon, during the act of presenta- 
tion, during the operation, and in the subsequent position.1 
4. The nails should be neither longer nor shorter than the points of 
the fingers; and the surgeon should practice with the extremities of the 
fingers, the index-finger being usually turned to the thumb; when using 
the entire hand, it should be prone; when both hands, they should be 
opposed to one another. It greatly promotes a dexterous use of the fin- 
gers when the space between them is large, and when the thumb is opposed 
to the index. But it is clearly a disease when the thumb is impaired 
from birth, or when, from a habit contracted during the time of nursing, 
it is impeded in its motions by the fingers. One should practice all sorts 
of work with either of them, and with both together (for they are both 
alike), endeavoring to do them well, elegantly, quickly, without trouble, 
neatly, and promptly.2 
5. The instruments, and when and how they should be prepared, will 
be treated of afterwards; so that they may not impede the work, and that 
there may be no difficulty in taking hold of them, with the part of the 
body which operates. But if another gives them, he must be ready a little 
beforehand, and do as you direct.3 
1 The description of the position of the operator, and of the person operated up- 
on, contained in this paragraph, is so clear as to stand little in need of elucidation. 
I may mention, that by the act of presentation, an expression which often occurs 
in the surgical treatises of Hippocrates, was meant the position in which the in- 
jured or diseased member of the patient is presented to the surgeon for operating 
upon it. By subsequent positions, it will readily be understood, is meant the 
state in which the limb is placed after the operation; such, for example, as the 
adjustment of the leg in a canal, and the suspension of the arm in a sling after 
bandaging for fracture. These questions we shall find fully discussed in the work 
On the Articulations. 
2 The importance of these general directions for the surgeon, in order that he 
may acquire skillful manipulation, is obvious. The free motion of the thumb and 
index-finger evidently contributes in an especial manner to the dexterity of the 
operator. The importance also of practicing with either hand, so as to become 
ambidextrous, is now generally admitted. The text in the clause of the sentence, 
where the impediment of the hand is described, would appear to be corrupted. 
See Galen, Foes, and Littre. 
8 The directions, I need scarcely remark, are most apposite, and bespeak a 
familiar acquaintance with surgical practice. By instruments, as Galen in his 10 
GENUINE WORKS OF HIPPOCRATES. 
6. Those about the patient must present the part to be operated upon 
as may seem proper, and they must hold the rest of the body steady, in 
silence, and listening to the commands of the operator. 
7. There are two views of bandaging: that which regards it while 
doing, and that which regards it when done.1 It should be done quickly, 
without pain, with ease, and with elegance; quickly, by despatching the 
work; without pain, by being .readily done; with ease, by being prepared 
for everything; and with elegance, so that it may be agreeable to the sight. 
By what mode of training these accomplishments are to be acquired has 
been stated. When done, it should fit well and neatly; it is neatly done 
when with judgment, and when it is equal and unequal, according as the 
parts are equal or unequal. The forms of it (the bandage ?) are the sim- 
ple, the slightly winding (called ascia), the sloping (sima), the monoculus, 
the rhombus, and the semi-rhombus.2 The form of bandage should be 
suitable to the form and the affection of the part to which it is applied. 
8. There are two useful purposes to be fulfilled by bandaging:3 (first,) 
strength, which is imparted by the compression and the number of folds. 
In one case the bandage effects the cure, and in another it contributes to 
the cure. For these purposes this is the rule-that the force of the con- 
striction be such as to prevent the adjoining parts from separating, with- 
out compressing them much, and so that the parts may be adjusted but 
Commentary remarks, is meant in this place not only mechanical contrivances, 
such as the ambe and bench, used in the reduction of dislocations, but all the ap- 
paratus used by the surgeon in performing operations. 
1 The meaning of this clause, although rather quaintly expressed, seems pretty 
obvious. It is thus rendered by Verduc: "We must observe, with Hippocrates, 
that with regard to the first difference drawn from the time of the operation, we 
must consider a bandage while it is yet amaking, by way of distinction from one 
that is already made. For the former there are three conditions required, which 
are couched under these three words, cito, tute, jucunde, i. e. speedily, safely, and 
dexterously, etc." (On Fractures, Bandages, etc.) 
2 Our author here describes, rather confusedly and indistinctly, six sorts of ban- 
dages, namely, three simple, and three compound: the simple are, the circular, the 
ascia, and the sima; the compound are, the monoculus, the rhombus, and the semi- 
rhombus. The circular cannot be misunderstood; it consisted of a single roll of 
bandage carried circularly round the limb or member. The ascia (cK&rapvov) and the 
sima were two forms of spiral bandage differing only in this respect, that in the 
former the edges of the bandage passed each other to a small extent, in the latter 
to a greater. The oculus, or monoculus, was a bandage adapted to dressing's on 
one eye. The rhombus and semi-rhombus took their names from their figure, 
and were used principally on the head and feet. It being very difficult to convey 
a correct idea of these bandages in words, I will give figures of them taken from 
Vidus Vidius, from which their construction will be readily comprehended at a 
glance. 
3 As Galen states in his Commentary, it does not clearly appear from the text 
what are the two purposes which bandaging supplies. M. Littre supposes that 
the exposition of the second begins at § 9. THE SURGERY. 
11 
not forced together; and that the constriction be small at the extremities, 
and least of all in the middle. The knot and the thread that is passed 
through should not be in a downward but in an upward direction, regard 
being had to the circumstances under which the case is presented; to 
position, to the bandaging, and to the compression. The commencement 
of the ligatures is not to be placed at the wound, but where the knot is 
situated.1 The knot should not be placed where it will be exposed to fric- 
tion, nor where it will be in the way, nor where it will be useless. The 
knot and the thread should be soft, and not large. 
9. (Second.) One ought to be well aware that every bandage has a ten- 
dency to fall off towards the part that declines or becomes smaller; as, for 
example, upwards, in the case of the head, and downwards, in the case of 
the leg. The turns of the bandage should be made from right to left, 
and from left to right, except on the head, where it should be in a straight 
direction.2 When opposite parts are to be bandaged together, we must 
use a bandage with two heads; or if we make use of a bandage with one 
head, we must attach it in like manner at some fixed point; such, for ex- 
ample, as the middle of the head; and so in other cases. Those parts 
which are much exposed to motion, such as the joints, where there is a 
flexion, should have few and slight bandages applied to them, as at the 
ham; but where there is much extension, the bandage should be single 
and broad, as at the kneepan; and for the maintenance of the bandage 
in its proper place, some turns should be carried to those parts which are 
not much moved, and are lank, such as the parts above and below the 
knee.3 In the case of the shoulder, a fold should be carried round by the 
other armpit; in that of the groin, by the flanks of the opposite side; and 
of the leg, to above the calf of the leg. When the bandage has a ten- 
dency to escape above, it should be secured below, and vice versa; and 
where there is no means of doing this, as in the case of the head, the 
turns are to be made mostly on the most level part of the head, and the 
folds are to be done with as little obliquity as possible, so that the firmest 
part being last applied may secure the portions which are more movable. 
When we cannot secure the bandaging by means of folds of the cloth, 
nor by suspending them from the opposite side, we must have recourse 
1 The meaning of this sentence is doubtful. See Galen's Commentary, and 
Littre's notes. 
2 Galen explains the meaning of this expression (/car' tftv) by stating that in 
bandaging the head, the fold of the bandage is to be brought from the top of the 
head straight down below the chin and is to be carried thence co the part affect- 
ed, and then again in like manner, either twice, or thrice, or as often as is thought 
necessary. 
3 The propriety of these directions for bandaging the knee will readily be ac- 
knowledged. By lank parts (Zar-apd), Galen explains, were meant loose and slender 
parts, as opposed to such as are full and prominent. 12 
GENUINE WORKS OF HIPPOCRATES. 
to stitching it with ligatures, either passed circularly or in the form of a 
seam.1 
10. The bandages should be clean, light, soft, and thin.2 One should 
practice rolling with both hands together, and with either separately. One 
should also choose a suitable one, according to the breadth and thickness 
of the parts. The heads of the bandages should be hard, smooth, and 
neatly put on. That sort of bandaging is the worst which quickly falls 
off; but those are bad bandages which neither compress nor yet come off.3 
11. The following are the object which the upper bandage, the under 
bandage, or both aim at:4 The object of the under bandage is either to 
bring together parts that are separated, or to compress such as are ex- 
panded, or to separate what are contracted, or to restore to shape what 
are distorted, or the contrary. It is necessary to prepare pieces of linen 
cloth, which are light, thin, soft, clean, having no seams nor protuber- 
ances on them, but sound, and able to bear some stretching, or even a 
little more than required; not dry, but wetted with a juice suitable to the 
purpose required. We must deal with parts separated {in a sinus?) in 
such wise, that the parts which are raised may touch the bottom without 
producing pressure; we must begin on the sound part, and terminate at 
the wound; so that whatever humor is in it may be expelled, and that it 
may be prevented from collecting more.5 And straight parts are to be 
bandaged in a straight direction, and oblique obliquely, in such a position 
1 The meaning in the last clause of this paragraph is difficult to determine. 
See Galen, Vidus Vidius, and Littre. 
2 Verduc translates and explains this passage as follows: " Hippocrates enjoins 
further, that the bands be smooth, plain, soft, and light; by smoothness and 
plainness he excludes unevenness, or the least puckering and rising unequally; by 
requiring softness, he insinuates that they must not press, or wring, or wound 
the part; and fineness is requisite to facilitate the passage of the liquors through 
its substance; and the inconveniency of overloading the affected part makes 
lightness a necessary quality." On Fractures, Bandages, &c., p. 231. 
3 Though the general drift of this paragraph be sufficiently clear, there are 
many things in it by no means easy to be understood. Indeed, Galen finds the 
language so unworthy of Hippocrates, that he does not scruple to g'ive it as his 
opinion that the work had never been finished for publication by the author. 
By heads Galen says, that some of the commentators understood the ends, and 
others the edges of the bandages. The text in the last clause seems evidently to 
be corrupt. 
4 The epidesmis and hypodesmis, which are both described in a very distinct 
manner in this paragraph, evidently apply principally to fractures and other in- 
juries of the extremities. There is little in this description that requires explana- 
tion. The application of them in the case of a fractured arm, we shall find minu- 
tely described in the work On the Articulations. 
0 This description seems evidently to apply to a sinus, or collection of matter 
below the skin. In this sense it is understood by Galen, and by Verduc, in his 
work on Fractures and Bandages. THE SURGERY. 
13 
as to create no pain; and so that there may be no constriction nor falling 
oft on a change of position, either for the purpose of taking hold of any- 
thing, or laying the limb; and that muscles, veins, nerves, and bones 
may be properly placed and adjusted to one another. It should be raised 
or laid in a natural position, so as not to occasion pain. In those cases 
in which an abscess is formed, we must act in a contrary way.1 When 
our object is to bring together parts which have become expanded, in 
other respects we must proceed on the same plan; and we must commence 
the bringing together from some considerable distance; and after their 
approach, we must apply compression, at first slight, and afterwards 
stronger, the limit of it being the actual contact of the parts. In order 
to separate parts which are drawn together, when attended with inflam- 
mation, we must proceed on the opposite plan; but when without inflam- 
mation, we must use the same preparations, but bandage in the opposite 
direction. In order to rectify distorted parts, we must proceed otherwise 
on the same principles; but the parts which are separated must be brought 
together by an under bandage, by agglutinants, and by suspending it (the 
limbF) in its natural position.2 And when the deformities are the con- 
trary, this is to be done on the contrary plan. 
12. In fractures we must attend to the length, breadth, thickness, and 
number of the compresses. The length should be that of the bandaging; 
the breadth, three or four fingers; thickness, three or fourfold; number so 
as to encircle the limb, neither more nor less; those applied for the purpose 
of rectifying a deformity, should be of such a length as to encircle it; the 
breadth and thickness being determined by the vacuity, which is not to 
be filled up at once. The under bandages are two, the first of which is to 
be carried from the seat of the injury upwards, and the second from the 
seat of the injury downwards, and from below upwards; the parts about the 
seat of the injury being most compressed, the extremities least, and the 
rest in proportion. The upper bandages should take in a considerable 
portion of the sound parts. We must attend to the number, length, and 
breadth of the bandages; the number must be such as not to be inferior 
to what the injury requires, nor occasion compression with the splints, 
nor prove cumbersome, nor occasion any slipping of them, nor render 
1 There is great uncertainty about the meaning of this sentence, as may be 
learned from the Commentary of Galen. He informs us that some read it nega- 
tively, that is to say, with the negative particle (juh), and that Asclepiades put an 
entirely different sense on the passage, understanding the words to apply to the 
loosening- of the bandages, and not to the condition of the part to which they are 
applied. Foes inclines to adopt this interpretation, which I must say is, in 
many respects, more feasible than the other. Galen seems undecided. 
2 This passage refers apparently to fractures of the fore-arm, which we shah 
find treated of very fully in the work On Fractures. The suspension of the limb 
in a napkin, or other cloth, constituted a very important part of the process of 
treatment. 14 
GENUINE WORKS OF HIPPOCRATES. 
them inefficient. As to length and breadth, they should be three, four, 
five, or six cubits in length, and as many fingers broad. The folds of the 
strings (selvages?)1 should be such as not to occasion pressure; they are to 
be soft and not thick; and all these things are to be proportionate to the 
length, breadth, and thickness of the part affected. The splints are to be 
smooth, even, and rounded at the extremities; somewhat less all along 
than the upper bandaging, and thickest at the part to which the fracture 
inclines. Those parts where there are tuberosities, and which are devoid 
of flesh, such as the ankles or fingers, we must guard from the splints 
which are placed over them, either by position, or by their shortness. 
They are to be secured by the strings in such a manner as not to occasion 
pressure at first. A soft, consistent, and clean cerate should be rubbed 
into the folds of the bandage.2 
1 There is a good deal of difficulty in determining the exact meaning of this 
term (napalpT/pa); indeed, there is considerable uncertainty about the reading. 
Consult Galen, Vidus Vidius, Foes, Littre, and Schneider (Lexicon). Both Foes 
and Littre incline to render it by lisiere in French, that is to say, the list or 
selvage of linen cloth. That this should have been used to secure the compresses, 
and keep them in position, seems very natural, and I am inclined to adopt this 
explanation of the term, as it suits so well with the sense. See Avicenna, iv., 5, 
2, 7 ; also, Sculteti Armamentarium Chirurgicum, tab. 29. In plate 4, the ap- 
pearance of the bandaged limb, having the splints secured with strings, is well 
represented. 
21 need scarcely remark that this description of the process of treating a 
fractured limb is remarkable for precision and clearness, and it may well be 
doubted whether in the whole compass of medical literature there be a passage 
which contains so judicious an exposition of the principles upon which this surgi- 
cal case should be managed. An important point connected with the ancient 
mode of treating fractures was the use of cerate, or a composition from wax, in 
the application of the bandages. Unfortunately our information regarding the 
use of this article by the ancient surgeons in bandaging is very limited, being 
mostly confined to this passage of our author, and the Commentary of Galen on 
the same, which, it is to be regretted, has come down to us in a corrupt state. 
It appears from it, however, that the wax was rubbed not only into the skin of 
the part to which the bandage was to be applied, but also upon every fold of the 
bandage as it was put on. It was applied in moderate quantity. See Chirurgici 
GraBci, ed. Cocchi (p. 66). There can be no doubt, then, that applied in this man- 
ner, the waxed bandages must have been fully as secure as the starched bandages 
now in use. The wax used for this purpose was cleansed from all impurities, and 
probably bleached. On the ancient mode of bleaching wax, see Dioscorides (ii., 
105). The Arabians adopted this and all the other steps of this process from the 
Greeks. See, in particular, Avicenna (iv., 5, 2, 6). I may be allowed to remark 
in this place, that it is not unlikely that the Arabs in Algiers, from whom it is 
well known that the French surgeons learned the process of treating fractures by 
the immovable apparatus, may have derived their knowledge from their fore- 
fathers. How or when this excellent practice fell into disuse in civilized Europe 
I cannot pretend to explain. I may mention, however, that Verduc, who professes 
to follow Galen and Hippocrates implicitly in describing the application of ban- THE SURGERY. 
15 
13. As to the temperature and quantity of the water used, its heat 
should be just such as the hand can bear, and it ought to be known 
that a large quantity is best for producing relaxation and attenuation, 
whereas a moderate quantity is best for incarnating and softening. 
The limit to the affusion is, to stop when the parts become swelled up, 
and before the swelling subsides; for the parts swell up at first, and fall 
afterward.1 
14. The object on which it (the limb?) is laid should be soft, smooth, 
and sloping upwards toward the protuberant parts of the body, such as the 
heel or hips, so that there may be no projection, nor bending inwards, nor 
turning aside.2 The canal (spout or gutter?) should rather comprehend 
the whole limb than the half of it, attention being paid to the injury and 
to whatever else appears to create inconvenience.' 
15. The presentation of the injured part to the physician, the exten- 
sion, the arrangement, and so forth, are to be regulated according to 
nature. What is nature in these operations is to be determined by the 
accomplishment of the object which we have in view, and for this purpose 
we must look to the part in the state of rest, in its middle state, and to 
habit; in regard to the state of rest and relaxation, as in the arm, that it 
be in a line with the hand; and with regard to the medium between flex- 
ion and extension, that the forearm be at right angles to the arm; and 
with regard to habit, it should be considered that some limbs bear certain 
positions preferably, as, for example, the thighs extension; for in such 
attitudes the parts can best bear to be placed for a considerable time with- 
out a change of posture. And in the change from the state of distention, 
the muscles, veins, nerves, and bones, when properly arranged and 
dages to fractured limbs, takes no notice whatever of the use of cerate. Thus it 
is that we always pass by valuable things when we do not estimate the use of 
them properly. 
1 The warm water, I may just mention, was applied upon the removal of the 
bandages. The objects for which it was applied are briefly noticed by our author, 
and are fully explained by Galen in his Commentary. Galen further alludes to 
the practice elsewhere. (Meth. Med., xiv.; and Hygiene, ii.) We shall find 
further mention of it in the work On Fractures. 
2 The meaning of this sentence, nothwithstanding the explanations furnished 
by Galen, is somewhat obscure. One can readily appreciate the propriety of the 
direction to lay the heel in particular on an elevated object, in order, as Galen re- 
marks, to prevent a defluxion to the part. 
3 The canal (called in French gouttiere), although Hippocrates elsewhere ex 
presses himself regarding its usefulness in rather equivocal terms, appears to me 
to be one of the simplest and most ingenious contrivances imaginable for secur- 
ing a fractured leg. For several years I have used in imitation of it a half boot 
made of the strongest pasteboard, and have found it the greatest improvement 
imaginable in the treatment of fractures. It appears to me preferable to any of 
the mechanical contrivances which are at present in use in the London hospitals. 16 
GENUINE WORKS OF HIPPOCRATES. 
secured, will preserve their relations to one another while the limb is 
raised or placed.1 
16. The extension should be most powerful when the largest and thick- 
est bones, or when both are broken; next when the under-bone, and least 
of all, when the upper. When immoderate, it is injurious, except in the 
case of children. The limb should be a little elevated. The model by 
which we judge if the part be properly set is the sound part of the same 
name, or the part which is its pair.2 
17. Friction can relax, brace, incarnate, attenuate: hard braces, soft 
relaxes, much attenuates, and moderate thickens.3 
18. The following should be the state of matters on the first applica- 
tion of the bandage. The person to whom it has been applied should say 
that he feels the compression particularly at the scat of the injury, but 
very little at the extremities; the parts should be adjusted but not pressed 
together, and that rather by the number of the bandages than by the 
force of the constriction; and the tightness should rather be on the 
increase during the first day and night; but on the next it should be less, 
and on the third the bandages should be loose. On the next day a soft 
swelling should be observed in the extremities;4 and on the third day, 
1 There is not much of any practical importance in this paragraph which re- 
quires illustration. The best position for a fractured limb, as Galen remarks, is 
that in which it can be longest kept without producing pain ; this, in the forearm, 
Hippocrates holds to be the state intermediate between pronation and supination, 
with the forearm at right angles to the arm, and m the leg complete extension. 
Galen pronounces decidedly in favor of the extended position during the treat- 
ment of a fractured thigh. 
2 This paragraph, it will readily be perceived, relates to fractures of the fore- 
arm. There is little in it which requires illustration. Galen remarks, that the 
bodies of young persons, being- of a softer and more humid nature, endure greater 
extension than those of the aged without being exposed to pain or more serious 
consequences. This is no doubt the fact, and it is equally true that aged persons 
can scarcely bear to be touched without experiencing- most acute pain. 
3 This subject is so fully treated of in the English edition of Paulus jEguneta, 
Book I., 18, that I need not touch upon it in this place. See, in particular, Galen 
(De Sanit. tuencL, ii., Comment, h. 1.), and Oribasius (Med. Collect., vi). 
4 On this direction Vercluc makes the following remark: " Hippocrates, who 
so often forewarns us of the danger of making the bandages either too tight or 
too slack, gives us a certain sign of the due tightness of the bandage, viz. the in- 
flammation and rising softness of the lower extremity, whether the foot or hand. 
So that if the foot is not at all inflamed, you must immediately undo the dress- 
ings, for fear of a false callus. If the inferior extremities are very much inflamed, 
and have a hard tumor upon them, you must slacken the rollers."-On Fractures, 
Bandages, etc. It is well known that in modern practice the extremities are 
bandaged to prevent swelling from taking place in them. Whether or not this 
be in all cases a wise practice, I have my doubts ; indeed I am inclined to think 
that the swelling below, relieves the swelling, and consequently the congestion, 
in the seat of the fracture. When the bandages are not too tight, nor tXb patient THE SURGERY. 
17 
when the bandaging is loosed, the swelling should be found diminished in 
size, and this should be the case every time the bandages are removed. 
At the second application of the bandage, it should be ascertained whether 
the dressing has been properly done, and then greater compression should, 
be made, and with more bandages; and on the third, still greater, and 
still more. On the seventh day from the first dressing, wdien the banda- 
ges are loosed, the limb should be found slender and the bones mobile. 
Wo must then have recourse to the splints, provided the limb be free of 
swelling, pruritus, and ulceration, and allow them to remain until twenty 
days after the accident; but if any suspicions arise, the bandages must be 
loosed in the interval. The splints should, be tightened every third day.1 
19. The suspending of a fractured limb in a sling, the disposition of 
it, and the bandaging, all have for their object to preserve it in position. 
The principal considerations with regard to the position are the habits and 
the peculiar nature of each of the limbs: the varieties are shown in run- 
ning, walking, standing, lying, action, repose.2 
20. It should be kept in mind that exercise strengthens, and inactivity 
wastes.3 
21. Compression should be produced by the number of bandages, 
rather than by the force of the constriction. 
22. In cases of ecchymosis, contusions, sprains, or swellings not 
attended with inflammations, blood is to be expelled from the wound, in 
greatest quantity to the upper part, and in smallest to the inferior; 
neither the arm nor the leg should be placed in a declining position: the 
head of the bandage should be placed on the wound, and there the great- 
est pressure should be made; the least at the extremities, and intermedi- 
ately in the middle; the last fold of the bandage should be at the upper 
part of the body. As to binding and compression, these objects are to be 
in an unhealthy condition of body, the swelling below, to say the least of it, can, 
do no harm, and, besides serving as an index of the state of the bandaging above, 
may, and I think certainly in some cases does, relieve the tension in the seat of 
the injury. The contents of this chapter is an accurate resume of the more ample 
directions which, as we shall see below, are given in the works On Fractures and 
On Articulations. 
1 The splints, I believe, were secured by ligatures going round the limb in dif- 
ferent places, care being taken to avoid the spot where the fracture was situated. 
See, in particular, Avicenna (iv., 5, 2, 7, 8). 
2 The subject-matters contained in this passage are evidently pretty much the 
same as those contained in § 15. Galen insists strongly upon this being a clear 
proof that the present work is a mere rough sketch, and that it had never been 
completed by our author. In the course of his Commentary, he repeatedly insists 
that the original publisher must have used great liberties with the text. 
3 As a corollary to this proposition Galen remarks, that in surgical treatment 
an injured limb ought not to be too long kept entirely without motion, but that 
as soon as the inflammation has subsided, it should be cautiously moved after hot 
water has been poured upon it, etc. 
Vol. II.-2. 18 
GENUINE WORKS OF HIPPOCRATES. 
attained rather by the number of the bandages than the force of the con- 
striction; and moreover, in these cases the bandages should be thin, light, 
soft, clean, broad, sound, so that they may effect their purpose, even 
without splints. And we must use affusions.1 
23. Dislocations, sprains, diastases of bones, violent separation, abrup- 
tion of the extremities of bones, and distrainings, so as to induce varus or 
valgus, in these cases we must apply the bandages so as not to compress 
the part whence the displacement took place, and that we may render 
them tight at the side to which the displacement was, and give the limb 
an inclination in the opposite direction, and that in an excessive degree. 
We employ bandages, compresses, suspension of the limb in a sling, atti- 
tude, extension, friction, rectification; and along with these the affusion 
of much water.2 
£4. In treating parts which are atrophied, we must comprehend a con- 
siderable part of the sound limb with the bandage, so that by the influx 
thereby produced, the wasted part may acquire a supply greater than its 
loss, and may be thus disposed to growth and restoration of its fleshy 
parts. It is better also to bandage the parts above, as the thigh in the 
case of the leg, and also the thigh and leg of the opposite side, so that 
they may be placed in similar circumstances, and may both equally be 
deprived of motion; and that the supply of nourishment may be alike 
curtailed and open to both. The compression should be the effect rather 
of the number of the bandages than of their tightness. We relax first the 
part most requiring it, and have recourse to that kind of friction which 
will promote the growth of flesh, and to affusion. No splints.3 
1 It is foreign to my purpose to enter upon a discussion of the different read- 
ings in this paragraph, as this would occupy too much time and space. See 
Galen, Foes, and Littre. As I have translated it, the meaning seems obvious, and 
the practice very rational. The subject herein treated will be found more fully 
discussed in the work On Fractures. 
2 This paragraph, as Galen remarks, contains an epitome of a variety of mat- 
ters which are fully treated of in the treatises, On Fractures, and On the .Articula- 
tions. Whatever is obscure in it will readily be understood upon reference to these 
works. I shall only notice a few of the terms which may be somewhat obscure 
to the modern reader who is not familiar with the two treatises now referred to. 
Diastasis is the separation of the two bones not connected together by diarthrosis, 
but in immediate connection, such as the separation of the radius from the ulna 
at the elbow-joint, and the separation of the cranial bones at a suture. Abrup- 
tion applies to the snapping off of the extremity of a bone, such as that of the 
humerus. The distrainings, or distortions (6La(jTpep.p.aTa), relate principally to 
cases of club-foot, and will come to be more properly treated of in the portion of 
the work On the Articulations, which relates to that subject. 
3 Upon reference to Galen, it will be seen that he bestows a very lengthy and 
elaborate Commentary on this paragraph, partly in illustration of the verbal 
meaning of the term here used, and partly in discussing the merit of the practical 
rules laid down by our author. By atrophied parts in this place, Hippocrates THE SURGERY. 
19 
25. Those things which are for the purpose of giving support and 
strength to the part, as to the breast, side, head, and so forth, are used in 
such cases as the following: for pulsations, that there may be no motion 
in the part; and in separation at the sutures of the skull, in order to give 
support; and in order to strengthen the chest and head, in coughs, sneez- 
ings, and other movements. In all these cases the same measure of ban- 
daging is to be observed, for where the injury is, there the bandage should 
compress most, and something soft is to be placed below that suits with 
the complaint; and we must not apply the bandages tighter than just to 
stop the pulsations from creating disturbance, and that the separated 
parts at the sutures may be brought into contact, they must not be such 
as absolutely to stop the coughs and sneezings, but so as to give support, 
and, without occasioning uneasiness,1 prevent the parts from being shaken. 
would appear to allude to parts which have become wasted in flesh owing' to the 
compression and want of exercise during- their treatment for fractures. The 
treatment of emaciated parts is briefly laid down by Paulus tEgineta, Book I., 
59, and the other authorities. See the Commentary. It is remarkable that, as 
far as I can discover, none of the later authorities make mention of the loose 
bandaging here recommended by our author. Galen, however, states that he had 
used it as directed by Hippocrates, and with good effect. 
1 There is not much in this paragraph which stands in need of illustration, but 
then Galen's Commentary is well deserving of being consulted. He explains 
that, in affections of the head and chest, it was customary to use small pillows 
and bags filled with millet to give support to the parts affected and stop motion 
in them. It will be remarked, that in this place our author makes distinct 
mention of diastasis or separation of the bones of the cranium at the sutures. See 
above. ON FRACTURES ON FRACTURES. 
THE ARGUMENT. 
The work commences with an announcement of the general principle 
upon which all cases of fracture and dislocation are to be rectified, which 
is this, that extension should be made as straight as possible, the term 
straight being immediately afterward explained to be meant as applying 
to that direction which is most natural to the limb affected, that is to say, 
the position which will afford the patient most ease and comfort after the 
limb has been properly arranged. This principle of treatment he illus- 
trates at considerable length, and with great force of argument, in the 
case of the fore-arm, and reviews the different positions in which it had 
been recommended that it should be placed, namely, the state of prona- 
tion, of supination, the intermediate, and, lastly, that of the archer when 
he is in the attitude of drawing the string of his bow. The author shows, 
in a very striking manner, the evil effects resulting from the practice of 
not putting the limb, during the process of bandaging, into the attitude 
in which it is meant that it should be kept afterwards, as by the change of 
position the whole apparatus will be in so far deranged. §§ 1-3. 
Fractures of the fore-arm are next considered, and most minute direc- 
tions are given regarding the whole process of managing it-the setting 
of the fractured bones-the application of the bandages, the compresses, 
and splints, and the arrangement of the limb after the process is com- 
pleted. The general rules of practice laid down for the management of 
this case are meant to apply to all fractures, with a few exceptions. 
§§ 4-7. 
Fracture of the arm, or humerus, is next considered, and here our 
author's mode of procedure is highly deserving of attention, as being con- 
siderably different from the method now in use: he attaches much impor- 
tance to the mode in which extension is made, and pointedly directs that 
the limb be placed in its proper position before the application of the ban- 
dages and the rest of the apparatus. § 8. 
He then proceeds to the consideration of the foot and the injuries of 
the bones which compose it. § 9. 
The displacement of the tarsal bones from those of the leg are next 
considered, by which luxations of the astragalus and os calcis are probably 
meant. §§ 10, 11. 24 
GENUINE WORKS OF HIPPOCRATES. 
After a brief description of the bones of the leg, he gives an account, 
in general terms, of luxations of the foot, and then describes very elabo- 
rately the process of reducing them, and of conducting the treatment after- 
ward. §§ 13, 14. 
Fractures of the leg are then treated of at considerable length in §§ 15, 
16, 17, 18. 
Fractures of the thigh-bone are next taken into consideration, and 
most minute directions are given for the management of them in §§ 19, 
20, 21, 22, 23. Our author gives some account of the canals, or gutters, 
then used for receiving the limb in cases of fractured leg or thigh; he does 
not much approve of them, but gives it as his opinion that the beneficial 
effects of them had been much exaggerated. 
Compound fractures are next considered, and all the different modes 
of treating them which were then in vogue are discussed, and freely crit- 
icised in §§ 24, 25, 26, 27, 28, 29. The exfoliation of the bones and the 
separation of spiculse are next brought under notice, and the treatment of 
such cases freely considered. § 30. 
Many minute directions are given relative to the reduction of broken 
bones by means of the lever, and the treatment afterward. §§ 31, 32. 
The treatment in those cases in which it has been found inpracticable 
to reduce the fractured bones is next delivered, including many important 
observations regarding the exfoliation of bones, and the resection of them. 
§§ 33, 34. 
The danger of compound fractures of the femur and humerus is point- 
edly declared, and the treatment of such cases when it is to be attempted 
is clearly indicated. §§ 35, 36. 
In § 37 is given a brief description of luxations of the knee, along with 
an elaborate, and, upon the whole, a very accurate statement of the points 
of analogy between the knee- and elbow-joints. 
In §§ 38, 39, 40, 41, 42, 43, 44, the luxations and sub-luxations at the 
elbow-joint are treated of very succinctly, but so as to display a very inti- 
mate acquaintance with this class of accidents. 
In § 45 there is given a curious, but rather obscure, description of frac- 
ture of the olecranon. 
In § 46 is given a brief account of fracture of the epiphysis, or trochlea 
of the humerus, a most interesting subject, on which we shall enter more 
fully by and by. 
In the last two paragraphs some general rules are given respecting ac- 
cidents at the elbow, as regards bandages and position. 
From this enumeration of the contents of the present work, it will be 
readily seen that it is not a complete work on fractures; and, moreover, 
that it contains many things which are altogether foreign to that subject. 
In short, a considerable portion of it is evidently devoted to dislocations 
and other cognate subjects, as in like manner it will be presently seen that FRACTURES. 
25 
a considerable portion of the next work, which is more especially devoted 
to dislocations, is occupied with observations on fractures. It is difficult 
to account in a satisfactory manner for this want of arrangement, more 
especially as the two treatises are generally acknowledged, to have consti- 
tuted originally one work. The most plausible conjecture which I can 
form, in order to account for this mixing up together of the different 
matters in each, is this,-that when, for convenience sake, the work was 
divided into two, namely, one part " On Fractures," and another " On the 
Articulations," it was found necessary, in order to give a clear view of the 
subjects treated of in the one, to illustrate them by extracts relative to the 
cognate subjects treated of in the other. And, in fact, although the sub- 
jects here discussed be given rather confusedly, it will be found, in a prac- 
tical point of view, very convenient, nay, indispensably necessary, to con- 
sider certain fractures and dislocations at the same time, in order to es- 
tablish an accurate diagnosis between them. For example, how is it pos- 
sible to understand dislocations at the elbow without a knowledge of frac- 
tures of the extremities of the bones which enter into the formation of it, 
namely, of the humerus and the bones of the fore-arm ? And again, who 
could understand fractures at the lower end of the tibia and fibula with- 
out an acquaintance with dislocations at the ankle-joint? Altogether, 
then, it certainly appears to me, upon mature reflection, rather an advan- 
tage to the student to have these two classes of accident treated of to- 
gether, as they are in this and the succeeding work. The complete man- 
ner in which the various subjects are handled, the admirable plan upon 
which our author proceeds from obvious and indisputable principles, can- 
not fail to command the admiration of every careful and intelligent reader. 
The whole treatise, also, is written in so lucid a style that, with the few 
foot-notes which I have added, the reader will find no more difficulty in 
availing himself of the contents of this work, although written twenty- 
two centuries ago, than if it had been a publication of the present day. 
I shall now only make a few observations on certain subjects, either be- 
cause they seem to require some elucidation, owing to their being treated 
of very succinctly, or because I look upon them as being particularly de- 
serving of attention. 
The process of setting, bandaging, and arranging a fractured limb, 
although this truly is now a hackneyed subject, will be found described 
in this treatise with so much precision, that I am persuaded the surgeon 
of the present day may derive information from it, for it appears to me 
that certain of the rules of practice here laid down by Hippocrates, are 
sometimes improperly overlooked by the modern practitioner. For ex- 
ample, although the propriety of putting a fractured limb, before it is set, 
into the position in which it is to be kept afterwards, is so clearly stated 
in this work, it is often disregarded in modern practice, and the conse- 
quences here described follow accordingly, namely, the derangement of 26 
GENUINE WORKS OF HIPPOCRATES. 
the bandages, and, consequently, displacement of the fractured portions 
of bone after the position of the limb is altered. I am also of opinion, 
after having repeatedly adopted the practice recommended by Hippoc- 
rates, that the rule here stated, not to apply the bandages and apparatus 
beyond the fractured limb, is consistent with sound principles, and that 
the departure from it in modern practice is, in many cases, anything but 
an improvement. This I have hinted in the annotations on the preceding 
treatise, and I am now glad to find that so distinguished an authority as 
M. Malgaigne joins me in expressing this opinion. Treating of the splints 
compresses, and bandages used in the Hippocratic system of bandaging 
a fractured limb, he adds: " Reste enfin leur longueur, qui choque nos 
habitudes; car ou est le chirurgien qui se borne a recouvrir 1'avant-bras 
fracture, sans empieter sur la main et avec les bandes et avec les attelles ? 
Or, dcja ne m'a pas manque pour le dire, et je n'hcsiterai pas 
a le repeter ici, ces bandes, ces attelles, prolongces sur la main, ne sont 
justifiees par aucune consideration serieuse et legitime, et elles ont de 
graves inconvenients. En these generale, attelles ou bandages ne sont 
faits que pour remplacer par un squelette exterieur le squellette naturel 
fracture, qui donnait an membre sa longueur, sa forme, sa solidite, et 
ils ne doivent pas se prolonger au-dela, a moins d'indications toutes 
speciales. Il faut ajouter cependant que tout membre fracture, pour 
arriver a la consolidation, devant rester long-temps dans 1'immobilite, a 
besoin d'une position stable qui la lui garantisse, et que 1'appareil que nous 
venons d'etudier serait insuffisant a cet cgard. Mais les moyens de rem- 
plir cette indication nouvelle sont divers pour chaque membre et pour 
chaque brisure du membre; ils pourraient etre decrits sous le nom d'ap- 
pareils complcmentaires. Or, ces appareils complementaires ne sont pas 
oublies pai- Hippocrate; 1'echarpe pour 1'avant-bras, le bandage de corps 
pour le bras, les coussins ou les gouttieres pour le membre inferieur. "1 
And, in addition to the reasons here assigned by M. Malgaigne for con- 
fining the apparatus, in general, to the fractured portion of the limb, I 
would again say, that I am inclined to think that bandaging the part 
below the injury, for example, the hand, in fractures of the fore-arm, has 
a tendency to increase the swelling above, which would otherwise be de- 
termined to the parts below, and thus relieve the seat of the injury. 
I would beg leave most particularly to direct attention to the condem- 
natory remarks of our author upon the method of treating compound frac- 
tures, by bandaging the parts on both sides of the wound, and leaving it 
uncovered to admit of dressings being applied to it. I may mention in 
this place, that the last occasion on which I met with the lamented Mr. 
Liston, we conversed on this subject, when he stated decidedly that he 
agreed with Hippocrates in condemning the practice, which, however, he 
1 Des Appareils pour le Traitement des Fractures en general, etc. FRACTURES. 
27 
often saw adopted in hospital practice. Our author's treatment of com- 
pound fractures is also deserving of much attention, as indicating the large 
amount of experience which he must have had in this way. 
There are three surgical subjects which are very fully, but yet rather 
confusedly, treated of by our author in this and the two following works, 
namely, the accidents which befall the knee, the ankle, and the elbow7. 
It strikes one as very remarkable, that the ancient surgeons should all 
speak of dislocations at the knee-joint as being of frequent occurrence, 
whereas they are now regarded as being among the rarest accidents of the 
kind to which the joints of the human body are subject. In this case, 
we must either suppose that the ancient surgeons had somehow been 
guilty of a mistake, or that the accident had been more common in ancient 
times than it is now. I have often wondered whether the difficulty might 
not be got over, by supposing that the wrestlers at the public games of 
his country, who, it is clear, furnished Hippocrates with a large propor- 
tion of his cases of fracture and dislocation, may not have been particu- 
larly liable to this accident. Having once met with a very interesting 
case of dislocation at the knee-joint, I persuade myself that I cannot 
better illustrate this subject than by giving a Report of it which I pub- 
lished in the London Medical Gazette, Dec. 1842. I do so the more 
readily, as it will enable me to correct some unfortunate typographical 
blunders which occur in the Report as it appeared in the Gazette. 
" Case of Dislocation of the Knee-joint.-By Francis Adams, Esq., 
Surgeon; Sept. 10th, 1842. AlexanderRobie, set. 55, while in the act of 
carrying provender between two large bullocks in their stall, was knocked 
down by a stroke of one of their hind legs on the right knee; and while lying 
down on the ground, was severely injured by being trod upon in several parts 
of the body, especially near the middle of the right leg. I saw him about 
two hours after the accident, and found the bones of the right leg lying- 
on the fore part of the femur; the articular cavities could be distinctly 
felt, while, below, the contour of the condyles could be traced; in short, 
I never saw a case of dislocation in which the symptoms were so 
strongly marked. The patella was pulled considerably up the thigh; but 
it appeared pretty obvious that neither the ligamentum patella), nor the 
tendon of the triceps, was ruptured; but my impression at the time cer- 
tainly was, that, in order to admit of so great a displacement, all the prin- 
cipal ligaments of the joint must be torn. The limb was immovably ex- 
tended. By making proper extension and counter-extension, the reduc- 
tion was effected with little difficulty. The limb was then bandaged 
loosely, from the toes to near the middle of the thigh, and laid half-bent 
on a thick pillow, and evaporating lotions were directed to be applied 
occasionally. For some days no severe symptoms occurred in the joint; 
On Dislocations of the Knee. 28 
GENUINE WORKS OF HIPPOCRATES. 
but swelling and suppuration having afterwards taken place in the leg, 
especially about the calf of it, the bandages had to be removed and poul- 
tices applied. The limb continued very much swollen, and the discharges 
became fetid, while, owing perhaps to its weight, the bones of the leg, 
about the twelfth day, were dragged downward, so as then to give the 
knee-joint the appearance of a semi-luxation backwards. The limb was 
secured in the best manner that could be managed in its tender state, and 
the bones retained in position by means of a jointed splint applied below 
the thigh and leg. 
" 30th. The limb has gone on getting daily into a worse state; the 
foot has lost its heat and sensibility, and the whole leg behind up to the 
knee is of a darkish green color. About the calf of the leg it is greatly 
swollen, and the discharge from it very copious. The joint is so loose 
that the bones can with difficulty be kept in position: the pulse about 115. 
He has agreed to have his limb removed to-morrow, if no improvement 
take place in the interval. 
" Oct. 1st. I amputated the limb to-day about the middle of the thigh, 
with the assistance of my professional neighbor Mr. Walker. The patient 
bore the operation with great fortitude, and appeared soon afterwards 
much relieved from his sufferings. The muscles felt so soft and flabby, 
as to excite apprehensions in my mind, that the vessels might not bear the 
ligatures well; no unpleasant symptoms, however, occurred, and in the 
course of three weeks the stump was completely healed. 
"We examined the parts about the* knee-joint immediately after the 
operation. As I had formerly supposed to be the case, the tendon of 
the quadriceps and ligamentum patellae were entire; the latter, however, 
was remarkably stretched and slackened; contrary to my expectations, 
I found that the lateral ligaments were not torn. Upon cutting into the 
joint, the crucial ligaments were found to be torn in pieces, but all the 
other parts were uninjured; the posterior ligament, the heads of the gas- 
trocnemius, and the popliteal vessels, being all safe from any serious in- 
jury. The limb below being a general mass of suppuration and putridity, 
was but cursorily examined; it appeared certain, however, that the back 
part of the leg had been bruised to the state of a pulp. The condyles 
of the femur were somewhat smaller than they normally are, and were so 
rounded as to show an unusual aptitude to slip out of the articular cavi- 
ties; and to this construction of the bones, joined, perhaps, to some pre- 
ternatural laxity of the ligaments, the accident, in all probability, is to be 
ascribed. 
" This would appear to be one of the rarest dislocations to which the 
joints of the human body are subject. The only unequivocal case which 
I know of as having been reported in this country, is the one related by 
Mr. Jonathan Toogood, in the " Provincial Medical and Surgical Journal," 
June, 1842. Another, supposed to be of a similar nature, he justly re- FRACTURES. 
29 
gards as probably incomplete. In these two cases recovery took place 
without any untoward symptoms, as I have no doubt would have hap- 
pened to my patient, had the injury been confined to the knee-joint. 
Mr. Toogood mentions, that neither Sir Astley Cooper, Dupuytren, nor 
Roux, had ever met with such a case, nor, as far as I can discover, do 
any of our latest writers on surgery mention having ever had occasion to 
treat this accident. Cheselden, although correct in stating that ' the knee 
cannot be completely dislocated without breaking the cross ligaments' 
(Anatom, p. 45), may be supposed from the problematical way in which 
he expresses himself, to have had no experience of such a case. Boyer 
also writes of the accident in equivocal terms, and is wrong in stating that 
the heads of the gastrocnemius, and other soft parts, must necessarily be 
torn. Of the ancient authorities in surgery Celsus is the only one who 
makes mention of dislocation forwards: he says, ' In priorem non prolabi 
plerique scripserunt; potestque id vero proximum esse, cum inde opposita 
patella ipsa quoque tibiae caput contineat. Meges tamen eum cui in pri- 
orem partem excidisset, a se curatum esse memorise prodidit.' (viii. 21.) 
Hippocrates, the great ancient authority on fractures and dislocations, 
describes dislocations of the knee outward, inward, and backward, but 
says nothing of dislocations forward; and all the other ancient writers on 
surgery, both Greek and Arabian, repeat the same statement. In like 
manner the earlier surgical writers in modern times, being all servile copy- 
ists of the Arabians, give the same account of dislocations at the knee. 
See Theodoricus, ii., 52. As far as I can learn, the case now related is 
the only one on record in which the actual state of the parts was ascer- 
tained by dissection." 
Since writing the above report, I have ascertained that I had overlooked 
an unequivocal case of dislocation at the knee-joint related by our old au- 
thority, Wiseman. He describes it most circumstantially, to the effect that 
"the head of the os tibiae was shot under the thigh-bone, and lay stretched 
out straight. By making extension and counter-extension, and fixing the 
limb towards the buttocks, it slipped into its place." This, then, was a 
case of dislocation of the tibia backwards, and in so far differed from mine, 
which was a dislocation forwards. It has been made a question whether 
or not our author, in treating of displacements at the knee, regards the 
femur or the tibia as the fixed point. M. Littre inclines to the opinion, 
that he makes the tibia the fixed point, and regards the femur as the part 
which is displaced; according to this rule, the case I have related would 
have been ranked by Hippocrates as a dislocation backwards. It would 
appear, then, after all, that the case related above is one of the forms 
which Hippocrates recognizes. Of the lateral dislocations noticed by 
Hippocrates, and the other ancient authorities, there is hardly any une- 
quivocal case reported in modern works on surgery. I am inclined to think 
that they must all be incomplete, or connected with congenital malfor- 30 
GENUINE WORKS OF HIPPOCRATES. 
mation. Subluxations constitute a class of accidents, about the nature of 
which there is still much uncertainty, after all the investigations which 
they have undergone of late years. Many of them would appear to be 
mere displacements of the semi-lunar cartilages. It is curious to remark, 
that all our earlier authorities agree with the ancient in representing dis- 
locations at the knee as a very mild class of accidents. Wiseman says, ' ' They 
are not difficult to reduce, nor subject to such accidents as those of the 
elbow." (v., 9.) Vesalius speaks of them as being very insignificant acci- 
dents, insomuch that the patient himself can readily reduce them. 
(Chirurg. Mag. i., 17.) Ambrose Pare writes of them in similar terms. 
It is probable that these, and other modern authorities, merely copy from 
the ancient authorities, and that severe sprains, exaggerated by the imagi- 
nations of the patients into dislocations, have been often recognized as 
such by the professional attendants. 
On the Accidents which befall the Bones of the Elbow. 
As there is scarcely a subject connected with surgery more puzzling, 
even at the present day, than the fractures and luxations which occur at 
the elbow-joint, so it is one to which Hippocrates had evidently paid the 
most minute attention, and accordingly he has treated of it in three differ- 
ent works, namely, at "Fractures" §§ 38, 39, 40, 41, 42, 43, 44, 45, 46; 
"Articulations," §§ 17, 18, 19, 20, 21, 22, 23, 24, 25, 66; " Mochlicus," 
§§ 7, 8, 9, 10, 11, 12, 13. Of the important matters contained in these 
paragraphs 1 now feel myself called upon to attempt an accurate analysis, 
without which it must fye admitted that my translation can possess but 
little value; for he forms but a very imperfect idea of the duties of a 
translator who thinks he has nothing to do but merely to render certain 
vocables of the original into the corresponding ones in the language of the 
translation, without concerning himself with the exact sense and import 
of the original author. 
I shall now proceed to enumerate all the varieties of dislocation and 
fracture at the elbow-joint, which our author describes, or, at least, 
appears to describe. 
1. Dislocation of the ulna and radius backwards, "Articulations," §§ 
19-23; "Fractures," § 42; "Mochlicus," § 9: there his descriptions 
agree very well with those of Sir Astley Cooper, Mr. Bransby Cooper,1 
and all the best modern authorities. Incomplete dislocations, described 
by our author, "Articulations," §§ 17-24; "Fractures," §§ 39, 40; 
" Mochlicus," § 14; but scarcely recognized by modern authorities.2 
2. Dislocation of the ulna and radius forwards; see " Fractures," § 43; 
1 Lectures in the Medical Gazette, No. 1065. 
2 Chelius, indeed, speaks of incomplete lateral dislocations, but only in very 
general terms (§ 1048). FRACTURES. 
31 
"Articulations," §§ 19-23; " Mochlicus," § 9. This case is scarcely 
admitted as possible, by modern authorities, unless attended with fracture 
of the olecranon. Dr. Fergusson, however, is not quite decided upon 
this point, and in great laxity of the joint I can easily suppose it possible. 
3. Complete lateral dislocation described at "Fractures," § 41; "Ar- 
tiulations," §§ 18-22; " Mochlicus," § 12. This case is scarcely recog- 
nized as possible by Sir Charles Bell, Sir Astley Cooper, Mr. Bransby 
Cooper, and Mr. Liston; but is distinctly admitted by Chelius, § 1048, 
and partially so by Mr. R. Adams, in the " Cyclopaedia of Anatomy." 1 
4. Partial or incomplete lateral dislocations described at " Fractures," 
§ 40. These are recognized and described by Sir Charles Bell, Mr. Lis- 
ton, Mr. R. Adams, in the " Cyclopaedia of Anatomy," and by Chelius, 
and all our best authorities of the present day. 
5. Luxation of the radius forward, backward, and to either side, ob- 
scurely noticed at "Fractures," § 41-44; "Articulations," § 18. Those 
backward and forward are described by Sir Astley Cooper, Mr. Bransby 
Cooper, Mr. R. Adams (Cyc. Anat., 1. c.), and all our best authorities; 
but lateral dislocation has been noticed by few. It is recognized, how- 
ever, by Sir Astley Cooper, in the Appendix to his work on Luxations, 
and Mr. R. Adams, in the " Dublin Journal of Medical Science," vol. 
xxii., p. 504. 
6. Fractures of the olecranon, described by our author at " Fractures," 
§ 45, and still more distinctly by Galen, (Chirurgici Graeci, p. 87). Sir 
Charles Bell, and all the best modern authorities describe this accident in 
similar terms. I may mention, under this head, that neither Hippocra- 
tes, nor any other author, ancient or modern, as far as I am aware, has 
noticed rupture of the tendon of the triceps, and yet I have met with a 
case of this accident. 
7. Abruption of the articular extremity of the humerus, that is to say, 
of its apophysis or trochlea, is described by our author as being an acci- 
dent which, although it may appear more serious, is, in fact, far milder 
than most of the injuries of the elbow-joint, " Fractures," § 46. It is 
more distinctly noticed by Galen, in a fragment of his " Commentary," 
preserved by Cocchi (Chirurg. Graec., p. 86): "Abruption is not a differ- 
ent sort of injury from fracture, but abruption is a fracture taking place 
in the seat of the articulation. In the articulation at the elbow sometimes 
the bone of the fore-arm is broken off,2 and sometimes that of the arm 
(the humerus)." Nothing can be more distinct than the description given 
1 Abnormal Condition of Ithe Elbow-joint. 
2 Does he mean fracture of the coronoid process of the ulna? Dr. Fergusson. 
as far as I am aware, is the only one of our recent authorities who hints that it is 
often fractured in dislocations backward. Sir A. Cooper, however, has also 
noticed fracture of the coronoid process. See his work on Dislocations, etc., p. 
483. 32 
GENUINE WORKS OF HIPPOCRATES. 
by these two authors, and yet it is singular that scarcely any modern 
authority has noticed this accident, although I believe it to be of frequent 
occurrence. Complicated with dislocations, it has, indeed, been described 
of late, and most distinctly by Sir Charles Bell and Baron Dupuytren. 
Sir Charles writes of it thus: " Fracture through the trochlea and across 
the fossa. Take care to distinguish this accident from dislocation of the 
ulna and radius backwards, etc. "1 Baron Dupuytren, in like manner, in 
his admirable work, on Fractures and Dislocations, lately reprinted by the 
Sydenham Society, gives a masterly account of this case when it puts on 
the appearance of dislocation at the elbow-joint, but neither he, nor any 
other authority of late years, as far as I am aware, has described the case 
when not accompanied by displacement. This appears to me most re- 
markable, since I can attest, from the most ample experience, that it is 
an accident of very frequent occurrence, insomuch that scarcely a year 
passes in which I am not called upon to treat several cases of it. It occurs 
most frequently in young persons from falls, and may be readily discov- 
ered by pulling gently at the arm and fore-arm, and placing the thumb 
on the front of the articulation, when a crepitus will be easily detected. 
If not detected and properly treated, the case ends in a stiff joint, so that 
extension cannot be made to a greater extent than about 130 or 140 de- 
grees, and flexion also is imperfectly performed. The fore-arm at first 
should be bent at about a right angle to the arm, and secured with band- 
ages, as the ligatures are usually put on after venesection, but these should 
soon be loosed, and the motion of the joint secured by making extension 
in good time. I also avail myself of the present opportunity to state it 
as my own belief, after a pretty extensive acquaintance with this class of 
accidents, that what is taken for a dislocation at the elbow is usually com- 
plicated with fracture of the apophysis of the humerus. Hence it is that 
patients so frequently complain of their surgeon having left them with a 
stiff joint after such an accident. 
8. Congenital dislocation at the elbow-joint is briefly noticed by our 
author; " Mochlicus," § 11; " Articulations," § 21. Cases of congenital 
dislocations would appear to be particularly rare, but yet congenital dislo- 
cation of the radius is noticed by Dupuytren and R. Adams.2 
From the account which I have now given of our author's opinions 
regarding the accidents which befall the elbow-joint, it will be admitted 
even at the present day, that his information on the subject was almost 
complete. The only well-marked case which is omitted by him is the 
separate dislocation of the ulna; it is noticed by Mr. Bransby Cooper in 
the following terms: "It sometimes, but very rarely, occurs that the 
ulna is thrown backward from the inner condyle, without a corresponding 
1 Institutes of Surgery, p. 126. 
2 Cyclopaedia of Anatomy, Abnormal Elbow-joint. FRACTURES. 
33 
displacement of the radius." It is also noticed by Sir Astley Cooper and 
by R. Adams in the "Cyclopaedia of Anatomy." But, in fact, it had 
been distinctly described in ancient times, by Celsus and Oribasius. See 
the Comment, on Paulus tEgineta, Book VI., 115. Is it not, in so far, 
consolatory to find that a great genius, like our author, does not antici- 
pate all the discoveries which any subject he handles is capable of receiv- 
ing ? Yet, after the lapse of twenty-two centuries, how few additions have 
been made to the information which he supplies on this head!1 
On the Fractures and Dislocations at the Ankle-joint. 
In order to understand the account given by our author of accidents 
which befall the ankle-joint, it will be necessary to advert to his descrip- 
tion of the bones which compose the leg. Turning, then, to 11 Fractures," 
§ 12, and " Mochlicus," § 1, it will be seen that Hippocrates describes the 
tibia and fibula as being united together, above and below, by an epiphysis, 
and it appears problematical whether, by the lower epiphysis, he meant 
the outer malleolus, or he two malldoli taken together; and further, it 
will be a question for the reader to consider whether he does not use the 
term vaguely, sometimes in the one sense and sometimes in the other. It 
is to be borne in mind that Hippocrates lived at a time when the terms of 
art were by no means strictly defined. Thus it is well known that he 
applies the term nerve (vevpov) to nerves properly speaking, and also to 
tendons and membranes. By " great vertebra" he sometimes means the 
second cervical, sometimes the first dorsal, and at other times the last 
lumbar. It seems undeniable that he applies the term "head of the 
humerus," both to its upper and inferior extremity.2 It need not be 
thought singular, then, that he should be found to use the term epiphysis 
in the same indefinite manner. He knows nothing of the distinction be- 
tween, epiphysis and apophysis, as applied by Galen, the one to the junc- 
tion of two bones together, and the other to a protuberance of a single 
bone;3 the latter term, indeed, he rarely or never uses, as applied to 
bones. See Foes, "(Econ. Hippocrat." 
We shall now examine the contents of the paragraphs in which these 
1 The reader may find it interesting to compare with the list of accidents de- 
scribed by our author that which is given of them in the Cyclopaedia of Anatomy: 
" 1, Luxations of both bones backwards; 2, Luxations of both bones laterally, com- 
plete and incomplete; 3, Luxations of both bones laterally and posteriorly; 4, Lux- 
ation of the ulna alone backwards; 5, Luxation of the radius alone forward; 6, 
Luxation of the radius externally and superiorly: 7, Complete luxation of the 
radius backwards; 8, Sub-luxation of the radius backwards; 9, Congenital luxa- 
tion of the radius." (Abnormal Elbow-joint.) 
2 Our old authority Wiseman, in like manner, applies the term "head" to the 
inferior as well as to the upper extremity of the humerus; he says, "the os hu- 
meri endeth broad towards the cubit, with a double head," etc. (vii., 6.) 
3 De Ossibus ad Tirones. 
Vol. IL-3. 34 
GENUINE WORKS OF HIPPOCRATES. 
accidents are described. See "Fractures," §10, 11, 12, 13; " Articula- 
tions," §§ 83, 84, 85, 86, 87; " Mochlicus," §§ 27, 28, 29, 30, 31. 
Dislocations of the astragalus, along with the other bones Of the tarsus 
from the bones of the leg, are described at "Fractures," § 10, and at 
" Articulations," §§ 83, 85, 87; in the last of these paragraphs to the fol- 
lowing effect: " In those cases in which the foot is displaced, either by 
itself or with its epiphysis, it generally is dislocated inwards." Nearly 
the same description is repeated at " Mochlicus," § 31, and dislocations of 
these bones are otherwise alluded to at §§ 27, 28, 29, of the same work. 
The great puzzle is the description given at § 13 of "Fractures," which 
is as follows: " The bones connected with the foot are sometimes dis- 
placed, sometimes both the bones with the epiphysis; sometimes the 
epiphysis is displaced, and sometimes the other bone." It would be 
tedious to the professional reader, I fear, if I were to go into a lengthened 
discussion of all the different interpretations which might be given of this 
very obscure passage, and I must own that I have but little heart for the 
task, knowing, as I do, that I should not arrive at any very satisfactory 
result at the conclusion of my long labors. I shall give, then, a summary 
view of a question, the consideration of which has cost me no little time 
and application. If by epiphysis is here meant the conjoined malleoli, 
that is to say, the extremity of both bones of the leg, the first case 
described thus: " The bones connected with the foot are sometimes dis- 
placed, sometimes both bones with the epiphysis," may be taken to mean 
simple fracture of the extremity of the leg in the immediate vicinity of the 
joint-a case of not unfrequent occurrence, and which, from ample ex- 
perience, I know, puts on very much the appearance of a dislocation; in 
fact, this is the case which Mr. Bransby Cooper describes as dislocation of 
the astragalus outwards.1 The next case, "sometimes the epiphysis is 
moved," may mean subluxation outward; and the third, "sometimes the 
other bone," may apply to subluxation inward. Indeed, the word here 
used (pMivrfOrf) is generally restricted by our author to subluxations. It 
is to be recollected that, by dislocation at the ankle, Hippocrates meant, 
like Sir Astley Cooper, Mr. Bransby Cooper, and most of our late 
authorities, displacement of the bones of the leg from the astragalus. 
If we turn to the authorities subsequent to Hippocrates, we shall not 
meet with much that is calculated to throw additional light upon the 
subject. Paulus 2Egineta describes dislocation at the ankle briefly and 
vaguely. Celsus says the displacements may be in all directions. Oribasius 
describes three, namely, inward, outward, and backward. The Arabian 
Albucasis, mentions only two, inward and outward. See Paulus 
JEgineta, Book VI., 120. Most of our late authorities, like Celsus, 
admit the possibility of displacements inward, outward, backward, and 
1 See his Lectures in the Medical Gazette, formerly referred to. FRACTURES. 
35 
forward. But, after all, it is a subject which still stands much in want of 
further elucidation. For my own part, after a good deal of experience in 
treating these accidents, I must say that I incline very much to Mr. Syme's 
views, and am disposed to range them with fractures rather than with 
luxations, for I believe that fracture is generally, if not always, the 
primary and the more important injury. 
Dislocation of the os calcis from the cuboid, or dislocation at Chopart's 
tarsal joint, would seem to be the accident described at § 11 of 
" Fractures," § 86 of " Articulations," and § 30 of " Mochlicus." See 
the annotations. 
These are the only luxations at the ankle described by our author, and 
I need scarcely say that they comprise the principal accidents of this class 
with which the modern surgeon is acquainted. It will be seen, that the 
explanation of the passages in which they are noticed is attended with 
much difficulty; and I am bound to say, that great credit is due to M. 
Littre, and his countrymen MM. Malgaigne and Bosquillon, for the 
pains they have taken in elucidating, their obscurities. I shall be much 
gratified if my exertions be found to have cast some additional light upon 
the subject. See further the annotations. 
Congenital dislocations at the ankle-joint, or clubfoot, and also those 
of the hip-joint and wrist will come to be treated of in the Argument 
prefixed to the next treatise. 
ON FRACTURES. 
In treating fractures and dislocations, the physician must make the 
extension as straight as possible, for this is the most natural direction.1 
But if it incline to either side, it should rather turn to that of pronation, 
for there is thus less harm than if it be toward supination. Those, then, 
who act in such cases without deliberation, for the most part do not fall 
into any great mistake, for the person who is to have his arm bound, 
presents it in the proper position from necessity, but physicians who fancy 
themselves learned in these matters, are they who commit blunders. 
11 may mention at the commencement, that, in this treatise and the succeed- 
ing one, On the Articulations, our author expresses himself in general so fully 
that there is little need of any commentary to explain his meaning. For this 
reason my annotations on these two works will be much briefer than those on the 
preceding treatises. In this place I have to remark that the reader must under- 
stand the epithet "straight," as explained by the context, that is to say, as sig- 
nifying "the most natural" direction for the limb to which it is applied; its mean- 
ing in the case of fractures of the fore-arm will appear presently. See an elabo- 
rate disquisition on the meaning of the term by M. Littre (CEuvres d'Hippocrat., 
tom. iii., p. 389). It does not appear to me, however, that there is any difficulty 
in comprehending- our author's use of the term. 36 
GENUINE WORKS OF HIPPOCRATES. 
There is no necessity for much study, then, in order to set a broken arm, 
and in a word, any ordinary physician can perform it; but I am under 
the necessity of giving the longer directions on this subject, because I 
know physicians who have the reputation of being skilled in giving the 
proper positions to the arm in binding it up, while in reality they are only 
showing their own ignorance. But many other things in our art are 
judged of in this manner, for people rather admire what is new, although 
they do not know whether it be proper or not, than what they are accus- 
tomed to, and know already to be proper; and what is strange, they prefer 
to what is obvious. I must now state what the mistakes of medical men 
are, which I wish to unteach, and what instructions I have to give as to 
the management of the arm; for what 1 have to say regarding it, will 
apply to the other bones in the body. 
2. The arm, then, for that is the subject we were treating of, was 
presented in the prone position to be bound, but the physician forced his 
patient to hold it as the archers do when they project the shoulder, and 
in this position he bound it up, thinking within himself that he was acting 
according to Nature, and in proof of this he pointed out that all the bones 
in the fore-arm were thus in a straight line, and that the integuments both 
inside and outside, were also in a straight line, and that the flesh and 
nerves (tendons ?) were thus put in their natural position, and he appealed 
to what happens in archery, as a proof of this.1 And so saying, and so 
doing, he is looked up to as a sage; and yet he forgets that in all the 
other arts and performances, whether executed by strength or dexterity, 
1 There is a good deal of difficulty in determining what position of the arm is 
here meant, and there is the greatest diversity of opinion among the expositors 
on this head. Palladius says expressly, that supination is the position here re- 
ferred to; but this apparently cannot be the case, as supination is treated of be- 
low in the third paragraph. Galen also calls the position either complete supin- 
ation or nearly so. Littre sought to solve the difficulty by examining the figures 
of ancient archers in the attitude of drawing the bow, as represented in the Temple 
of Jupiter in Egina. In g-eneral, he found the arm in the position intermediate 
between pronation and supination. This, then, would appear to be the position 
here meant; but as this is, in fact, the best and easiest position in which a fract- 
ured arm can be placed, it may be asked in what respect then is it condemned as 
faulty ? From what is stated in the latter part of this paragraph, it is clear that 
it is in being completely extended; whereas the easy and natural position is that 
with the fore-arm at right angles to the body. In the attitude of drawing the 
bow, of course the left arm is strongly extended. Were a fractured arm, then, 
to be put into this position while it was in the act of being bandaged, its position 
could not be changed without deranging the bandages; and if it were to be kept 
thus extended for a time, the attitude, as stated by our author, would no doubt 
be very painful. Galen, in his very lucid description of the process of putting- up 
fractured limbs, states decidedly that, in the case of the fore-arm, the proper po- 
sition is the rectangular (eyyuviov).-Meth. Med., vi., 5. This is a principle which 
our author enforces on all occasions. FRACTURES. 
37 
what is reckoned the natural position is not the same, and that in the 
same piece of work it may happen that the natural position of the right 
arm is not the same as that of the left. For there is one attitude in 
throwing the javelin, and another in slinging, another in casting stones, 
another in boxing, and another in a state of repose. And whatever arts 
one examines, it will be found that the natural position of the arms is not 
the same in each, but that in every case the arms are put into the attitude 
which suits best with the instrument that is used, and the work to be 
performed. In practicing archery, no doubt this is the best attitude of 
the left arm, for the ginglymoid extremity of the humerus being fixed in 
the cavity of the ulna, in this position, throws the bones of the fore-arm 
and arm into a line, as if they constituted a single bone, and all flexion at 
the joint is prevented in this position. It is no doubt certain that the 
member is thus put into the most unbending and extended position possi- 
ble, so as not to be overcome or yield when the string is drawn by the 
right arm, and thus will the archer be enabled to draw the string farthest, 
and discharge his arrow with the greatest force and rapidity, for arrows 
thus discharged have the greatest swiftness and force, and are carried to 
the greatest distances. But there is nothing in common between the 
binding up of an arm and archery. Moreover, if having thus bound up 
the arm, the physician direct the patient to keep it thus, he will occasion 
him greater pain than he had from the wound itself; and thus also, if the 
physician order him to bend the arm, neither the bones, the nerves, nor the 
flesh will any longer be in the same condition, but will be arranged differ- 
ently, having overcome the bandaging. What use, then, is there of the 
archer's attitude? And these mistakes, the physician, conceited in his 
knowledge, would probably not have committed if he had allowed the 
patient himself to present his arm. 
3. But another physician putting the arm into the state of supination, 
gives orders to extend the arm thus, and bandages it in this position, 
reckoning it the one according to nature, judging thus from the skin, 
and also fancying the bones to be thus in their natural position, because 
the bone which protrudes at the wrist, where the little finger is, appears 
to be in a line with the bone from which people measure the bone of the 
fore-arm. These things he brings forward as proofs that the parts are in 
their natural state, and he is supposed to speak correctly. But, indeed, if 
the arm be kept stretched in a supine position, it will become very pain- 
ful, and this fact any one may ascertain by extending his own arm in this 
attitude. And also a weaker man grasping with his hands a stronger man 
whose arm is turned in a supine position, could lead him wherever he 
chose, and neither, if a man held a sword thus in his hand, could he make 
any proper use of it, so constrained is this position. And, moreover, if, 
when a physician has thus bound up the arm, he allow it to remain in the 
same position, the patient will endure greater pain if he walk about, but 38 
GENUINE WORKS OF HIPPOCRATES. 
considerable, even if he remain at rest. And thus, too, if he shall bend 
the arm, the muscles and the bones must necessarily assume a different 
position. But, in addition to other mischief, he is ignorant of these facts 
regarding the position, that the bone which protrudes at the wrist, close 
to the little finger, belongs to the fore-arm, whereas the one at the joint, 
from which people measure the fore-arm, is the head of the humerus. He 
fancies that both these belong to the same bone, and many others are of 
this opinion. The latter, in fact, is the same part as that which is called 
the elbow, upon which we sometimes rest,1 and when he holds the arm 
thus in a supine position, in the first place the bone appears distorted, 
and in the next place the tendons which extend from the carpus along 
the inner side and from the fingers become distorted while the arm has a 
supine position; for these tendons proceed to the bone of the humerus, 
from which the fore-arm is measured. Such, and so many mistakes and 
marks of ignorance are committed, regarding the natural construction of 
the arm. But if one will extend a broken arm as I direct, he will turn 
the bone, situated at the extremity of the little finger, into the straight 
line, and also the one at the elbow, and the tendons which stretch from 
the carpus to the extremity of the humerus will be placed in the straight 
line; and when the arm is suspended in a sling, it will be in the same 
attitude as that in which it was bound up, and will give no pain to the 
patient when he walks about, nor when he lies reclined, and will not 
become fatigued.2 The man should be so seated that the prominent part 
of the bone may be turned to the brightest light which is at hand, so 
that the operator in making the extension, may be at no loss to discover 
if it be sufficiently straight. The prominence of a broken bone could not 
escape being detected by the hand of an experienced person, when applied 
for this purpose, and, moreover, the projecting part is particularly painful 
to the touch. 
4. In cases of fracture in either of the bones of the forearm, it is easier 
to effect a cure if the upper bone be broken, although it be the thicker 
one, both because the sound bone is situated below, and forms a support 
to it, and because the deformity is more easily concealed, there being a 
thick mass of flesh on the upper side, except near to the wrist. But the 
lower bone is without a covering of flesh, is not easily concealed, and 
requires stronger extension. If it is not this bone, but the other which 
is broken, a more feeble extension proves sufficient, but if both be broken, 
a more powerful extension is required. In the case of a young person I 
have known the extension made more strong than was necessary, but in 
1 Compare Ruff us Ephesius (DePartib. Hom.), and Galen (De MotuMuscul., ii.). 
■ All the ancient authorities put a fractured fore-arm in this position, with the 
thumb above and the little finger below. See Paulus jEgineta, Book VI., 100, 
and the authorities quoted in the Commentary, Syd. Soc. edition. FRACTURES. 
39 
general the extension made is less than what is required. And when they 
are extended, the physician should apply the palms of the hands, and 
adjust the fractured parts and then having rubbed the parts with cerate,1 
but not in large quantity, so that the bandages may not come off, it is to 
be bound up in this state, care being taken that the hand be not lower 
than the elbow, but a little higher, so that the blood do not flow toward 
the extremity, but may be determined to the upper part; and then it is 
to be secured with the bandage, the head of which is to be placed at the 
fracture, and the bandage should impart firmness to the parts without 
occasioning strong compression.2 When you have carried the bandage 
twice or thrice round at the seat of the fracture, it is to be carried upward, 
so that the afflux of blood into it may be stopped, and the bandage should 
terminate there, and the first bandages ought not to be long. The head 
of the second bandage is also to be placed -upon the seat of the fracture, 
and a single round of it being made there, it is then to be carried down- 
ward, and is not to be applied so tight as the other, and there should be 
greater distances between the turns, so that the bandage may prove suffi- 
cient to revert to the spot where the other terminated. The bandages 
may be rolled to the left hand or to the right, or to whatever side suits 
best with the position of the fractured arm, or according to the inclination 
which it may have. Afterward we must place along the arm, compresses, 
smeared with a little cerate, for thus they occasion less uneasiness, and 
are more easily arranged. And then we must apply the bandages cross- 
ways, sometimes to the right hand, and sometimes to the left, for the 
most part beginning below and terminating above, but sometimes com- 
mencing above and ending below. The parts which are thinly covered 
with flesh should be wrapped round with compresses, and inequalities 
should be made up, not by a number of folds at once, but by degrees. 
Some slack turns are also to be made around the wrist, to this side and 
to that. These two bandages are sufficient at first.3 
11 have drawn attention, in the annotations on the work, On the Surgery, to 
this highly important article on the ancient system of bandaging. Palladius says 
expressly, that the object for which it was used was to secure the fractured parts 
by agglutinating the bandages. On the nature of the ancient cerates, see Galen's 
Comment., tom. v., p. 531; ed. Basil. Galen, however, seems to say, in another 
place, that the cerate was used to dispel inflammation (Meth. Med., vi., 5). Men- 
tion, however, is made on various occasions of rosin being added to the cerate* 
evidently for the purpose of rendering it more glutinous. 
- Galen, in his description of the process, points out in strong terms the pro- 
priety of putting the arm into position before the bandages are applied, otherwise 
they will become deranged when the position is altered. (Meth. Med., vi., 5.) 
This rule, I have reason to think, is often forgot in modern practice. 
3 The dimensions of these two bandages, in the work On the Surgery, are fixed 
to be three or four cubits in length, and three, four, five, or six inches in breadth, 
according to the age and size of the patient. See Galen's Comment. Pelladius re- 40 
GENUINE WORKS OF HIPPOCRATES. 
5. And these are the signs that the patient has been well treated and 
properly bandaged: if you ask him if the arm feels tight, and he says it 
does, but moderately so, and especially about the fracture; and this reply 
he should make all along, if the bandage be properly applied. And these 
are symptoms of the bandaging being moderately tight; if for the first 
day and night he fancies that the tightness does not diminish, but rather 
increases; and if on the next day there be a soft swelling in the hand, for 
this is a sign of moderate compression, but at the end of the second day 
the compression should feel less, and on the third day the bandaging 
should appear loose.' And if any of these symptoms be wanting, you may 
conclude that the bandaging is slacker than it should be; or if any of 
these symptoms be in excess, you may infer that the compression is more 
than moderate; and judging from these, you will apply the next bandages 
either slacker or tighter. Having removed the bandages on the third 
day, you must make extension and adjust the fracture, mid bind it up 
again; and if the first bandaging was moderately applied, the second 
bandaging should be made somewhat tighter. The heads of the bandages 
should be placed on the fractures as in the former case; for, by so doing, 
the humors will be driven to the extremities, whereas if you bandage any 
other part beforehand, the humors will be forced from it to the seat of 
the fracture: it is of much importance that this should be properly 
understood. Thus the bandaging and compression should always com- 
mence at the seat of the fracture, and everything else should be conducted 
on the same principle, so that the farther you proceed from the fracture, 
the compression should always be the less. The bandages should never 
be actually loose, but should be smoothly put on. At each dressing the 
number of bandages should be increased; and the patient, if asked, should 
answer, that he feels the bandages somewhat tighter than on the former 
occasion, especially about the fracture, and everything else in proportion; 
and with respect to the swelling, the pain, and recovery, everything should 
proceed as after the former dressing. But on the third day the outer 
bandaging should appear looker. Then having removed the bandages, 
you should bind it up again, somewhat tighter than before, and with all 
the bandages which will be required on the occasion, and afterwards one 
ought to experience the same train of symptoms as at the former periods 
of bandaging. 
6. When the third day arrives, that is to say, the seventh from the 
first dressing, if properly done, the swelling in the hand should be not 
very great; and the part which has been bandaged should be found more 
slender and less swelled at each time, and on the seventh day the swelling 
should be quite gone, and the broken bones should be more readily 
marks, that it is inconvenient to have the bandages very broad, as they get ruffled, 
that is to say, do not lie smooth on the limb. FRACTURES. 
41 
moved, and admit of being easily adjusted. And if these things be so, 
you should, after setting the fracture, apply the bandages so as to suit the 
splints, and a little more tight than formerly, unless there be more pain 
from the swelling in the band. When you have applied the bandages, 
you must adjust the splints all around the limb, and secure them with 
strings so loose as just to keep them in their place, without the applica- 
tion of the splints contributing at all to the compression of the arm.1 
After this the pain and recovery should proceed as in the preceding 
periods of the bandaging. But if, on the third day, the patient say that 
the bandaging is loose, you must then fasten the splints, especially at the 
fracture, but also elsewhere, wherever the bandaging is rather loose than 
tight. The splint should be thickest where the fracture protrudes, but 
it should not be much more so than elsewhere. Particular attention 
should be paid to the line of the arm corresponding to the thumb, so that 
no splint be laid on it, but upon each side of it, nor in the line of the 
little finger where the bone is prominent at the wrist, but on each side of 
it. And if it be found necessary that splints should be applied in these 
directions at the seat of the fracture, they should be made shorter than 
the others, so as that they may not reach the bones which are prominent 
at the wrist, for otherwise there is danger of ulceration, and of the 
tendons being laid bare. The splints should be adjusted anew every third 
day, in a very gentle manner, always keeping in mind that the object of 
1 Our author nowhere describes the ferulas or splints, nor defines their dimen- 
sions or the materials of which they consisted. Palladius speaks of their being 
made of the wood of the philyra, by which was probably meant the Tilia europoea, 
or limetree. See Theophrastus (H. P., i., 12: C. Pl. vi., 12). When they could 
not be procured, he recommends reeds (kciIm/wi) to be used instead. The ancients 
have described various calami, but the sort here referred to was most probably 
the common reed, or Arundo phragmites. I can readily suppose that it might serve 
this purpose very well. The Arabian medical authors make mention of various 
other substances out of which splints were fabricated, such as the pine-tree, the 
alcanna, the oleander, the palm-tree, and the pomegranate. See the authorities 
quoted at Paulus /Egineta, Book VI., 99. Triller, as quoted by M. Littre in the 
Advertisement to the fourth volume of Hippocrates, decides, respecting the splints 
of the ancients, that they were composed of the stalks of ferulas and of reeds. 
Not having seen Triller's work, I am ignorant what his authorities are for this 
opinion,.but I cannot suppose them superior to those I have referred to above. 
Palladius says, the splints were secured by three loose fillets or ribbons, one at 
each end and another in the middle. From the directions given by our author, 
it will be readily seen that he was aware of the danger of tying the ligatures too 
tight. I need scarcely say that tight bandages and strings, in fractures of the 
fore-arm, do mischief by encroaching upon the inter-osseous space. For the same 
reason our author has properly forbid splints to be put on along the bone of the 
thumb and the little finger. I need scarcely add that modern surgery can boast 
of no new views or improved methods of practice in the treatment of fractures of 
the fore-arm. 42 
GENUINE WORKS OF HIPPOCRATES. 
the splints is to maintain the lower bandages in their place, and that they 
are not needed in order to contribute to the compression. 
7. If, then, you see that the bones are properly adjusted by the first 
dressings, and that there is no troublesome pruritus in the part, nor any 
reason to suspect ulceration, you may allow the arm to remain bandaged 
in the splints until after the lapse of more than twenty days. The bones 
of the fore-arm generally get consolidated in thirty days altogether; but 
there is nothing precise in this matter, for one constitution differs from 
another, and one period of life from another. When you remove the 
bandages, you must pour hot water on the arm and bind it up again, but 
somewhat slacker, and with fewer bandages than formerly: and again on 
the third day you undo the bandages, and bind it still more loosely, and 
with still fewer bandages. And if, while the arm is bound up in the 
splints, you should at any time suspect that the bones do not lie properly, 
or if anything about the bandages annoys the patient, you should loose 
them at the middle of the time, or a little earlier, and apply them again. 
A diet slightly restricted will be sufficient in those cases in which there 
was no external wound at first, or when the bone does not protrude; but 
one should live rather sparingly until the tenth day, as being now 
deprived of exercise; and tender articles of food should be used, such as 
moderately loosen the bowels; but one should abstain altogether from 
flesh and wine, and then by degrees resume a more nourishing diet.1 
This doctrine may be laid down as a just rule in the treatment of fractures, 
both as to how they should be treated, and what will be the results of a 
proper plan of treatment; so that one may know, that if things do not 
turn out thus, there has been some defect or excess in the treatment. 
And in this simple plan of treatment it is necessary to attend also to the 
following directions, which some physicians pay little attention to, al- 
though, when improperly executed, they are capable of marring the whole 
process of bandaging: for if both the bones be broken, or the lower one 
only, and the patient who has got his arm bandaged keep it slung in a 
shawl, and that the shawl is particularly loose at the fracture, so that the 
arm is not properly suspended at this end or that, in this case the bone 
must necessarily be found distorted upwards; whereas, when both bones 
are thus broken, if the arm recline in the shawl at the wrist and elbow, 
but the rest of it be not kept up, the bone in this case will be distorted to 
the lower side. The greater part of the arm and the wrist of the hand 
should therefore be equally suspended in a broad soft shawl.'2 
1 Galen, in his Commentary, states that our author, in his works, makes men- 
tion of three modes of diet, namely, the full, the ordinary, and the low. That 
which is here recommended as applicable in the case of fractures is the ordinary, 
wine and flesh being principally forbidden. 
2 Galen, in his Commentary, has some very sensible observations on the two 
forms of displacement occasioned by suspending- the arm improperly in the sling, FRACTURES 
43 
8. When the arm is broken, if one stretch the fore-arm and adjust it 
while in this position, the muscle of the arm will be bound while extended; 
but when the dressing is over, and the patient bends his arm at the elbow, 
the muscle of the arm will assume a different shape.1 The following, 
then, is the most natural plan of setting the arm: having got a piece of 
wood a cubit or somewhat less in length, like the handles of spades, 
suspend it by means of a chain fastened to its extremities at both ends; 
and having seated the man on some high object, the arm is to be brought 
over, so that the armpit may rest on the piece of wood, and the man can 
scarcely touch the seat, being almost suspended; then having brought 
another seat, and placed one or more leather pillows under the arm, so 
as to keep it a moderate height while it is bent at a right angle, the best 
plan is to put round the arm a broad and soft skin, or broad shawl, and 
to hang some great weight to it, so as to produce moderate extension; or 
otherwise, while the arm is in the position I have described, a strong man 
is to take hold of it at the elbow and pull it downward.2 But the physi- 
cian standing erect, must perform the proper manipulation, having the 
one foot on some pretty high object,3' and adjusting the bone with the 
but they are pretty obvious, and are given in two diffuse a style to suit my neces- 
sary limits. The process of suspending the arm in a sling was called analepsis 
a term for which we have no equivalent in modern nomenclature. 
1 The muscle of the arm to which our author refers is evidently the biceps. 
The direction here given to apply the bandages to a broken arm, while it is held 
in the same position as it is to be kept in afterwards, appears to me most impor- 
tant; and yet it is now generally overlooked. Galen expresses himself very forci- 
bly on the propriety of not changing the position of the arm after the apparatus 
is adjusted. (See note, § 4.) The process of adjusting the parts in fracture of the 
arm is minutely described by Paulus See the Commentary, Vo], II., 
p. 456, Syd. Soc. edition. 
2 The description of this process, as given by our author, is remarkably distinct 
and easily understood when illustrated by a drawing, as is done in the Latin edi- 
tion of Galen's works published by the Juntas, from which M. Littr6 would appear 
to have borrowed the figure which he gives (tom. iii., p. 445). The following de- 
scription of the method of setting a fractured humerus is taken from a modern 
author, who is a servile copyist from Hippocrates and Galen, and deserves to be 
introduced here as illustrating the principles upon which our author proceeded in 
the management of this case: " Here there is one remark to be made that is very 
necessary in the way of practice, namely, that in setting the arm the patient must 
sit on an unarmed chair, that a servant may embrace and grasp him under the 
armpit of the sound arm; that another servant must take hold of his arm and 
draw it upwards, without raising it; that, at the same time, a third servant is to 
pull the arm downwards towards the ground; and, in fine, that the arm must 
never be extended, and that the elbow must be always bent in when you thus 
draw the arm." (Verduc, Treatise on Fractures, etc., p. 352.) 
3 Galen explains, that the intention in directing the physician to stand in this 
position is to give steadiness to him. This attitude is alluded to in the work On 
the Surgery, as Galen also remarks. 44 
GENUINE WORKS OF HIPPOCRATES. 
palms of his hands; and it will readily be adjusted, for the extension is 
good if properly applied. Then let him bind the arm, commencing at 
the fracture, and do otherwise as directed above; let him put the same 
questions and avail himself of the same signs to ascertain whether the arm 
be moderately tight or not; and every third day let him bind it anew and 
make it tighter; and on the seventh or ninth day let him bind it up with 
splints, and leave it so until after the lapse of more than thirty days. 
And if he suspect that the bone is not lying properly, let him remove the 
bandages in the interval, and having adjusted the arm, let him bind it up 
again. The bone of the arm is generally consolidated in forty days. 
When these are past, the dressing is to be removed, and fewer and slacker 
bandages applied instead of it. The patient is to be kept on a stricter 
diet, and for a longer space of time than in the former case; and we must 
form our judgment of it from the swelling in the hand, looking also to 
the strength of the patient. This also should be known, that the arm is 
naturally inclined outward; to this side, therefore, the distortion usually 
takes place, if not properly treated; but indeed, all the other bones are 
usually distorted during treatment for fracture to that side to which they 
naturally incline. When, therefore, anything of this kind is suspected, 
the arm is to be encircled in a broad shawl, which is to be carried round 
the breast, and when the patient goes to rest, a compress of many folds, 
or some such thing, is to be folded and placed between the elbow and the 
side, for thus the bending of the bone will be rectified, but care must be 
taken lest it be inclined too much inwards. 
9. The human foot is composed of several small bones like the hand.1 
These bones therefore are scarcely ever broken, unless the skin at the same 
time be wounded by some sharp and heavy body. The treatment of such 
injuries, therefore, will be delivered under the head of wounds. But if 
any bone be moved from its place, or a joint of the toes be luxated, or any 
of the bones of the part called the tarsus be displaced,2 it must be forced 
back again to its place as described with regard to the hand; and is to 
be treated with cerate, compresses, and bandages, like the fractures, with 
the exception of the splints; and is to be secured tightly in the same way, 
1 The analogy between the construction of the hand and the foot is strikingly 
described by Galen in his Commentary on this passage. His description of the 
ankle-joint and the tarsal bones is, upon the whole, wonderfully accurate, except 
that he makes the number of the tarsal bones to be equal to those of the carpal. 
How this mistake originated I do not well know. I need scarcely add that modern 
anatomists count eight bones of the carpus, and only seven of the tarsus. 
2 The account of the displacement of the tarsal bones here given is, on the 
whole, very correct. In this way the navicular bone is sometimes displaced from 
the astragalus, and the cuboid from the os calcis. Several cases of this nature 
have been related in modern times. See Sir Astley Cooper's Lectures, and Bransby 
Cooper's Lectures, Medical Gazette, No. 1069, as quoted in the Annotations on the 
eleventh paragraph. FRACTURES. 
45 
and the bandages renewed on the third day; and the patient thus bandaged 
should return the same answers as in fractures, as to the bandages feeling 
tight or slack. All these bones recover perfectly in twenty days, except 
those that are connected with the bones of the leg, and are in a. line with 
them. It is advantageous to lie in bed during the whole of this time; but 
the patients, thinking light of the complaint, have not perseverance to 
do this, and they walk about before they get well; wherefore many of 
these do not make a perfect recovery. And often the pain puts them in 
mind of the injury; and deservedly, for the feet sustain the weight of the 
whole body. When, therefore, they walk about before they are whole, 
the joints which have been luxated are cured incompletely; and, on that 
account, while walking about, they have pains in the leg from time to 
time. 
10. But those bones which are connected with the bones of the leg are 
larger than the others,1 and the cure of them when luxated is more pro- 
tracted. The mode of treatment then is the same; but we must use more 
bandages and more splints, and the bandage is to be carried round to this 
side and to that, and pressure is to be made as in the other cases, particu- 
larly at the seat of the luxation, and the first circles of the bandages are 
to be made there. And at each time the bandages are taken off, much 
hot water is to be used, for in all injuries at joints the affusion of hot 
water in large quantity is to be had recourse to. And the same symp- 
toms of compression and relaxation should manifest themselves in the 
same times, as in the cases formerly treated of, and the subsequent 
bandagings should be conducted in like manner. These cases get com- 
pletely well for the most part in forty days, if the patients have resolution 
to keep their bed; but if not, they are subjected to the complaints 
formerly described, or still worse. 
11. In persons who jumping from any high object pitch upon their 
heel with great force, the bones are separated, and the veins pour forth 
their contents, owing to the contusion of the flesh surrounding the bone, 
and hence a swelling and much pain supervene.2 For this bone (os calcis) 
1 The meaning would appear to be this, that the tarsal bones are larger than 
their analogues in the upper extremities, namely, than the carpal. The accident 
described in this paragraph seems evidently to be displacement of the foot, either 
complete or partial, from bones of the leg, that is to say (to use the terminology 
lately introduced by Mr. Bransby Cooper), displacement of the astragalus. It ap- 
pears clear that by dislocation at the ankle-joint, Hippocrates here meant a dis- 
placement of the astragalus along with the other tarsal bones from the ends of 
the bones of the leg. 
2 Galen, in his Commentary, states expressly that the accident here described 
consists in a separation of the astragalus from its connection with the navicular, 
and of the os calcis from its connection with the cuboid, by the rupture of the liga- 
ments which unite them. The following- description of this accident was lately 
given by Mr. Bransby Cooper, in one of his lectures published in the Medical 46 
GENUINE WORKS OF HIPPOCRATES. 
is not a small one, protrudes beyond the line of the leg, and is connected 
with important veins and tendons; for the back tendon of the leg is in- 
serted into this bone. Such cases are to be treated with cerate, and with 
compresses and bandages; and hot water is to be used in large quantity; 
and they require many bandages, which ought to be particularly good and 
appropriate. And if the patient happen to have a tender skin about the 
heel, nothing is to be done to it; but if, as some have it, the skin be thick 
and hardened, it is to be pared down smoothly and thinned, but without 
wounding it. It is not everybody who can apply the bandage properly in 
such cases; for if one shall bind the parts, as in other accidents about 
the ankle, sometimes bringing a fold round the foot and sometimes round 
the tendon, these turns leave out the heel, which is the seat of the con- 
tusion, and thus there is danger that the os calcis may sphacelate; and if 
this should take place, the impediment may endure for life and also in 
all the other cases of sphacelus, not proceeding from such a cause as this; 
as when, from being carelessly allowed to lie in a certain position during 
confinement to bed, the heel becomes black, or when a serious wound has 
occurred in the leg and it is long of healing, and is connected with the 
heel, oi- when the same thing happens in the thigh, or when in any dis- 
ease a protracted decubitus takes place on the back, in all such cases the 
sores are inveterate, troublesome, and frequently break out again, unless 
particular attention be paid to the cure, along with much rest, as in all 
the cases attended with sphacelus. And cases of sphacelus connected with 
this cause, in addition to other inconveniences, are attended with great 
danger to the whole body. For they are apt to be attended with very 
Gazette, No. 1069: " Dislocation of the navicular bone from the astragalus and 
the cuboid from the os calcis.-This is, in fact, a dislocation of ' Chopart's tarsal 
joint.' I once saw it in the case of a man who was admitted into Guy's Hospital. 
The toes, metatarsus, and anterior part of the tarsus were twisted inwards; the 
anterior articulatory surface of the astragalus and os calcis formed a projection 
on the outer side of the foot, the astragalus being- so tightly pressed against the 
skin as to threaten momentary laceration; and a deep hollow, evidently resulting 
from the displacement of the cuboid bone, could be felt just in front of the os 
calcis. Reduction was accomplished by the usual extension and counter-exten- 
sion, and by forcing the metatarsus outwards, while pressure on the bones of the 
leg in the opposite direction guided the displaced tarsal bones into their proper 
situation." This accident is obscurely described in Liston's Practical Surgery. 
It is not noticed in the elaborate work of Baron Dupuytren On the Injuries of 
Bones. The case, however, which we are now treating of would appear to be 
noticed by Paulus JEgineta in the following passage, where, however, the descrip- 
tion is rather obscure: "If from a leap, as commonly happens, the bone of the 
heel is moved from its place, or if any inflammatory state is brought on, it is to 
be remedied by gentle extension and reduction, anti-inflammatory embrocations 
and secure bandages, the man being kept also in a quiet state until the part is re- 
stored." (VI., 120.) See the Commentary of Palladius on this passage of our 
author, p. 926, ed. Foes. FRACTURES. 
47 
acute fevers, of the continual type, accompanied with tremblings, hiccup, 
aberration of intellect, and which prove fatal within a few days: and there 
may be lividities of bloody veins,1 with nausea, and gangrene from pres- 
sure; these diseases may occur, besides the sphacelus.2 Those which have 
been described are the most violent contusions; but in general the contu- 
sions are mild, and no great care is required with regard to the treatment, 
and yet it must be conducted properly. But when the contusion appears 
to be severe, we must do as described above, making many turns of the 
bandage around the heel, sometimes carrying it to the extremity of the foot, 
sometimes to the middle, and sometimes around the leg; and, in addition, 
all the surrounding parts are to be bandaged in this direction and that, as 
formerly described; and the compression should not be made strong, but 
we should make use of many bandages, and it is better also to administer 
hellebore the same day or on the morrow; and the bandages should be 
removed on the third day and reapplied. And these are the symptoms 
by which we discover whether the case will get worse or not: when the 
extravasated blood, the lividities, and the surrounding parts become red 
and hard, there is danger of an exacerbation. But if there be no fever, 
we must give emetics, as has been said, and administer the other remedies 
which are applicable when the fever is not of a continual type; but if 
continual fever be present, we must not give strong medicines, but enjoin 
abstinence from solid food and soups, and give water for drink, and not 
allow wine but oxyglyky* (a composition from vinegar and honey?). But 
1 By bloody veins is meant veins of a large size, as Galen explains. Contus- 
ions of such necessarily produce extravasation and hemorrhage, and the other bad 
consequences described by our author. 
2 That gangrene should have often supervened in such a case, as described by 
our author, need not appear surprising. It shows that Hippocrates had a wonder- 
ful talent for original observation when he was able to detect and describe such a 
case; and it ought to teach our profession a lesson of humility, in comparing- our 
present state of knowledge with that of our forefathers, when we thus find that 
the "old man of Cos," twenty-two centuries ago, understood the nature of this 
accident better than many of us did not many years since. We are all too apt to 
flatter ourselves with the belief that we are possessed of all the knowledge which 
our forefathers had acquired, along with many valuable additions of our own. It 
is unfortunately but too certain that there is a tendency in the human mind, at 
certain times, to retrograde, as well as in others to advance, both in knowledge 
and in virtue. 
" Sic omnia fatis 
In pejus ruere et retro sublapsa referri. 
Non aliter quam qui adverso vix flumine lembum 
Remigiis subig'it, si brachia forte remisit, 
Atque ilium in praeceps prono rapit alveus amni." 
Virgil, Georg, i. 
3 Galen states that if the oxyglyTcy be not at hand, oxymel may be used in its 
stead. 48 
GENUINE WORKS OF HIPPOCRATES. 
if the case be not going to get worse, the ecchymosed and livid parts, and 
those surrounding them become greenish and not hard; for this is a satis- 
factory proof in all cases of ecchymosis, that they are not to get worse; 
but when lividity is complicated with hardness, there is danger that the 
part may become blackened. And we must so manage the foot as that it 
may be generally raised a little higher than the rest of the body. Such 
a patient will get well in sixty days if he keep quiet. 
12. The leg consists of two bones, of which the one is much more 
slender than the other at one part, but not much more slender at another. 
These are connected together at the foot, and form a common epiphysis,1 
but they are not united together along the line of the leg; and at the thigh 
they are united together and form an epiphysis, and this epiphysis has a 
diaphysis;2 but the other bone in a line with the little toe is a little longer. 
Such is the nature of the bones of the leg. 
13. Sometimes the bones connected with the foot are displaced, some- 
times both bones with their epiphysis; sometimes the whole epiphysis is 
slightly moved, and sometimes the other bone.3 These cases are less 
troublesome than the same accidents at the wrist, if the patients will have 
resolution to give them rest. The mode of treatment is the same.as that 
of the other, for the reduction is to be made, as of the other, by means 
of extension, but greater force is required, as the parts of the body con- 
cerned are stronger in this case. But, for the most part, two men will be 
sufficient, by making extension in opposite directions, but, if they are not 
1 Galen states expressly, that although the tibia and fibula are described as 
being connected together at the foot, it is not to be understood that they form 
one bone, but merely that they are in close contact together. It would seem, 
then, that by epiphysis our author, in this place, meant the malleolus externus. 
We shall find many examples of its occurring in this sense in the present and two 
following works. 
2 Galen states in explanation, that the epiphysis or protuberance here described 
belongs principally to the tibia. By diaphysis, he says, is meant a ligamento- 
cartilaginous prominence connected with it; it appears therefore doubtful whether 
he applied it to the spinous process of the tibia, or to the semilunar cartilages, as 
Bosquillon supposed. M. Littre refers the term to the former; but Galen's descrip- 
tion of the diaphysis, as being- of a ligamento-cartilaginous nature, and not being 
to be met with in the skeleton, would seem to exclude this supposition. 
3 If by epiphysis we understand the outer malleolus, the meaning of this pas- 
sage will be, "The bones of the leg at the ankle may be completely dislocated 
along- with the outer malleolus, or subluxated, in which case either the malleolus 
externus or the tibia may be partially displaced." This is pretty much the same 
interpretation as is given to this passage by Gardeil, as quoted by M. Littre (CEcon. 
Hip., tom. iii., p. 393), who, however, does not at all approve of it, but enters into 
a very elaborate disquisition on this passage, yet without bringing it to any very 
satisfactory conclusion. I need scarcely mention that partial dislocations have 
been frequently observed and described recently. See Sir Charles Bell's Surgery, 
p. 196; and the discussion on the luxations at the ankle given in the Argument. FRACTURES. 
49 
sufficiently strong, it is easy to make more powerful extension in the fol- 
lowing way: having fixed in the ground either the nave of a wheel, or any 
such object, something soft is to be bound round the foot, and then some 
broad thongs of ox-skin being brought round it, the heads of the thongs 
are to be fastened to a pestle or any other piece of wood, the end of which 
is to be inserted into the nave, and it, the pestle, is to be pulled away, 
while other persons make counter-extension by grasping the shoulders 
and the ham. It is also sometimes necessary to secure the upper extremity 
otherwise; this if you desire to effect, fasten deeply in the ground 
a round, smooth piece of wood, and place the upper extremity of the piece 
of wood at the perineum, so that it may prevent the body from yielding 
to the pulling at the foot, and, moreover, to prevent the leg while 
stretched, from inclining downward; some person seated at his side should 
push back the hip, so that the body may not turn round with the pulling, 
and for this purpose, if you think fit, pieces of wood may be fastened 
about the armpits on each side, and they are to be stretched by the hands, 
and thus secured, while another person takes hold of the limb at the knee, 
and aids in thus making counter-extension. Or thus, if you prefer it: 
having bound other thongs of leather about the limb, either at the knee, 
or around the thigh, and having fastened another nave of a wheel in the 
ground above the head, and adjusted the thongs to some piece of wood 
adapted to the nave, extension may thus be made in the opposite direction 
to the feet. Or if you choose, it may done thus: instead of the naves, 
lay a moderate-sized beam under the couch, and then having fastened 
pieces of wood in this beam, both before and behind the head, make 
counter-extension by means of thongs, or place windlasses at this extrem- 
ity and that, and make extension by means of them. There are many 
other methods of making extension. But the best thing is, for any phy- 
sician who practices in a large city, to have prepared a proper wooden 
machine, with all the mechanical powers applicable in cases of fractures 
and dislocation, either for making extension, or acting as a lever. For 
this purpose it will be sufficient to possess a board in length, breadth, and 
thickness, resembling the quadrangular threshing-boards made of oak.1 
14. When you have made proper extension, it is easy to reduce the 
joint, for the displaced bone is thus raised into a line with the other. 
And the bones are to be adjusted with the palms of the hands, pressing 
upon the projecting bone with the one, and making counter-pressure be- 
low the ankle with the other. When you have replaced the bones, you 
1 These descriptions are remarkably clear and easily understood when illus- 
trated by drawings, as they are by Vidus Vidius and M. Littre. All our author's 
modes of making extension and counter-extension appear to be very judicious. 
The board or bench (scamnum Hippocratis) is described in the work On the Artic- 
ulations. The text in the conclusion of the paragraph is in a doubtful state. I 
have adopted the emendation of M. LittrA 
Vol. IL-4. 50 
GENUINE WORKS OF HIPPOCRATES. 
must apply the bandages while the parts are upon the stretch, if you pos- 
sibly can; but if prevented by the thongs, you must loose them, and make 
counter-extension until you get the bandages applied. The bandage is 
to be applied in the manner formerly described, the heads of the band- 
ages being placed on the projecting part, and the first turns made in like 
manner, and so also with regard to the number of compresses and the 
compression; and turns of the bandages are to be brought frequently 
round on this and on that side of the ankle. But this joint must be 
bound more tight at the first dresssing than in the case of the hand. But 
when you have applied the bandage, you must place the bandaged part 
somewhat higher than the rest of the body, and in such a position that 
the foot may hang as little as possible. The attenuation of the body is 
to be made proportionate to the magnitude of the luxation, for one luxa- 
tion is to a small, and another to a great extent. But in general we must 
reduce more, and for a longer time, in injuries about the legs, than in 
those about the hands; for the former parts are larger and thicker than 
the latter, and it is necessary that the body should be kept in a state of 
rest, and in a recumbent position. There is nothing to prevent or require 
the limb to be bandaged anew on the third day. And all the treatment 
otherwise is to be conducted in like manner, as in the preceding cases. 
And if the patient have resolution to lie quiet, forty days will be sufficient 
for this purpose, if only the bones be properly reduced, but if he will not 
lie quiet, he will not be able to use the limb with ease, and he will find 
it necessary to wear a bandage for a long time. When the bones are not 
properly replaced, but there has been some defect in this respect, the hip, 
the thigh, and the leg become wasted, and if the dislocation be inward, 
the external part of the thigh is wasted, and vice versa. But for the 
most part the dislocation is inward.1 
15.2 And when both bones of the leg are broken without a wound of 
the skin, stronger extension is required. We may make extension by 
some of the methods formerly described, provided the bones ride over one 
another to a considerable degree. But extension by men is also sufficient, 
and for the most part two strong men will suffice, by making extension 
and counter-extension. Extension must naturally be made straight in a 
line with the leg and thigh, whether on account of a fracture of the 
1 According- to Galen, the cause why dislocation inwards is more common than 
outwards is, that the end of the fibula extends lower down than the inner mal- 
leolus, and that has a tendency to prevent dislocation outwards. All our best 
authorities at the present day are agreed that dislocation of the astragalus in- 
wards is the most frequent form of luxation at the ankle-joint. See Bransby 
Cooper's Lectures, where the same reason is assigned for the greater frequency 
of this mode of displacement as that given by Galen : " This is the most frequent 
luxation, in consequence of the malleolus internus not descending so low as the 
external." (Med. Gaz., 1069.) 
2 The treatment of fractures of the bones of the leg, as given in this and the 
two following paragraphs, is deserving of much attention. FRACTURES. 
51 
bones of the leg or of the thigh. And in both cases they are to be band- 
aged while in a state of extension, for the same position does not suit with 
the leg and the arm. For when the fractured bones of the arm or fore- 
arm are bandaged, the fore-arm is suspended in a sling, and if you bind 
them up while extended, the figures of the fleshy parts will be changed 
in bending the arm at the elbow, for the elbow cannot be kept long ex- 
tended, since persons are not in the custom of keeping the joint long in 
this form, but in a bent position, and persons who have been wounded in 
the arm, and are still able to walk about, require to have the arm bent at 
the elbow-joint. But the leg, both in walking and standing, is habitually 
extended, either completely or nearly so, and is usually in a depending 
position from its construction, and in order that it may bear the weight 
of the rest of the body. Wherefore it readily bears to be extended when 
necessary, and even when in bed the limb is often in this position. And 
when wounded, necessity subdues the understanding, since the patients 
become incapable of raising themselves up, so that they neither think of 
bending the limb nor of getting up erqct, but remain lying in the same 
position. For these reasons, neither the same position nor the same 
mode of bandaging applies to the arm and to the leg. If, then, exten- 
sion by means of men be sufficient, we should not have recourse to any 
useless contrivances, for it is absurd to employ mechanical means when 
not required; but if extension by men be not sufficient, you may use any 
of the mechanical powers which is suitable. When sufficiently extended, 
it will be easy to adjust the bones and bring them into their natural posi- 
tion, by straightening and arranging them with the palms of the hand. 
16. When the parts are adjusted, you should apply the bandages while 
the limb is in a stretched position, making the first turns to the right or 
to the left, as may be most suitable; and the end of the bandage should be 
placed over the fracture, and the first turns made at that place; and then 
the bandage should be carried up the leg, as described with regard to the 
other fractures. But the bandages should be broader and longer, and 
more numerous, in the case of the leg than in that of the arm. And 
when it is bandaged it should be laid upon some smooth and soft object, 
so that it may not be distorted to the one side or the other, and that there 
may be no protrusion of the bones either forward or backward; for this 
purpose nothing is more convenient than a cushion, or something similar, 
either of linen or wool, and not hard; it is to be made hollow along its 
middle, and placed below the limb. With regard to the canals {gutters?} 
usually placed below fractured legs, I am at a loss whether to advise that 
they should be used or not.1 For they certainly are beneficial, but not 
1 I have given a summary of all the information which I cohid collect respect- 
ing the canals or gutters, used by the ancients for greater security to a fractured 
leg, in my annotations On the Surgery, and in the Commentary on Paulus 
JEgineta, Book VI., 106. Galen mentions, in his Commentary on this part, that 52 
GENUINE WORKS OF HIPPOCRATES. 
to the extent which those who use them suppose. For the canals do not 
preserve the leg at rest as they suppose; nor, when the rest of the body 
is turned to the one side or the other, does the canal prevent the leg from 
following, unless the patient himself pay attention; neither does the canal 
prevent the limb from being moved without the body to the one side or 
the other. And a board is an uncomfortable thing to have the limb laid 
upon, unless something soft be placed above it. But it is a very useful 
thing in making any subsequent arrangements of the bed and in going to 
stool.) A limb then may be well and ill treated or without the canal. But 
the common people have more confidence, and the surgeon is more likely 
to escape blame, when the canal is placed under the limb, although it is 
not secundum artem. For the limb should by all means lie straight upon 
some level and soft object, since the bandaging must necessarily be over- 
come by any distortion in the placing of the leg, whenever or to whatever 
extent it may be inclined. The patient, when bandaged, should return 
the same answers as formerly stated, for the bandaging should be the 
same, and the same swellings should arise in the extremities, and the 
slackening of the bandages in like manner, and the new bandaging on 
the third day ; and the bandaged part should be found reduced in swelling; 
and the new bandagings should be more tightly put on, and more pieces 
of cloth should be used; and the bandages should be carried loosely about 
the foot, unless the wound be near the knee. Extension should be made 
and the bones adjusted at every new bandaging; for, if properly treated, 
and if the swelling progress in a suitable manner, the bandaged limb will 
have become more slender and attenuated, and the bones will be more 
mobile, and yield more readily to extension. On the seventh, the ninth, 
or the eleventh day, the splints should be applied as described in treating 
of the other fractures. Attention should be paid to the position of the 
splints about the ankles and along the tendon of the foot which runs up 
the leg. The bones of the leg get consolidated in forty days, if properl- 
treated. But if you suspect that anything is wanting to the proper ar- 
rangement of the limb, or dread any ulceration, you should loose the 
bandages in the interval, and having put everything right, apply them 
again. 
17. Bqt if the other bone (fibula of the leg be broken, less powerful 
extension is required, and yet it must not be neglected, nor be performed 
slovenly, more especially at the first bandaging. For in all cases of fract- 
the more ancient authorities sometimes made use of a mechanical apparatus which 
he calls glossocomum, a drawing of which is given in the Latin translation of Ga- 
len by Vidus Vidius (Venetiis apud Juntas, 1565); and still a better one in the In- 
stitutiones Chirurgicae of Tagaultius (iv., 3). It would appear to me to be a most 
ingenious machine, and excellently adapted for the position required. It is so 
constructed, that extension and counter-extension are constantly kept up by a. 
double set of pulleys. FRACTURES. 
53 
ure this object should be attained then as quickly as possible. For when 
the bandage is applied tight while the bones are not properly arranged, the 
part becomes more painful. The treatment otherwise is the same.1 
18. Of the bones of the leg, the inner one, called the tibia, is the more 
troublesome to manage, and requires the greater extension; and if the 
broken bones are not properly arranged, it is impossible to conceal the 
distortion, for the bone is exposed and wholly uncovered with flesh; and 
it is much longer before patients can walk on the leg when this bone is 
broken. But if the outer bone be broken, it causes much less trouble, 
and the deformity, when the bones are not properly set, is much more 
easily concealed, the bone being well covered with flesh; and the patients 
speedily get on foot, for it is the inner bone of the leg which supports the 
most of the weight of the body. For along with the thigh, as being in a 
line with weight thrown upon the thigh, the inner bone has more work to 
sustain; inasmuch as it is the head of the thigh-bone which sustains the 
upper part of the body, and it is on the inner and not on the outer side 
of the thigh, being in a line with the tibja; and the other half of the body 
approximates more to this line than to the external one; and at the same 
time the inner bone is larger than the outer, as in the fore-arm the bone 
in the line of the little finger is the slenderer and longer. But in the 
joint of the inferior extremity, the disposition of the longer bone is not 
alike, for the elbow and the ham are bent differently.2 For these reasons 
1 In this paragraph fracture of the fibula is treated of so distinctly, that no il- 
lustration of the text is needed. 
2 The analogy which our author describes between the bones of the upper and 
the lower extremity is very striking, and has been the subject of much discussion 
with modern physiologists, especially those of the French school, namely, Vicq- 
d'Azyr, Cuvier, Cruveilhier, and Flourens. M. Littre gives some very interesting 
extracts from the works of these authors in his Argument to this treatise. The 
following passage, taken from the work of Flourens, contains a very lucid expo- 
sition of what I regard as the most rational view of the subject: " La longue in- 
decision des anatomistes touch ant les rapports reels des membres superieurs et 
inferieurs ne tenait done qu'a 1'oubli, dans des comparaisons faites sur le squelette, 
du mecanisme vrai de la pronation de la main par la rotation du radius ; et la 
simple restitution de ce mecanisme suffit pour rendre, comme je viens de le dire, 
a toutes les parties correspond antes une position semblable.-Or, dans cette po- 
sition semblable de toutes les parties des du meme cot6, donnee par le 
mecanisme vrai de la pronation de la main, le radius repond au tibia, et le cu- 
bitus an perone. C'est justement le contraire de ce qu'a pens6 Vicq-d'Azyr, qui 
assimile le cubitus au tibia, et le radius au pyrone. Mais, independamment de la 
raison decisive tiree du vrai mecanisme de la pronation de la main, combien 
d'autres raisons encore ne se presente-t-il pas contre 1'opinion que je refute, les 
unes prises de 1'anatomie meme de 1'homme et les autres de 1'anatomie compare ! 
-Dans 1'homme, 1'os essentiel de 1'avant-bras, 1'os qui continue le bras, 1'os qui 
porte la main, est le radius ; le cubitus n'est la que pour, d'une part, elargir la 
surface des insertions musculaires, et, de 1'autre, prefer un appui solide au mem- 
hre pendant la rotation de 1'os principal, du radius. De meme au membre in- 54 
GENUINE WORKS OF HIPPOCRATES. 
when the external bone is broken, the patients can soon walk about; but 
in fractures of the inner, it is a long time before they can walk. 
19.1 When the thigh-bone is broken, particular pains should be taken 
with regard to the extension that it may not be insufficient, for when 
excessive, no great harm results from it. For, if one should bandage a 
limb while the extremities of the bone are separated to a distance from 
one another by the force of the extension, the bandaging will not keep 
them separate, and so the bones will come together again as soon as the 
persons stretching it let go their hold; for the fleshy parts (muscles ?) 
being thick and strong, are more powerful than the bandaging, instead of 
being less so. In the case then which we are now treating of, nothing 
should be omitted in order that the parts may be properly distended and 
put in a straight line; for it is a great disgrace and an injury to exhibit a 
shortened thigh,') For the arm, when shortened, might be concealed, and 
the mistake would not be great; but a shortened thigh-bone would exhibit 
the man maimed. For when the sound limb is placed beside it, being 
longer than the other, it exposes the mistake, and therefore jt would be to 
the advantage of a person who would be improperly treated that both his 
legs should be broken, rather than either of them; for in this case the 
one would be of the same length as the other. When, then, proper 
extension has been made, you must adjust the parts with the palms of the 
hands, and bandage the limb in the manner formerly described, placing 
the hands of the bandages as was directed, and making the turns upward. 
And the patient should return the same answers to the same questions as 
formerly, should be pained and recover in like manner, and should have 
the bandaging renewed in the same way; and the application of the splints 
should be the same. The thigh-bone is consolidated in fifty days. 
20. But this also should be known, that the thigh-bone is curved 
rather to the outside than to the inside, and rather forward than back- 
ward; when not properly treated, then, the distortions are in these direc- 
tions; and the bone is least covered with flesh at the same parts, so that 
the distortion cannot be concealed. If, therefore, you suspect anything 
of this kind, you should have recourse to the mechanical contrivances 
recommended in distortion of the arm. And a few turns of the bandage 
should be brought round by the hip and the loins, so that the groin and 
ferieur, 1'os essentiel de la jambe, 1'os qui continue la cuisse, 1'os qui porte le pied, 
est le tibia Plus evidemment encore qu'au membre supGrieur, le pyrone n'est la 
que pour 1'agrandissement des surfaces musculaires ; il ne prend aucune part a 
1'articulation du femur, il n'en prend qu'une laterale avec le pied." (Sur le Par- 
allele des Extremites dans 1'Homme et les Quadrupedes.) The remarks made by 
Galen in his Commentary on the points of analogy between the elbow and the 
knee-joints are very pertinent. 
1 Fracture of the femur is elaborately treated of in this and the four following 
paragraphs. FRACTURES. 
55 
the articulation near the perineum may be included in the bandage; and 
moreover, it is expedient that the extremities of the splints should not do 
mischief by being placed on parts not covered with the bandages. The 
splints, in fact, should be carefully kept off the naked parts at both ends; 
and the arrangement of them should be so managed, as that they may not 
be placed on the natural protuberances of the bone at the knee-joint, nor 
on the Rendon which is situated there. 
21. The swellings which arise in the ham, at the foot, or in any other 
part from the pressure, should be well wrapped in unscoured and carded 
wool, washed with wine and oil, and anointed with cerate, before bandag- 
ing; and if the splints give pain they should be slackened. , You may 
sooner reduce the swellings, by laying aside the splints, and applying 
plenty of bandages to them, beginning from below and rolling upward; 
for thus the swellings will be most speedily reduced, and the humors be 
propelled to the parts above the former bandages. But this form of 
bandaging must not be used unless there be danger of vesications or 
blackening in the swelling, and nothing of the kind occurs unless the 
fracture be bound too tight, or unless the limb be allowed to hang, or it 
be rubbed with the hand, or some other thing of an irritant nature be 
applied to the skin.1 
22. More injury than good results from placing below the thigh a 
canal which does not pass farther down than the ham, for it neither 
prevents the body nor the leg from being moved without the thigh. And 
it creates uneasiness by being brought down to the ham, and has a ten- 
dency to produce what of all things should be avoided, namely, flexion at 
the knee, for this completely disturbs the bandages; and when the thigh 
and leg are bandaged, if one bend the limb at the knee, the muscles 
necessarily assume another shape, and the broken bones are also necessarily 
moved. Every endeavor then should be made to keep the ham extended.2 
But it appears to me, that a canal which embraces the limb from the nates 
to the foot is of use. And moreover, a shawl should be put loosely round 
at the ham, along with the canal, as children are swathed in bed; and 
1 The text of this paragraph, which is very corrupt in all the previous editions, 
is very ingeniously restored by M. Littr6, so as to afford a meaning which exactly 
suits the context. No experienced surgeon will question the propriety of the 
practice here recommended ; that is to say, when the splints are producing much 
pain, swelling, and irritation, to remove them for a time and trust entirely to 
bandages. The text of Galen's Commentary is remarkably corrupt. M. Littr6 
attempts to restore it, but whether or not he was warranted in making so many 
conjectural emendations, I dare scarcely venture to express my opinion. 
2 From the text it will be seen how strongly our author disapproves of the half 
bent position in the treatment of a fractured leg. All the ancient authorities 
adopted his views in this case, with the exception of Rhazes, who approves of the 
limb being partially bent. (Contin., xxix.) See further Paulus ALgineta, Book 
VI., 102. 56 
GENUINE WORKS OF HIPPOCRATES. 
then, if the thigh-bone gets displaced either upward or to the side, it can 
be more easily kept in position by this means along with the canal.1 The 
canal then should be made so as to extend all along the limb or not used 
at all. 
23. The extremity of the heel should be particularly attended to, so 
that it may be properly laid, both in fractures of the leg and of the thigh. 
For if the foot be placed in a dependent position, while the rest of the 
body is supported, the limb must present a curved appearance at the 
forepart of the leg; and if the heel be placed higher than is proper, and 
if the rest of the leg be rather too low, the bone at the forepart of the leg 
must present a hollow, more especially if the heel of the patient be 
naturally large. But all the bones get consolidated more slowly, if not 
laid properly, and if not kept steady in the same position, and in this 
case the callus is more feeble. 
24. These things relate to cases in which there is fracture of the bones 
without protrusion of the same or wound of any other kind.2 In those 
cases in which the bones are simply broken across, and are not com- 
minuted, but protrude, if reduced the same day or next, and secured in 
their place, and if there be no reason to anticipate that any splintered 
bones will come away; and in those in which the broken bones do not 
protrude, nor is the mode of fracture such that there is reason to expect 
the splinters will come out, some physicians heal the sores in a way which 
neither does much good nor harm, by means of a cleansing application, 
applying pitch ointment, or some of the dressings for fresh wounds, or 
anything else which they are accustomed to do, and binding above them 
compresses wetted with wine, or greasy wool, or something else of the like 
nature. And when the wounds become clean and are new healed, they 
endeavor to bind up the limb with plenty of bandages, and keep it straight 
with splints. This treatment does some good, and never much harm. 
The bones, however, can never be equally well restored to their place, but 
the part is a little more swelled than it should be; and the limb will be 
somewhat shortened, provided both bones either of the leg or fore-arm 
have been fractured. 
25. There are others who treat such cases at first with bandages, 
1 Galen, in his Commentary, informs us that the mode in which the shawl or 
scarf was to be used had been differently understood, some supposing that the 
shawl was to be wrapped round the canal after it had been adjusted, and others 
holding that the shawl was to be wrapped round the limb at the ham, so as to se- 
cure immobility of the limb at the knee before applying the canal. 
2 Our author now proceeds to lay down the treatment of fractures complicated 
with a wound of the skin. In this paragraph he describes the first plan which he 
does not much approve of, nor strongly condemns. It consists in applying suitable 
dressings to the wound until it is healed, and then attending to the fractured 
bones. The disadvantages of this system he has briefly stated, namely, that the 
fractured parts are apt to be swelled and the limbs shortened. FRACTURES. 
57 
applying them on both sides of the seat of the injury, but omit them 
there, and leave the wound uncovered, and afterward they apply to the 
wound some cleansing medicine, and complete the dressing with com- 
presses dipped in wine and greasy wool. This plan of treatment is bad, 
and it is clear that those who adopt this mode of practice are guilty of 
great mistakes in other cases of fracture as well as these. For it is a most 
important consideration to know in what manner the head of the bandage 
should be placed and at what part the greatest pressure should be, and 
what benefits would result from applying the end of the bandage and the 
pressure at the proper place, and what mischiefs would result from apply- 
ing the head of the bandage and the pressure otherwise than at the proper 
place. Wherefore it has been stated in the preceding part of the work 
what are the results of either; and the practice of medicine bears witness 
to the truth of it, for in a person thus bandaged, a swelling must neces- 
sarily arise on the wound. For, if even a sound piece of skin were 
bandaged on either side, and a part were left in the middle, the part thus 
left unbandaged would become most swelled, and would assume a bad 
color; how then could it be that a wound would not suffer in like manner ? 
The wound then must necessarily become discolored and its lips everted, 
the discharge will be ichorous and without pus, and the bones, which 
should not have got into a state of necrosis, exfoliate; and the wound gets 
into a throbbing and inflamed condition. And they are obliged to apply 
a cataplasm on account of the swelling, but this is an unsuitable applica- 
tion to parts which are bandaged on both sides, for a useless load is added 
to the throbbing which formerly existed in it. At last they loose the 
bandages when matters get very serious, and conduct the rest of the treat- 
ment without bandaging; and notwithstanding, if they meet with another 
case of the same description, they treat it in the same manner, for they 
do not think that the application of the bandages on both sides, and the 
exposure of the wound are the cause of what happened, but some other 
untoward circumstance. Wherefore I would not have written so much 
on this subject, if I had not well known that this. mode of bandaging is 
unsuitable, and yet that many conduct the treatment in this way, whose 
mistake it is of vital importance to correct, while what is here said is a 
proof, that what was formerly written as to the circumstances under which 
bandages should be tightly applied to fractures or otherwise has been 
correctly written.1 
1 The method of treating- compound fractures, which our author has so fully 
described and so pointedly condemned, I have occasionally seen practiced by sur- 
geons who, I have no doubt, thought themselves too expert in the art of bandag- 
ing to take a lesson from the ancients ; yet there can be no doubt that the plan 
deserves all the censure which Hippocrates bestows upon it. As he represents, 
by bandaging the surrounding parts, and leaving the wound uncovered or not 
equally supported, great congestion and swelling, with all their attendant ill con- 58 
GENUINE WORKS OF HIPPOCRATES. 
26. As a general rule it may be said, that in those cases in which a- 
separation of bone is not expected, the same treatment should be applied 
as when the fractures are not complicated with an external wound; for 
the extension, adjustment of the bones, and the bandaging, are to be 
conducted in the same manner. To the wound itself a cerate mixed with 
pitch is to be applied, a thin folded compress is to be bound upon it, and the 
parts around are to be anointed with white cerate. The cloths for bandages 
and the other things should be torn broader than in cases in which there 
is no wound, and the first turn of the bandage should be a good deal 
broader than the wound. For a narrower bandage than the wound binds 
the wound like a which is not proper, or the first turn should 
comprehend the whole wound, and the bandaging should extend beyond 
it on both sides. The bandage then should be put on in the direction of 
the wound, and should be not quite so tight as when there is no wound, 
but the bandage should be otherwise applied in the manner described 
above. The bandages should be of a soft consistence, and more especially 
so in such cases than in those not complicated with a wound. The 
number of bandages should not be smaller, but rather greatei' than those 
formerly described. When applied, the patient should have the feeling 
of the parts being properly secured, but not too tight, and in particular 
he should be able to say that they are firm about the wound. And the 
intervals of time during which the parts seem to be properly adjusted, 
and those in which they get loose, should be the same as those formerly 
described. The bandages should be renewed on the third day, and the 
after treatment conducted in the same manner as formerly described, 
except that in the latter case the compression should be somewhat less 
than in the former. And if matters go on properly, the parts about the 
wound should be found at every dressing always more and more free of 
swelling, and the swelling should have subsided on the whole part com- 
prehended by the bandages. And the suppurations will take place more 
speedily than in the case of wounds treated otherwise; and the pieces of 
flesh in the wound which have become black and dead, will sooner separate 
and fall off under this plan of treatment than any other, and the sore will 
come more quickly to cicatrization when thus treated than otherwise. The 
reason of all this is, that the parts in which the wound is situated, and 
the surrounding parts, are kept free of swelling. In all other respects 
the treatment is to be conducted as in cases of fracture without a wound 
of the integuments. Splints should not be applied. On this account the 
bandages should be more numerous than in the former case, both because 
they must be put on less tight, and because the splints are later of being 
sequences, are produced in the wound. What he says against the use of poultices 
in such a case, I regard as being equally well founded. The method described and 
recommended by our author in the next paragraph I believe to be based upon most 
correct principles, and the best that can possibly be desired. FRACTURES. 
59 
applied. But if you do apply the splints, they should not be applied 
along the wound, and they are to be put on in a loose manner, especial 
care being taken that there may be no great compression from the splints. 
This direction has been formerly given. And the diet should be more 
restricted, and for a longer period, in those cases in which there is a wound 
at the commencement, and when the bones protrude through the skin; 
and, in a word, the greatei* the wound, the more severe and protracted 
should the regimen be. 
27. The treatment of the sores is the same in those cases of fracture 
in which there was no wound of the skin at first, but one has formed in 
the course of treatment, owing to the pressure of the splints occasioned 
by the bandages, or from any other cause. In such cases it is ascertained 
that there is an ulcer, by the pain and throbbing; and the swelling in the 
extremities becomes harder than usual, and if you apply your finger the 
redness disappears, but speedily returns. If you suspect anything of the 
kind you must loose the dressing, if there be any itching below the 
under-bandages, or in any other part that -is bandaged, and use a pitched 
cerate instead of the other. If there be nothing of that, but if the ulcer 
be found in an irritable state, being very black and foul, and the fleshy 
parts about to suppurate, and the tendons to slough away, in these cases 
no part is to be exposed to the air, nor is anything to be apprehended 
from these suppurations, but the treatment is to be conducted in the 
same manner as in those cases in which there was an external wound at 
first. You must begin to apply the bandages loosely at the swelling in 
the extremities, and then gradually proceed upward with the bandaging, 
so that it may be tight at no place, but particularly firm at the sore, and 
less so elsewhere. The first bandages should be clean and not narrow, 
and the number of bandages should be as great as in those cases in which 
the splints were used, or somewhat fewer. To the sore itself a compress, 
anointed with white cerate, will be sufficient, for if a piece of flesh or 
nerve (tendon?} become black, it will fall oft; for such sores are not to be 
treated with acrid, but with emollient applications, like burns. The 
bandages are to be renewed every third day, and no splints are to be 
applied, but rest is to be more rigidly maintained than in the former cases, 
along with a restricted diet. It should be known, that if any piece of 
flesh or tendon be to come away, the mischief will spread much less, 
and the parts will much more speedily drop off, and the swelling in the 
surrounding parts will much more completely subside, under this treat- 
ment, than if any of the cleansing applications be put upon the sore. 
And if any part that is to come away shall fall off, the part will incarnate 
sooner when thus treated than otherwise, and will more speedily cicatrize. 
Such are the good effects of knowing how a bandage can be well and 
moderately applied. But a proper position, the other parts of the regi- 
men, and suitable bandages co-operate. 60 
GENUINE WORKS OF HIPPOCRATES. 
28. If you are deceived with regard to a recent wound, supposing 
there will be no exfoliation of the bones, while they are on the eve of 
coming out of the sore, you must not hesitate to adopt this mode of treat- 
ment; for no great mischief will result, provided you have the necessary 
dexterity to apply the bandages well and without doing any harm. And 
this is a symptom of an exfoliation of bone being about to take place 
under this mode of treatment; pus runs copiously from the sore, and 
appears striving to make its escape. The bandage must be renewed more 
frequently on account of the discharge, since otherwise fevers come on; 
if the sore and surrrounding parts be compressed by the bandages1 they 
become wasted. Cases complicated with the exfoliation of very small 
bones, do not require any change of treatment, only the bandages 
should be put on more loosely, so that the discharge of pus may not 
be intercepted, but left free, and the dressings are to be frequently 
renewed until the bone exfoliate, and the splints should not be applied 
until then. 
29. Those cases in which the exfoliation of a larger piece of bone is 
expected, whether you discover this at the commencement, or perceive 
subsequently that it is to happen, no longer require the same mode of 
treatment, only that the extension and arrangement of the parts are to be 
performed in a manner that has been described; but having formed double 
compresses, not less than half a fathom in breadth (being guided in this 
by the nature of the wound), and considerably shorter than what would 
be required to go twice round the part that is wounded, but considerably 
longer than to go once round, and in number what will be sufficient, these 
are to be dipped in a black austere wine; and beginning at the middle, as 
is done in applying the double-headed bandage, you are to wrap the part 
around and proceed crossing the heads in the form of the bandage called 
"ascia."2 These things are to be done at the wound, and on both sides 
of it; and there must be no compression, but they are to be laid on so as 
to give support to the wound. And on the wound itself is to be applied 
the pitched cerate, or one of the applications to recent wounds, or any 
other medicine which will suit with the embrocation. And if it be the 
summer season, the compresses are to be frequently damped with wine; 
but if the winter season, plenty of greasy wool, moistened with wine and 
oil, should be applied. And a goat's skin should be spread below, so as 
to carry off the fluids which run from the wound; these must be guarded 
against, and it should be kept in mind, that parts which remain long 
1 The text in this place is in a very corrupt state, at least there are various 
readings, which involve considerable diversity of interpretation. I must own that 
I prefer the old reading in the edition of Foes, and in the Basle edition of Galen, 
to that proposed by M. Littre. 
2 These bandages are described in the annotations on the Surgery. See also 
Galen, Meth. Med., vi., and his Commentary on this place. FRACTURES. 
61 
in the same position are subject to excoriations which are difficult to 
cure.1 
30. In such cases as do not admit of bandaging according to any of 
the methods which have been described, or which will be described, great 
pains should be taken that the fractured part of the body be laid in a 
right position, and attention should be paid that it may incline upward 
rather than downward. But if one would wish to do the thing well and 
dexterously, it is proper to have recourse to some mechanical contrivance, 
in order that the fractured part of the body may undergo proper and not 
violent extension; and this means is particularly applicable in fractures 
of the leg. There are certain physicians who, in all fractures of the leg, 
whether bandages be applied or not, fasten the sole of the foot to the 
couch, or to some other piece of wood which they have fixed in the 
ground near the couch. These persons thus do all sorts of mischief but 
no good; for it contributes nothing to the extension that the foot is thus 
bound, as the rest of the body will no less sink down to the foot, and 
thus the limb will no longer be stretched, neither will it do any good 
toward keeping the limb in a proper position, but will do harm, for when 
the rest of the body is turned to this side or that, the bandaging will not 
prevent the foot and the bones belonging to it from following the rest of 
the body. For if it had not been bound it would have been less distorted, 
as it would have been the less prevented from following the motion of the 
rest of the body. But one should sew two balls of Egyptian leather, 
such as are worn by persons confined for a length of time in large shackles, 
and the balls should have coats on each side, deeper toward the wound, 
but shorter toward the joints; and the balls should be well stuffed and 
soft, and fit well, the one above the ankles, and the other below the knee. 
Sideways it should have below two appendages, either of a single or double 
thong, and short, like loops, the one set being placed on either side of the 
ankle, and the other on the knee. And the other upper ball should have 
others of the same kind in the same line. Then taking four rods, made 
of the cornel tree, of equal length, and of the thickness of a finger, and 
of such length that when bent they will admit of being adjusted to the 
appendages, care should be taken that the extremities of the rods bear 
not upon the skin, but on the extremities of the balls. There should be 
three sets of rods, or more, one set a little longer than another, and 
another a little shorter and smaller, so that they may produce greater or 
less distention, if required. Either of these sets of rods should be placed 
on this side and that of the ankles. If these things be properly contrived, 
they should occasion a proper and equable extension in a straight line, 
1 Galen, in illustration, refers to the ulcerations which occur over the os sacrum, 
and are often found very difficult to cure. See the last section of the Second 
Book of Paulus ./Egineta. 62 
GENUINE WORKS OF HIPPOCRATES. 
without giving any pain to the wound; for the pressure, if there is any, 
should be thrown at the foot and the thigh. And the rods are commo- 
diously arranged on either side of the ankles, so as not to interfere with 
the position of the limb; and the wound is easily examined and easily 
arranged. And, if thought proper, there is nothing to prevent the two 
upper rods from being fastened to one another; and if any light covering 
be thrown over the limb, it will thus be kept off from the wound. If, 
then, the balls be well made, handsome, soft, and newly stitched, and if 
the extension by the rods be properly managed, as has been already 
described, this is an excellent contrivance; but if any of them do not fit 
properly, it does more harm than good.1 And all other mechanical con- 
trivances should either be properly done, or not be had recourse to at all, 
for it is a disgraceful and awkward thing to use mechanical means in an 
unmechanical way. 
31. Moreover, the greater part of physicians treat fractures, both with 
and without an external wound, during the first days, by means of 
unwashed wool, and there does not appear to be anything improper in 
this. It is very excusable for those who are called upon to treat newly- 
received accidents of this kind, and who have no cloth for bandages at 
hand, to do them up with wool; for, except cloth for bandages, one 
could not have anything better than wool in such cases; but a good deal 
should be used for this purpose, and it should be well carded and not 
rough, for in small quantity and of a bad quality it has little power. 
But those who approve of binding up the limb with wool for a day or two, 
and on the third and fourth apply bandages, and make the greatest com- 
pression and extension at that period, such persons show themselves to be 
ignorant of the most important principles of medicine; for, in a word,'at 
no time is it so little proper to disturb all kinds of wounds as on the third 
and fourth day; and all sort of probing should be avoided on these days 
in whatever other injuries are attended with irritation. For, generally, 
the third and fourth day in most cases of wounds, are those which give 
1 When illustrated by a good drawing, as it is in the edition of M. Littre, the 
description here given is easily understood, and the machine would appear to be 
an ingenious contrivance well adapted for the purpose of keeping- the leg extend- 
ed. It evidently consisted of two pairs of elastic rods running along the sides of 
the leg, and fastened to two pads, or, rather, air-bladders, applied at the knee 
and the ankle. The contrivance is distinctly described by Palladius in his Com- 
mentary on this work. By the way, I am at a loss to apprehend exactly the ob- 
jections which M. Littre states to the drawings given by Vidus Vidius; indeed 
they appear to me to be in principle the same as his own, except that they are 
more rudely constructed. I have given both drawings, so that the reader may 
judge for himself. Though, as I'have stated, the nature of this mechanical con- 
trivance may be pretty clearly understood from the description, when compared 
with the drawings, it must be admitted that there is a good deal of difficulty in de- 
termining certain expressions contained in this paragraph. FRACTURES. 
63 
rise to exacerbations, whether the tendency be to inflammation, to a foul 
condition of the sore, or to fevers. - And if any piece of information be 
particularly valuable this is; to which of the most important cases in 
medicine does it not apply ? and that not only in wounds but in many 
other diseases, unless one should call all other diseases wounds. And this 
doctrine is not devoid of a certain degree of plausibility, for they are allied 
to one another in many respects. But those who maintain that wool 
should be used until after the first seven days, and then that the parts 
should be extended and adjusted, and secured with bandages, would 
appear not to be equally devoid of proper judgment, for the most danger- 
ous season for inflammation is then past, and the bones being loose can 
be easily set after the lapse of these days. But still this mode of treat- 
ment is far inferior to that with bandages from the commencement; for, 
the latter method exhibits the patient on the seventh day free from 
inflammation, and ready for complete bandaging with splints; while the 
former method is far behind in this respect, and is attended with many 
other bad effects which it would be tedioris to describe.1 
31.2 In those cases of fracture in which the bones protrude and cannot 
be restored to their place, the following mode of reduction may be prac- 
ticed:-Some small pieces of iron are to be prepared like the levers which 
the cutters of stone make use of, one being rather broader and another 
narrower; and there should be three of them at least, and still more, so 
that you may use those that suit best; and then, along with extension, 
we must use these as levers, applying the under surface of the piece of 
iron to the under fragment of the bone, and the upper surface to the 
upper bone; and, in a word, we must operate powerfully with the lever 
as we would do upon a stone or a piece of wood. The pieces of iron 
should be as strong as possible, so that they may not bend. This is a 
powerful assistance, provided the pieces of iron be suitable, and one use 
them properly as levers. Of all the mechanical instruments used by men, 
the most powerful are these three, the axis in peritrochio, the lever, and 
the wedge.3 Without these, one or all, men could not perform any of 
1 This mode of treating recent fractures and other injuries would appeal' to be 
now entirely lost sight of, and yet I can well believe that, under peculiar circum- 
stances, as, for example, in military practice, it might be often found a very ad- 
vantageous and useful method of treatment to bind a limb at first either, as our 
author mentions, with well-carded wool or with raw cotton. If disposed of in this 
way, and laid in the half-boot of pasteboard, which I have formerly mentioned 
as being used by myself in lieu of the ancient canals, I have no doubt but a fract- 
ured limb would lie very securely, and the patient in this state might be carried 
to a distance if required. 
9 Bis. 
3 From the terms in which our author expresses himself, it has been supposed 
that these are the only mechanical powers which were known in his day. But, 
considering the advances in the arts which had then been made, it is not likely 64 
GENUINE WORKS OF HIPPOCRATES. 
their works which require great force. Wherefore, reduction with the 
lever is not to be despised, for the bones will be reduced in this way, or 
not at all. But if the upper fragment which rides over the other does 
not furnish a suitable point of support for the lever, but the protruding 
part is sharp, you must scoop out of the bone what will furnish a proper 
place for the lever to rest on. The lever, along with extension, may be had 
recourse to on the day of the accident, or next day, but by no means on the 
third, the fourth, and the fifth. For if the limb is disturbed on these days, 
and yet the fractured bones not reduced, inflammation will be excited, and 
this no less if they are reduced; for convulsions are more apt to occur if re- 
duction take place, than if the attempt should fail. These facts should be 
well known, for if convulsions should come on when reduction is effected, 
there is little hope of recovery; but it is of use to displace the bones again 
if this can be done without trouble. For it is not at the time when the 
parts are in a particularly relaxed condition that convulsions and tetanus 
are apt to supervene, but when they are more than usually tense.1 In 
the case we are now treating of, we should not disturb the limb on the 
aforesaid days, but strive to keep the wound as free from inflammation as 
possible, and especially encourage suppuration in it. But when seven 
days have elapsed, or rather more, if there be no fever, and if the wound 
be not inflamed, then there will be less to prevent an attempt at reduc- 
tion, if you hope to succeed; but otherwise you need not take and give 
trouble in vain. 
32. When you have reduced the bones to their place, the modes of 
treatment, whether you expect the bones to exfoliate or not, have been 
already described. All those cases in which an exfoliation of bone is 
expected, should be treated by the method of bandaging with cloths, be- 
ginning for the most part at the middle of the bandage, as is done with 
the double-headed bandage; but particular attention should be paid to the 
shape of the wound, so that its lips may gape or be distorted as little as 
possible under the bandage. Sometimes the turns of the bandage have 
to be made to the right, and sometimes to the left, and sometimes a 
double-headed bandage is to be used. 
33. It should be known that bones, which it has been found impossi- 
ble to reduce, as well as those which are wholly denuded of flesh, will be- 
that the Greeks could have been entirely unacquainted with the screw, although 
our author omits to mention it here as not being of any application to surgical 
practice. The pulley (trochlea) is mentioned in the work On the Articulations, § 
43, and, if I recollect right, in other parts of the Hippocratic treatises; but, as 
we have already stated, it does not appear* that it was used anciently in the 
reduction of dislocations. 
1 We recognize here two terms, the striatum and laxum, which formed the 
ground work of the whole system of the Methodists. See Caelius Aurelianus, 
passim. FRACTURES. 
65 
come detached. In some cases the upper part of the bone is laid bare, 
and in others the flesh dies all around; and, from a sore of long standing, 
certain of the bones become carious, and some not, some more, and some 
less; and in some the small, and in others the large bones. From what 
has been said it will be seen, that it is impossible to tell in one word when 
the bones will separate. Some come away more quickly, owing to their 
smallness, and some from being merely fixed at the point; and some, from 
pieces not separating, but merely exfoliating, become dried up and putrid; 
and besides, different modes of treatment have different effects. For the 
most part, the bones separate most quickly in those cases in which suppu- 
ration takes place most quickly, and when new flesh is most quickly 
formed, and is particularly sound, for the flesh which grows up below in 
the wound generally elevates the pieces of bone. It will be well if the 
whole circle of the bone separate in forty days; for in some cases it is pro- 
tracted to sixty days, and in some to more; for the more porous pieces of 
bone separate more quickly, but the more solid come away more slowly; 
but the other smaller splinters in much less time, and others otherwise. 
A portion of bone which protrudes should be sawn off for the following 
reasons: if it cannot be reduced, and if it appears that only a small piece 
is required in order that it may get back into its place-; and if it be such 
that it can be taken out, and if it occasions inconvenience and irritates any 
part of the flesh, and prevents the limb from being properly laid, and 
if, moreover, it be denuded of flesh, such a piece of bone should be taken 
off. With regard to the others, it is not of much consequence whether 
they be sawed off or not. For it should be known for certain, that such 
bones as are completely deprived of flesh, and have become dried, all sepa- 
rate completely. Those which are about to exfoliate should not be sawn 
off. Those that will separate completely must be judged of from the 
symptoms that have been laid down. 
34. Such cases are to be treated with compresses and vinous applica- 
tions, as formerly laid down regarding bones which will separate. We 
must avoid wetting it at the beginning with anything cold; for there is 
danger of febrile rigors, and also of convulsions; for convulsions are in- 
duced by cold things, and also sometimes by wounds.1 It is proper to 
know that the members are necessarily shortened in those cases in which 
the bones have been broken, and have healed the one across the other, 
and in those cases in which the whole circle of the bone has become de- 
tached. 
35. Those cases in which the bone of the thigh, or of the arm, pro- 
trudes, do not easily recover. For the bones are large, and contain much 
marrow; and many important nerves, muscles, and veins are wounded at 
1 See Aphorism v., 17, 20. Celsus renders this sentence as follows: "Frigus 
omni ratione vitandum," etc., (viii., 10.) 
Vol. II.-5. 66 
GENUINE WORKS OF HIPPOCRATES. 
the same time. And if you reduce them, convulsions usually supervene; 
and, if not reduced, acute bilious fevers come on, with singultus and 
mortification.1 The chances of recovery are not fewer in those cases in 
which the parts have not been reduced, nor any attempts made at reduc- 
tion.2 Still more recover in those cases in which the lower, than those in 
which the upper part of the bone protrudes; and some will recover when 
reduction has been made, but very rarely indeed. For modes of treat- 
ment and peculiarity of constitution make a great difference as to the 
capability of enduring such an injury. And it makes a great difference 
if the bones of the arm and of the thigh protrude to the inside; for there 
are many and important vessels situated there, some of which, if wounded, 
will prove fatal; there are such also on the outside, but of less importance. 
In wounds of this sort, then, one ought not to be ignorant of the dangers, 
and should prognosticate them in due time. But if you are compelled to 
have recourse to reduction, and hope to succeed, and if the bones do not 
cross one another much, and if the muscles are not contracted (for they 
usually are contracted), the lever in such cases may be advantageously 
employed. 
36. Having effected the reduction, you must give an emoliient draught 
of hellebore3 the same day, provided it has been reduced on the day of 
the accident, but otherwise it should not be attempted. The wound 
should be treated with the same things as are used in fractures of the 
bones of the head, and nothing cold should be applied; the patient should 
be restricted from food altogether, and if naturally of a bilious constitu- 
tion, he should have for a diet a little fragrant oxyglyky sprinkled on 
water; but if he is not bilious, he should have water for drink; and if 
fever of the continual type come on, he is to be confined to this regimen 
for fourteen days at least, but if he be free of fever, for only seven days, 
1 Modern experience has amply confirmed the opinion here expressed by our 
author as to the danger there is in all cases of compound fracture of the femur or 
humerus from tetanus and gangrene. In whatever way treated, whether the 
parts be let alone at first, or reduced, or amputation be practiced, such cases com- 
monly prove fatal. 
2Paulus TEgineta, in reference to this passage, says: "Hippocrates, in fract- 
ures of the thigh and arm, dissuades from replacing at once the protruding bones, 
predicting danger from it, owing to the inflammation, or perhaps spasm of the 
muscles and nerves, which are apt to be broug'hton by the extension. But time 
has shown that the attempt will sometimes succeed." (VI., 107.) For the prac- 
tice of the other ancient authorities in this case, see the Commentary, 1. c. 
3 Even Galen confesses himself unable to determine what is the exact meaning 
of the term (y«Z0aKdj) here applied by our author, but supposes it probable that he 
means some gentle method of administering the hellebore. He mentions that he 
was in the practice of giving an infusion of radishes in oxymel with a few branch- 
es of hellebore in such cases, and that when thus administered the purgative op- 
eration of the hellebore was mild. The reader will remark our author's partiality 
to hellebore in all cases of spasmodic nature, such as tetanus. FRACTURES. 
67 
and then you must bring him back by degrees to a common diet. To those 
cases in which the bones have not been reduced, a similar course of medi- 
cine should be administered, along with the same treatment of the sores 
and regimen; and in like manner the suspended part of the body should 
not be stretched, but should rather be contracted, so as to relax the parts 
about the wound. The separation of the bones is protracted, as also was 
formerly stated. But one should try to escape from such cases, provided 
one can do so honorably, for the hopes of recovery are small, and the 
dangers many; and if the physician do not reduce the fractured bones 
he will be looked upon as unskillful, while by reducing them he will bring 
the patient nearer to death than to recovery. 
37. Luxations and subluxations at the knee are much milder accidents 
than subluxations and luxations at the elbow.1 For the knee-joint, in 
proportion to its size, is more compact than that of the arm, and has a 
more even conformation, and is rounded, while the joint of the arm is 
large, and has many cavities. And in addition, the bones of the leg are 
nearly of the same length, for the external one overtops the other to so 
small an extent as hardly to deserve being mentioned, and therefore 
affords no great resistance, although the external nerve (ligament at 
the ham arises from it; but the bones of the fore-arm are unequal, and 
the shorter is considerably thicker than the other, and the more slender 
(ulna protrudes, and passes up above the joint, and to it (the olecra- 
non I*) are attached the nerves (ligaments F) which go downward to the 
1 The subject of dislocations at the knee and elbow-joints is so important, that 
I have thought it necessary to enter into a pretty full discussion of it in the Argu- 
ment. A few points, notwithstanding, will require consideration in this place. 
There is still great diversity of opinion respecting the nature of subluxations at 
the knee-joint, even after all the investigations which the subject has received 
from Hey of Leeds, Sir Astley Cooper, Mr. Liston, and Mr. Bransby Cooper. No 
doubt, partial displacements of the femur from the tibia do take place occasionally; 
but there appears good reason for suspecting that the accidents generally referred 
to this category have been displacements of the semilunar cartilages; with these 
it does not appear that Hippocrates or any other of the ancient authorities was 
acquainted. Partial dislocations from diseases I have frequently seen, I am ac- 
quainted with a case of nearly complete luxation backward of the tibia, from the 
disease usually called white swelling; and yet, strange to say, the limb is still not 
much impaired either in its strength or motions. These cases of displacement 
from disease have probably been sometimes confounded with subluxations from 
accident: indeed I cannot but think that the ancient surgeons must have com- 
mitted this mistake sometimes, otherwise they would not have represented this 
accident as being of so frequent occurrence as they describe it to be. As we have 
stated elsewhere, of all the joints of the human body this perhaps is the one which 
most rarely meets with dislocation. The description winch our author gives of 
the ligaments connected with the elbow-joint is so curious, that I have inserted 
in the Argument to the next work Bedard's very ingenious observations on the 
subject. 68 
GENUINE WORKS OF HIPPOCRATES. 
junction of the bones; and the slender bone {ulna?) has more to do with 
the insertion of the ligaments in the arm than the thick bone {radius?). 
The configuration then of the articulations, and of the bones of the elbow, 
is such as I have described. Owing to their configuration, the bones at 
the knee are indeed frequently dislocated, but they are easily reduced, 
for no great inflammation follows, nor any constriction of the joint. They 
are displaced for the most part to the inside, sometimes to the outside, 
and occasionally into the ham.1 The reduction in all these cases is not 
difficult, but in the dislocations inward and outward, the patient should 
be placed on a low seat, and the thigh should be elevated, but not much. 
Moderate extension for the most part sufficeth, extension being made at 
the leg, and counter-extension at the thigh. 
38. Dislocations at the elbow are more troublesome than those at the 
knee, and, owing to the inflammation which comes on, and the configura- 
tion of the joint, are more difficult to reduce if the bones are not imme- 
diately replaced. For the bones at the elbow are less subject to dislocation 
than those of the knee, but are more difficult to reduce and keep in their 
position, and are more apt to become inflamed and ankylosed.2 
39. For the most part the displacements of these bones are small, some- 
times toward the ribs, and sometimes to the outside; and the whole articu- 
lation is not displaced, but that part of the humerus remains in place 
which is articulated with the cavity of the bone of the fore-arm that has 
a protuberance {ulna?). Such dislocations, to whatever side, are easily 
reduced, and the extension is to be made in the line of the arm, one per- 
son making extension at the wrist, and another grasping the armpit, while 
a third, applying the palm of his hand to the part of the joint which is 
displaced, pushes it inward, and at the same time makes counter-pressure 
on the opposite side near the joint with the other hand.3 
1 The Commentary of Galen is particularly valuable on this passage, as putting 
it beyond a doubt that, in dislocations at the knee, our author represents the 
femur as the bone which is displaced. In modern works the femur is generally 
considered as the fixed point. See Mr. Bransby Cooper's Lectures, and Mr. 
Liston's Practical Surgery. 
2 No person possessed of a practical acquaintance with the subject can fail to 
perceive that, in the following descriptions of dislocation at the elbow-joint, oui' 
author comprises (and perhaps I may say confounds together) simple displace- 
ment of the trochlea of the humerus from the great sigmoid cavity of the ulna, 
and fractures of the humerus immediately above the epiphysis, accompanied 
with displacement of the bones of the fore-arm, See the Argument, and Dupuy- 
tren on Injuries of Bones, p. 102, &c., Sydenham Society edition. Dupuytren was 
well aware of the occurrence of abruption of the extremity of the humerus with 
displacement, although not without it. See § 46. 
3 The case here described would seem to be dislocation of the radius at its up- 
per extremity, an accident which has been described by Duverney, Desault, Sir 
Astley Cooper, and many other modern authorities. It is distinctly noticed by 
Oribasius (De Machinamentis, xiii. and xiv.). Our author, upon this supposition, FRACTURES. 
69 
40. The end Of the humerus at the elbow gets displaced (subluxated ?) 
by leaving the cavity of the ulna. Such luxations readily yield to reduc- 
tion, if applied before the parts get.inflamed. The displacement for the 
most part is to the inside, but sometimes to the outside, and they are readily 
recognized by the shape of the limb. And often such luxations are re- 
duced without any powerful extension. In dislocations inward, the joint 
is to be pushed into its place, while the fore-arm is brought round to a 
state of pronation. Such are most of the dislocations at the elbow.1 
41. But if the articular extremity of the humerus be carried to either 
side above the bone of the fore-arm, which is prominent, into the hollow 
of the arm (?), this rarely happens; but if it do happen, extension in the 
straight line is not so proper under such circumstances; for in such a 
mode of extension, the process of the ulna (olecranon prevents the bone 
of the arm (humerus F) from passing over it. In dislocations of this kind, 
extension should be made in the manner described when treating of the 
bandaging of fractured bones of the arm, extension being made upward 
at the armpit, while the parts at the elbow are pushed downward, for in 
this manner can the humerus be most readily raised above its cavity; and 
when so raised, the reduction is easy with the palms of the hand, the one 
being applied so as to make pressure on the protuberant part of the arm, 
and the other making counter-pressure, so as to push the bone of the fore- 
arm into the joint. This method answers with both cases. And perhaps 
this is the most suitable mode of reduction in such a case of dislocation. 
The parts may be reduced by extension in a straight line, but less readily 
than thus.2 
describes both the dislocations forward and backward. This is the explanation 
of the paragraph which Apollonius Citiensis would appear to sanction. (Schol. 
in Hippocrat., tom. i., p. 15.) Galen, however, in his Commentary preserved by 
Cocchi, would seem to refer it to the incomplete lateral luxations of the arm. A 
third interpretation of the meaning has been advanced by Bosquillon, and to it 
M. Littre at last inclines, namely, that it is incomplete dislocation backwards. 
His observations on this point show the great pains which the French editor takes 
in elucidating the text of his author ; but I cannot say that I think he and his 
countrymen make out anything like a strong case in support of their opinion, and 
I still incline to agree with Apollonius in referring the case here described to 
dislocation of the radius. I leave the reader, however, to judge for himself. 
1 This would certainly appear to be incomplete lateral luxation of the fore-arm. 
See the Argument. 
2 This is evidently meant as a description of complete lateral luxation. Such 
a case of displacement is very uncommon ; indeed, until lately, it was thought 
impossible. See Cooper's Surgical Dictionary, p. 391, Fifth edition, 1825. It is 
described, however, by Mr. Liston in the following terms: "Displacement of 
both bones laterally is met with, though rarely, the olecranon process being placed 
upon either the outer or inner condyle ; in the latter case the head of the radius 
rests in the fossa on the posterior aspect of the humerus." (Practical Surgery, p. 
124, Third edition.) 70 
GENUINE WORKS OF HIPPOCRATES. 
42. If the arm be dislocated forward-this rarely happens, indeed, 
but what would a sudden shock not displace ? for many other things are 
removed from their proper place, notwithstanding a great obstacle,-in 
such a violent displacement the part (olecranon ?) which passes above the 
prominent part of the bones is large, and the stretching of the nerves 
(ligaments ?) is intense; and yet the parts have been so dislocated in cer- 
tain cases. The following is the symptom of such a displacement: the 
arm cannot be bent in the least degree at the elbow, and upon feeling 
the joint the nature of the accident becomes obvious. If, then, it is not 
speedily reduced, strong and violent inflammation, attended with fever, 
will come on, but if one happen to be on the spot at the time it is easily 
reduced. A piece of hard linen cloth (or a piece of hard linen, not very 
large, rolled up in a ball, will be sufficient) is to be placed across the bend 
of the elbow, and the arm is then to be suddenly bent at the elbow, and 
the hand brought up to the shoulder. This mode of reduction is suffi- 
cient in such displacements; and extension in the straight line can rectify 
this manner of dislocation, but we must use at the same time the palms 
of the hands, applying the one to the projecting part of the humerus at 
the bend of the arm for the purpose of pushing it back, and applying the 
other below to the sharp extremity of the elbow, to make counter-pres- 
sure, and incline the parts into the straight line. And one may usd with 
advantage in this form of dislocation the method of extension formerly 
described, for the application of the bandages in the case of fracture of the 
arm; but when extension is made, the parts are to be adjusted, as has 
been also described above.1 
43. But if the arm be dislocated backward (but this very rarely hap- 
pens, and it is the most painful of all, and the most subject to bilious 
fevers of the continual type, which prove fatal in the course of a few 
days), in such a case the patient cannot extend the arm. If you are 
quickly present, by forcible extension the parts may return to their place 
of their own accord; but if fevei' have previously come on, you must no 
longer attempt reduction, for the pain will be rendered more intense by 
any such violent attempt. In a word, no joint whatever should be reduced 
during the prevalence of fever, and least of all the elbow-joint.2 
44. There are also other troublesome injuries connected with the 
elbow-joint; for example, the thicker bone (radius?) is sometimes par- 
1 This would seem to be dislocation of the fore-arm forwards. Whether or not 
it ever occurs without fracture of the olecranon, as our author's description seems 
to infer, I cannot pretend to determine. See the Argument. 
2 There can be no mistake about the nature of the accident described in this 
paragraph ; it is evidently the ordinary luxation of the elbow-joint, namely, dis- 
placement of the bones of the fore-arm backward. The following description of 
its leading character agrees exactly with our author's account of it: " The fore- 
arm is in a state of half-flexion, and every attempt to extend it produces acute 
pain." Cooper's Surgical Dictionary, p. 390, Fifth edition.) FRACTURES. 
71 
tially displaced from the other, and the patient can neither perform ex- 
tension nor flexion properly. This accident becomes obvious upon exami- 
nation with the hand at the bend of the arm near the division of the vein 
that runs up the muscle. In such a case it is not easy to reduce the 
parts to their natural state, nor is it easy, in the separation of any two 
bones united by symphysis, to restore them to their natural state, for 
there will necessarily be a swelling at the seat of the diastasis. The method 
of bandaging a joint has been already described in treating of the appli- 
cation of bandages to the ankle.1 
45. In certain cases the process of the ulna (olecranon behind the 
humerus is broken; sometimes its cartilaginous part, which gives origin 
to the posterior tendon of the arm, and sometimes its fore part, at the 
base of the anterior coronoid process; and when this displacement takes 
place, it is apt to be attended with malignant fever.2 The joint, however, 
remains in place, for its whole base protrudes at that point. But when 
the displacement takes place where its head overtops the arm, the joint 
becomes looser if the bone be fairly broken across. To speak in general 
terms, all cases of fractured bones are less dangerous than those in which 
the bones are not broken, but the veins and important nerves (tendons ,?) 
situated in these places are contused; for the risk of death is more imme- 
diate in the lattei- class of cases than in the former, if continual fever 
come on. But fractures of this nature seldom occur. 
4G. It sometimes happens that the head of the humerus is fractured 
at its epiphysis; and this, although it may appear to be a much more 
troublesome accident, is in fact a much milder one than the other injuries 
at the joint.3 
47. The treatment especially befitting each particular dislocation has 
been described; and it has been laid down as a rule, that' immediate re- 
duction is of the utmost advantage, owing to the rapid manner in which 
inflammation of the tendons supervenes. For even when the luxated 
parts are immediately reduced, the tendons usually become stiffened, and for 
a considerable time prevent extension and flexion from being performed 
to the ordinary extent. All these cases are to be treated in a similar way, 
whether the extremity of the articulating bone be snapped off, whether 
the bones be separated, or whether they be dislocated; for they are all to 
be treated with plenty of bandages, compresses, and cerate, like other 
fractures. The position of the joint in all these cases should be the same, 
as when a fractured arm or fore-arm has been bound up. For this is the 
most common position in all dislocations, displacements, and fractures; 
1 This seems to be lateral displacement of the radius. See the Argument. 
2 These are evidently fractures of the olecranon, near its extremity, and at its 
base, that is to say, at its connection with the coronoid process. See Sir Astley 
Cooper's Lectures, and Cooper's Surgical Dictionary. 
3 This, beyond all doubt, is abruption of the epiphysis or trochlea of the hu- 
merus. See the Argument. 72 
GENUINE WORKS OF HIPPOCRATES. 
and it is the most convenient for the subsequent movements, whether of 
extension or flexion, as being the intermediate stage between both. ) And 
this is the position in which the patient can most conveniently carry or 
suspend his arm in a sling. And besides, if the joint is to be stiffened by 
callus, it were bettei' that this should not take place when the arm is ex- 
tended, for this position will be a great impediment and little advantage; 
if the arm be wholly bent, it will be more useful; but it will be much more 
convenient to have the joint in the intermediate position when it becomes 
ankylosed. So much with regard to position.1 
48. In bandaging, the head of the first bandage should be placed at 
the seat of the injury, whether it be a case of fracture, of dislocation, or 
of diastasis {separation ?), and the first turns should be made there, and 
the bandages should be applied most firmly at that place, and less so on 
either side. The bandaging should comprehend both the arm and the 
fore-arm, and on both should be to a much greater extent than most phy- 
sicians apply it, so that the swelling may be expelled from the seat of the 
injury to either side. And the point of the fore-arm should be compre- 
hended in the bandaging,2 whether the injury be in that place or not, in 
order that the swelling may not collect there. In applying bandages, we 
must avoid as much as possible accumulating many turns of the bandage 
at the bend of the arm. Foi' the principal compression should be at the 
seat of the injury, and the same rules are to be observed, and at the same 
periods, with regard to compression and relaxation, as formerly described 
respecting the treatment of broken bones; and the bandages should be 
renewed every third day; and they should appear loose on the third day, 
as in the other case. And splints should be applied at the proper time 
(for there is nothing unsuitable in them, whether the bones be fractured 
or not, provided there is no fever); they should be particularly loose, 
whether applied to the arm or the fore-arm,3 but they must not be thick. 
It is necessary that they should be of unequal size, and that the one should 
ride over the other, whenever from the flexion it is judged proper. And 
the application of the compresses should be regulated in the same manner 
as has been stated with regard to the splints; and they should be put on 
in a somewhat more bulky form at the seat of the injury. The periods 
are to be estimated from the inflammation, and from what has been writ- 
ten on them above. 
1 These rules for the adjustment of the parts in injuries of the elbow-joint are 
most important and apposite., Whether in dislocation, subluxation, abruption of 
the epiphysis of the humerus, fracture of the olecranon, and in fact, I believe in 
all injuries at the elbow-joint, the half-bent position at first will be found the 
best. See Sir Astley Cooper's Lectures, and all the best modern authorities. 
2 Meaning, no doubt, the olecranon. 
3 The meaning in this passage is very doubtful, owing to the uncertainty about 
the proper reading. See Foes and LittrA ON THE ARTICULATIONS. ON THE ARTICULATIONS. 
THE ARGUMENT. 
The author commences the work with an elaborate dissertation on 
dislocations at the shoulder-joint, of which he decidedly recognizes only 
one form, namely, dislocation downward, or into the armpit, but he does 
not positively deny the possibility of dislocations upward, outward, and 
forward, only he states that he had never met with any instance of them. 
He concludes § 1 with some general remarks on this accident. He then 
describes various modes of reduction:-with the hand, § 2;-with the heel, 
§ 3;-with the shoulder introduced into the patient's armpit, § 4;-with a 
pestle or pole introduced into the armpit, § 5;-with a ladder, § 6;-or 
with the machine called the ambe, § 7. In § 8 are contained some 
remarks on the general subject of luxations, in which place mention is 
made of the occurrence of this accident in cattle when in a lean condition. 
In § 8 the after-treatment is accurately laid down. In § 10 some very 
important and acute remarks are made on the method of avoiding mistakes 
in treating these dislocations; and in § 11 the surgical treatment in cases 
which show a great tendency to relapse is minutely treated of. The con- 
sequent effects on the limb when the reduction is not accomplished are 
circumstantially described in § 12. 
In § 13 is given a description of abruption of the acromion, by which 
is probably meant dislocation of the clavicle from the acromion, compli- 
cated, perhaps, with fracture of the latter. 
The subject of fracture of the clavicle is next taken up, and it is 
treated of through §§ 14, 15, 16, where everything relating to the symp- 
toms and treatment of this accident is given with remarkable precision. 
The subject of luxations and subluxations at the elbow, which had 
been treated of in the work " On Fractures," is here resumed, and is fully 
discussed in §§ 17, 18, 19, 20, 21, 22, 23, 24, 25. 
Luxations at the wrist, and their consequences, are given in §§ 26, 27, 
28. 
Luxations of the fingers are briefly treated of in § 29. 
Luxations of the lower jaw, with all their varieties and consequences, 
are described in §§ 30, 31. 
Fracture of the same, without displacements, is given in § 32, and 76 
GENUINE WORKS OF HIPPOCRATES. 
with displacement, in § 33. Fracture of the lower jaw, at its symphysis, 
is treated of in § 34. 
Fractures and contusions of the nose are elaborately treated of in 
§§ 35, 36, 37, 38, 39. 
Fractures of the ear are treated of in § 40. 
Incurvation of the spine is treated of in § 41, and the application of 
the process of succussion by means of a ladder, for the cure of it, is 
minutely described in §§ 42, 43, 44. In § 35, the spinal vertebrae, liga- 
ments, and nerves are minutely described. Inferences from their ana- 
tomical structure are given at considerable length in § 46. The methods 
of treating incurvations of the spine by a mechanical process are minutely 
described in § 47. Curvature forward is described in § 48. 
Fracture of the ribs is treated of in § 49, and contusion of them in § 50. 
It is worthy of remark that contusions are held to be more dangerous 
than fractures. 
The symptoms of dislocations at the hip-joint, whether congenital or 
otherwise, and whether occasioned by external violence or disease, are 
described with extraordinary minuteness and accuracy of detail in §§ 51, 
52, 53, 54, 55, 56, 57, 58, 59, 60. In § 61 are given some general reflec- 
tions on the subject of luxations. 
In § 62, congenital displacement of the bones of the ankle-joint, that 
is to say, congenital club-foot, is treated of with great precision. 
Luxation of the bones of the ankle-joint, with protrusion of them 
through the skin, that is to say, compound luxation, is treated of in § 63. 
Compound luxations at the wrist are described in § 64. 
Compound luxations at the knee are treated of in § 65. 
Compound luxations at the elbow are treated of in § 66. 
Compound luxations of the bones of the fingers are accurately treated 
of in § 67. 
Resection of the bones of a joint in compound luxations is the subject 
treated of in § 68. 
The subject of gangrene supervening in cases of fracture and other 
severe accidents is treated of in § 69. 
Reduction of dislocations at the hip-joint is minutely described in §§ 70, 
71, 72, 73, 74, 75, 76, 77, 78. 
In § 97 are given some general observations on the articulations and 
their dislocations. 
Simple dislocations of the joints of the fingers are treated of in § 80. 
Some general rules for the management of luxations are given in § 81; 
after which our author proceeds to the consideration of luxations at the 
knee, in § 82. 
Luxations at the ankle-joint are briefly described in § 83. 
Luxations of the bones of the foot are noticed in a succinct style in 
§84. ARTICULATIONS. 
77 
Luxations, as it would appear, of the tarsal bones are obscurely noticed 
in § 85. 
Displacement of the os calcis, followed by gangrene, with the treat- 
ment of the same when connected with other causes, is given in § 86. 
The work concludes with a paragraph on the treatment of dislocations 
at the ankle-joint, § 87. 
From this statement of its contents it will be readily seen that this 
work, like the preceding one, treats both of luxations and fractures; but 
with this difference, that as fractures constitute the groundwork of the 
other, so luxations form the principal subject of this treatise, the matter 
relating to fractures being introduced most probably for the sake of 
diagnosis. Altogether, there is not in all antiquity a medical treatise 
which contains more interesting materials than the present one, or that 
deserves to be more carefully studied. 
Several sections of the work are perfect masterpieces, such, for example, 
as the parts which relate to dislocations at the shoulder and the hip-joint, 
and more especially the latter, in which, as it appears to me, he has given 
a fuller and more complete history of everything relating to the subject 
than is to be found in any single work, even at the present day. Thus, 
not only does he describe the four ordinary forms of dislocation now 
recognized, namely, dislocation upward, downward, forward, and back- 
ward, but he gives what is omitted by all our modern authorities, a very 
minute description of the appearances which the limb presents when the 
luxated bone has been left unreduced. And, moreover, he describes con- 
genital luxations and luxation from disease. Now, I repeat, no systematic 
writer on surgery has given so comprehensive a view of the subject of dis- 
locations in all its bearings as what is here given by Hippocrates. The 
reader, however, will find it very interesting to compare the excellent 
account of this subject given in the recent publication of Chelius, illus- 
trated by the valuable notes of Mr. South. Among the older of our 
modern authorities on surgery, Pare is the one who approaches the nearest 
to Hippocrates in the fullness with which he treats of luxations at the hip- 
joint, but even he is much less complete in regard to congenital disloca- 
tions, and those connected with disease.1 On one statistical point alone 
1 Chelius ranks Pare, along- with Hippocrates and Avicenna, among the au- 
thorities on congenital dislocations at the hip-joint; but if Pare really treats of 
congenital dislocations, it is not in the place where luxations in general are 
treated of. Although somewhat out of place, I may here be excused in saying 
a few words on the nature of congenital dislocations. Some of our modern 
authorities look upon them as being connected with arrested development of 
the bones, but I must say that judging of them from what I know of congenital 
club-foot, I am rather inclined to consider them as being originally produced by 
retraction of the muscles. This is the theory of Guerin (Gazette M6dicale, 1841), 
and it appears to me most probable. I should state, however, that, although I 78 
GENUINE WORKS OF HIPPOCRATES. 
do modern authorities controvert his opinion, and even in this case 
Hippocrates has a high modern authority on his side-I mean the com- 
parative frequency of the different forms of dislocation; he, and all the 
ancient authorities after him, having stated that dislocation inward is the 
most frequent, whereas Sir Astley Cooper and all our late authorities hold 
that dislocation upward is the most frequent. It is deserving of remark, 
however, that if Cooper be against Hippocrates, Pare is upon his side, 
and I need scarcely remark that he is not one who bows servilely to 
ancient authority, but was an original observer, and thought for himself; 
and, moreover, his experience was on a very large scale. On another 
point connected with this class of accidents, it is worthy of remark, that 
it was only the other day that an eminent anatomist in London decided 
that Hippocrates was right, and that all our modern authorities were 
wrong; I mean with respect to the situation of the head of the femur in 
the fourth form of dislocation. Sir Astley Cooper, Mr. Liston, Sir 
Charles Bell, Mr. Samuel Cooper, and, in a word, all our best authorities 
of late years, maintained that the head of the bone in this form is lodged 
in the ischiatic notch; but Mr. Richard Quain has lately determined, by 
actual dissection, that the bone is lodged where it is described to be by 
Hippocrates, namely, behind the acetabulum in the nates.-See the note 
on Articulations, § 57. 
The methods of reduction, too, which our author describes, are all 
based on the most correct principles, and some of them might, perhaps, 
be held preferable to those now in use. He does not appear, indeed, to 
have been acquainted with the use of pulleys in the treatment of this 
accident, but the axles which he describes as being attached to the bench 
which bears his name (Scamnum Hippocratis) must have been quite capable 
of exercising a degree of force fully adequate to effect the desired purpose.1 
The method, too, according to which the patient was placed astride upon 
a cross-beam, and with a weight attached to the injured limb, would seem 
to be one admirably adapted to wear out the strength of the contracted 
muscles, and in this way facilitate the adjustment of the bone. 
But in all the works on ancient surgery, I verily believe there is not 
a more wonderful chaptei' than the one which relates to Club-foot, § 62. 
In it he has not only stated correctly the true nature of this malformation, 
but he has also given very sensible directions for rectifying the deformity 
in early life. Now it appears to me a lamentable reflection, as proving 
that valuable knowledge after being discovered may be lost again to the 
have seen cases of congenital impediment at the hip-joint at a very early age, I 
never had an opportunity of ascertaining their nature by actual dissection. 
1 The reader will see the machine and the process of reduction figured in the 
Armamentarium Chirurgicum of Scultet, Tab. xxv.; in the edition of Galen's 
Works by the Juntas ; and in Littre's edition of Hippocrates. I have given the 
last two ; and the first is scarcely at all different from the second. ARTICULATIONS. 
79 
world for many ages, that not only did subsequent authorities, down to a 
very recent period, not add any thing to the stock of valuable information 
which he had given on the subject, but the important knowledge which 
he had revealed to the profession came to be disregarded and lost sight of, 
so that, until within these last few years, talipes was regarded as one of 
the " opprobria medicinae." I cannot omit this opportunity of mention- 
ing, however, that some centuries ago certain individuals would appear to 
have practiced successfully the treatment of club-foot on the principles laid 
down by Hippocrates. To give an instance in point, Arcseus, who, in his 
work "De Curandis Vulneribus," (Amstel, 1658,) has given a chapter on 
the treatment of club-foot, not only describes the process correctly, but 
actually gives the form of two mechanical contrivances for reducing the 
derangement of the foot, and keeping it in situ. The former of these 
contrivances is evidently the original of Scarpa's apparatus, now very 
generally usedin the adjustment of club-foot; and the other is as evidently 
the very same as the boot delineated in Syme's " System of Surgery," and 
which I myself have often used in the treatment of club-foot. As a 
matter of curiosity, I shall give drawings of them. That the author (I 
mean Arcaeus) was very successful in the treatment of congenital club-foot 
appears obvious, from the terms in which he speaks of the results of his 
experience in this way: "Saepe accidit, nt infans nascatur aut altero aut 
utroque pede distorto, aut incurvo, aut repando, ita ut aegre admodum 
possit incedere. Ea de causa hoc loco volui methodum tradere, qua pthirimos 
rat de claudos liberavi, inter quos unus curatu difficillimus," etc. The 
whole process of cure is most circumstantially described, and the author 
concludes with the very proper advice, that the patient should be made 
to wear the boot for six months after the parts have been restored. All 
this shows, that although our author's excellent instructions for the man- 
agement of this deformity were long lost to the profession at large, there 
were not wanting individuals who knew how to appreciate their value. 
With regard to the description of the mode of bandaging a distorted 
limb in club-foot, as given by our author, I have little to add to what is 
stated in my annotations on the passage. Though there be certain 
obscurities in some of the expressions which occur in it, its general mean- 
ing is sufficiently obvious and I can attest from ample experience recently 
acquired in the treatment of this surgical case, that the rules of treatment 
here laid down by our author are very judicious, and I have no doubt 
would be found amply sufficient for restoring a recent case of talipes. 
The reader will remark, that our author concludes his account of club- 
foot with the declaration, that treated in this way it may be cured sooner 
than one would have thought, " without burning or cutting, or any other 
complicated method." And here I cannot deny myself the pleasure of 
quoting the very candid reflections which Dr. Little, in his work " On 
Club-foot " makes on the account of talipes given by Hippocrates. He 80 
GENUINE WORKS OF HIPPOCRATES. 
says, " Hippocrates describes the bandages to which he resorted for the 
cure of varus, and his success may be estimated from the encomiums he 
bestows on them,-' citius enim talia medicinee obtemperant, quam quis 
putarit.' The candor displayed throughout the writings of the Father 
of Medicine leaves little doubt that he has not exaggerated the success 
which he experienced; and we may conclude that, by commencing the 
treatment at the earliest period of life, aided by his unremitting persever- 
ance, many of these distortions were remedied. An observation, which 
would have passed unheeded prior to the introduction of the division of 
the tendo Achillis, follows the last quotation: 'atque heec quidem est 
curatio, et neque sectione, neque ustione, neque alia varietate quicquam 
opus habet,'-of the import of which, doubts may now be entertained. 
Whether Hippocrates, or any of his contemporaries, had discovered the 
means of curing this distortion by section of tendons, but preferring the 
application of bandages, nevertheless rejected it, or whether he employed 
this observation with a different meaning, cannot at the present day be 
decided. It is possible that Hippocrates, being accustomed to cure 
external disorders by the knife or cautery, may have adduced his treat- 
ment of this disease as an exception to the more severe methods so fre- 
quently resorted to in other affections; whilst it would not be surprising 
if, by his great ingenuity and skill, he had detected the possibility of 
removing the obstacles to a cure by a division of the tendons. He may 
have apprehended suppurations and other unfavorable symptoms from the 
section of so important a tendon as that of Achilles; or, having been un- 
successful in his first attempts, he may have been deterred from a repeti- 
tion." (Introduction, p. 48.) 
The description which our author gives of luxations at the wrist, 
Articulations §§ 26, 27, 28, and Mochlicus §§ 16, 17, 18, is attended with 
peculiar difficulties, and hence it has given rise to a good deal of confusion 
and misapprehension from the time of Pare1 down to Malgaigne and 
Littre. His usage of the terms " inward" and " outward" is somewhat 
vague; but it appears to me that we need have little hesitation in deciding 
them to apply to the modern acceptation of ' ' forward " and "backward." 
But the great puzzle is, does he mean that the bones of the carpus are 
displaced from those of the fore-arm ? or does he recognize the carpus as 
the fixed point ? His language would certainly apply most naturally to 
the interpretation that the bones of the hand were the parts which he 
understood to be displaced; but yet M. Malgaigne holds, that our author 
understood the bones of the fore-arm to be the movable part. We shall 
1 The disagreement between Pare and the ancient authorities (especially Hip- 
pocrates and Galen) in the use of the terms which he applies to the parts in de- 
scribing dislocations at the wrist, is adverted to in the marginal notes to all the 
old editions. See Book XV. ARTICULATIONS. 
81 
examine the question somewhat more narrowly. One of the best of our 
recent authorities on dislocations lays it down as a rule, that in dislocation 
of the carpus backward there is permanent flexion of the hand, and in 
dislocations forward, that there is permanent extension. (See Mr. B. 
Cooper's Lectures, Med. Gaz. 1065.) Now, according to Hippocrates, in 
luxation inward (meaning, as stated above forward) the patient cannot 
bend his fingers, (this then, agrees with the character of dislocation of the 
carpus forward), and in luxation outward (meaning, in modern language, 
backward), that he cannot extend them; this case, then, would seem to 
agree with the characters of dislocation backward, agreeably to modern 
views. All this would lead us to the conclusion, that Hippocrates agreed 
with our recent authorities in regarding the bones of the hand as the part 
which is displaced. Moreover, it is difficult to understand Celsus, who, 
it is probable, translated the words of Hippocrates, in any other sense: he 
says, 11 Manus quoque in omnes quatuor partes prolabitur. Si in poste- 
riorem partem excidit, porrigi digiti non possunt " (Mr. B. Cooper's de- 
scription of dislocation of the carpus backward is, " permanent flexion of 
the hand")-"si in priorem non inclinatur" (Mr. Cooper's description 
of dislocation forward is, "it is characterized by permanent extension of 
the hand ") viii. 17. Still, however, I believe, that not only is the litera- 
ture of this subject perplexed by an ill-defined nomenclature, but that the 
nature of the accidents which befall the bones of the wrist is far from 
being satisfactorily determined even at the present day. For my own 
part, after full thirty years' experience in treating these and other surgi- 
cal cases, I must say that I never saw a distinct and decided case of dislo- 
cation at the wrist, and that I incline with Baron Dupuytren 1 and Pro- 
fessor Syme in regarding most of the accidents which have been set down 
for luxations as having been in reality fractures of the bones of the fore- 
arm in the vicinity of the joint. And in conclusion, I beg leave to state 
it as my decided opinion, that with regard to the accidents which befall 
the elbow, the wrist, and the ankle-joints, much misapprehension still 
prevails. While a certain creed is established on any given professional 
subject, most people are disposed to see the phenomena connected with it 
as they fancy that they should see them, and independent thought and 
original observation are talents rarely vouchsafed to any one. Professional 
men of late have been impressed with the idea, that by entirely renounc- 
3 See the Syd. Soc. edition of his works. I perceive, from the note given on 
Chelius's chapter On Dislocations at the Wrist," that the opinions of Dupuytren 
have been controverted by Voillemier, who thinks he has shown the existence of 
such dislocations by the most careful examination of a complete displacement of 
the wrist backward, and of the bones of the fore-arm forward. Now I do not 
pretend to deny the actual possibility of such an occurrence ; but I must say that 
my own experience leads me to the conclusion that a case of dislocation without 
fracture must be extremely rare indeed. 
Vol. II.-6. 82 
GENUINE WORKS OF HIPPOCRATES. 
ing the authority of the ancients, they show themselves to be original 
observers; but such persons are more the slaves of established modes of 
thought and conventional opinions, than if they were familiarly acquainted 
with all the authorities in medicine from the earliest time down to the 
present day; for it is only when possessed of this knowledge, that a man 
of a well-constituted mind feels that he is fully warranted to exercise an 
independent judgment of his own. In literature, as in warfare, it is 
knowledge which confers true self-reliance. 
A very interesting subject handled by our author in this work is the 
treatment of compound luxations. One can readily perceive, that he had 
correctly estimated the dangers of this very grave class of accidents; and 
accordingly, in one place, he makes it a consideration, whether or not the 
surgeon should incur the responsibility of undertaking the charge of them. 
As a general rule, he forbids reduction, unless in the case of the smaller 
joints, such as those of the hands and feet. Now it is curious to remark, 
that in the time of Celsus and Galen, this rule of practice was still adhered 
to, but Paulus JEgineta ventures for once to rebel against the authority 
of the Coan sage. In the section '' On dislocations with a wound," he 
says, " Wherefore Hippocrates, by all means, forbids us to apply reduc- 
tion and strong bandaging to them, and directs us to use only anti- 
inflammatory and soothing applications to them at the commencement; 
for that, by this treatment, life may be sometimes preserved. But what 
he recommends for the fingers alone, we would attempt to do for all the 
other joints: at first, and while the part remains free from inflammation, 
we would reduce the dislocated joint by moderate extension; and, if we 
succeed in our object, we may persist in using the anti-inflammatory treat- 
ment only." (vi. 121.) All the Arabian authorities follow the rule of 
practice here laid down by Paulus JEgineta. See the Commentary, 1. c. 
Syd. Soc. ed. I need scarcely remark, that this mode of treatment is 
that now followed by the profession. It will further be remarked, that 
at § 68, our author treats of resection of the bones in compound luxation 
of the bones of the hands, feet, ankle, and wrist; and that, upon the 
whole, he approves of the practice. In the annotations on that section, I 
have briefly adverted to modern experience in the application of this 
method of treatment; and in this place I shall merely add the rule of 
practice as laid down by Chelius, which the reader will find it interesting 
to remark, is very little different from that recommended by Hippocrates, 
except that Chelius, in all cases, approves of attempts at reduction: " If 
the reduction of the head of the bone, protruded through the soft parts, 
be in no way possible, even after proper enlargement of the wound in the 
skin, nothing remains but to saw off the protruding bone, by which the 
stretching and tearing of the muscles are relieved, and the joint -can be 
brought to its natural position; after which the symptoms, in general, 
soon and considerably diminish. When the reduction of a bone pro- ARTICULATIONS. 
83 
trading through the soft parts is not immediately possible, it is still less 
so when the inflammation runs into suppuration; the symptoms continue 
increasing, and amputation may be rendered necessary by gangrene, and 
by progressive destruction, if the head of the bone have not been removed 
at the propel- time/' (Vol. i., p. 769, Engl, edition.) 
In the brief annotations which I have given on the first paragraph, I 
have brought forward certain passages in this and the other works of our 
author, which seem to prove beyond all doubt, that he must have had 
more or less acquaintance with Human Anatomy from actual dissection. 
On this point I have long been confident, and the more I become familiar 
with his admired works, the stronger my impression is that his anatomical 
knowledge must have been far from contemptible; in fact, I do not at 
present recollect a single instance of mistake committed by him in any of 
his anatomical descriptions, if we except that with regard to the sutures 
of the head, and even in that case I have endeavored to show that the 
meaning of the passage is very equivocal. His descriptions of the verte- 
brae, with all their processes and ligaments, and his general characters of 
the internal viscera, would not have been so free from error as they are, 
if his knowledge had been all derived from the dissection of the inferior 
animals. Indeed, I am of opinion that Hippocrates and the othei- medi- 
cal authorities of antiquity had practiced inspectiones cadaverum more 
frequently than they durst publicly acknowledge, for fear of suffering from 
popular prejudice; but even that would appear to have been overrated, 
for, as it is proved beyond all possibility of doubt, that the human body 
was openly dissected in the anatomical schools of Alexandria, considera- 
bly less than 100 years after the death of Hippocrates,1 it is highly proba- 
ble that the practice had prevailed before that time, although to an infe- 
rior extent. Such a taste was not likely to have sprung up all at once 
under the Ptolemies. Indeed, that Aristotle, who was almost contem- 
porary with Hippocrates, and who was dead before the distinguished 
Alexandrian period, had seen the human body dissected, will not be ques- 
tioned by any one who has read his admirable works " On the Parts of 
Animals," and "The History of Animals." See, in particular, the last 
chapter of the First Book of the latter work; also, ibid, i., 11; ii., 5; de 
Respiratione, 15; de Partibus Animalium, iii., 4. In fact, he does not 
hesitate to declare, that certain things must be learned from dissection. 
(H. A. i., 11, and vi., 10.) 
In addition to the observations on this interesting subject, which will 
be found at the place above indicated, I now beg leave to quote from M. 
Littre's notes on § 37 of the work " On Fractures," the very ingenious 
remarks of M. Beclard on the description of the parts connected with the 
elbow-joint, both because they appear to me very interesting, as illustrat- 
1 See the authorities quoted in Marx's Life of Herophilus. 84 
GENUINE WORKS OF HIPPOCRATES. 
ing the meaning of our author, and further as proving irrefragably, that 
Hippocrates must have had considerable acquaintance with human 
anatomy. 
" Le passage d'Hippocrate est tres href, et a cause de cela il pent 
paraitre obscur a ceux qui n'auraient pas presente a 1'esprit la disposition 
anatomique. La description suivante de l'articulation du coude, donnee 
par Beclard, servira de complement, et montrera que la phrase d'Hippocrate 
suppose une connaissance tres precise de la disposition de cette articulation: 
' L'articulation du coude est maintenue par quatre ligaments, un anterieur, 
un posterieur, un externe, et un interne. Les ligaments, quoique tres dis- 
tincts par leur disposition les uns des autres, se confondent par leurs bords 
voisins, de maniere a entourer l'articulation circulairement. L'anterieur 
et le posterieur sont membraneux et minces, surtout le second; les lateraux 
sont beaucoup plus forts. Le ligament anterieur s'attache, en haut, au- 
dessus des enfoncements qui surmontent la petite tete et la poulie, et an 
devant des tuberosites de 1'humerus; en has, a 1'apophyse coronoide du 
cubitus et an ligament annulaire du radius; ses fibres laterales sont 
obliques, les moyennes verticales et separees en haut, par des intervalles 
celluleux qui les rendent tres apparentes. Le ligament posterieur fixe, en 
haut, an bord de la cavite olecranienne de 1'humerus et a la partie su- 
perieure des tuberosites s'attache, en bas, an sommet et an bord externe 
de 1'olecrane; ses fibres forment deux bandes obliques qui se confondent 
et se croisent en partie en descendant 1'une vers 1'autre. Le ligament 
externe est attache, par son extremite superieure, au bas de la tubcrosite 
externe de 1'humerus; ses fibres descendent de la en divergeant: les mo- 
yennes etles anterieures s'unissent au ligament annulaire du radius tan dis 
que les posterieures passent sur ce ligament, et parviennent au cote ex- 
terne du cubitus, on elles se fixent: ces dernieres sont confondues par en 
haut avec le ligament posterieur. Le ligament interne est plus large que 
le precedent, auquel il ressemble d'ailleurs assez bien; il nait de la tube- 
rosite interne, dont il embrasse toute la partie inferieure, et se termine, 
d'une part, au cote interne de 1'apophyse coronoide du cubitus, de 1'autre, 
au bord interne de 1'olecrane, en sorte que les fibres forment deux faisceaux 
distincts par leur situation et leur direction.1 On voit qu'en effet la plus 
grande partie des fibres ligamenteuses s'attache au cubitus. La connaissance 
d'un detail aussi precis dans les rapports qu'ont les ligaments avec les os 
de 1'avant bras ne pent pas avoir etc, chez Hippocrate, le resultat de 
1'anatomied es animaux.' On est en droit de la citer comme une presomption 
qui, jointe a plusieurs metres, porte a croire que les Hippocratiques out 
disseque des corps humains."2 
I shall only acid further in conclusion, that Ruff us Ephesius and 
1 Dictionnaire de Medecine, 2e edit., tom. ix., p. 207; Paris, 1835. 
2 Voyez tom. i., p. 236. ARTICULATIONS. 
85 
Galen, whose works that are still extant bear undoubted marks of their 
having possessed a very considerable acquaintance with-human anatomy, 
uniformly refer to Hippocrates with great deference as one of the best of 
the ancient authorities on this subject. See Ruffus Ephesius (de Part. 
Hom., pluries), and Galen (de Dissect. Vulvae, 9). 
ON THE ARTICULATIONS. 
1. I am acquainted with one form in which the shoulder-joint is dis- 
located, namely, that into the armpit; I have never seen it take place up- 
ward nor outward; and yet I do not positively affirm whether it might be 
dislocated in these directions or not, although I have something which I 
might say on this subject. But neither have I ever seen what I consid- 
ered to be a dislocation forward.1 Physicians, indeed, fancy that disloca- 
tion is very apt to occur forward, and they are more particularly deceived 
in those persons who have the fleshy parts about the joint and arm much 
emaciated; for, in all such cases, the head of the arm appears to protrude 
forward. And I in one case of this kind having said that there was no 
dislocation, exposed myself to censure from certain physicians and com- 
mon people on that account, for they fancied that I alone was ignorant 
of what everybody else was acquainted with, and I could not con- 
vince them but with difficulty, that the matter was so. But if one 
1 Our author, it will be remarked, states modestly the results of his own ex- 
perience regarding the modes of dislocation at the shoulder ; he had never seen 
any other dislocation than that downward, but he does not positively say that 
dislocations upward, forward, and outward may not occur, although he had 
never met with them. May I be allowed td remark, that thirty years' practice of 
the art of surgery in my locality has brought me to the same conclusions as Hip- 
pocrates ; I have seen many, very many dislocations downward, but I never saw 
what could, strictly speaking, be called a dislocation either forward or back- 
ward. I suppose, however, there can be no reason to question the occurrence 
of such displacements, after the statements of Galen and so many other sur- 
gical authorities, both ancient and modern. Galen relates that in the course of 
his life he had met with five instances of the two uncommon forms of dislocation, 
and accounts for the different results of his experience and that of Hippocrates 
from having exercised his profession in a populous city like Rome, which Polemo 
the Rhetorician had pronounced to be "the compendium, as it were, of the inhab- 
ited world," and from his having been frequently called in by his brethern to see 
rare cases in surgery. Most of the ancient authorities after Galen admit the real- 
ity of these rarer forms of luxation. See Paulus JEgineta, B. VI., 114. Celsus 
describes the dislocation forward, but does not seem to have admitted the reality 
of dislocation backward, (viii., 15.) I may mention that, in the course of thirty- 
eight years' practice of his profession, Sir Astley Cooper states that he had met 
with only two dislocations backward, but that he had seen several cases of dislo- 
cation'forward. (On Dislocations, p. 416.) 86 
GENUINE WORKS OF HIPPOCRATES. 
will strip the point of the shoulder of the fleshy parts, and where 
the muscle (deltoid?) extends, and also lay bare the tendon that goes 
from the armpit and clavicle to the breast (ijectoral muscle?), the head 
of the humerus will appear to protrude strongly forward, although 
not dislocated, for the head of the humerus naturally inclines forward, 
but the rest of the bone is turned outward.1 The humerus is connected 
obliquely with the cavity of the scapula, when the arm is stretched along 
the sides; but when the whole arm is stretched forward, then the head of 
the humerus is in a line with the cavity of the humerus, and no longer 
appears to protrude forward. And with regard to the variety we are now 
treating of, I have never seen a case of dislocation forward; and yet I do 
not speak decidedly respecting it, whether such a dislocation may take 
place or not. When, then, a dislocation into the armpit takes place, see- 
ing it is of frequent occurrence, many persons know how to reduce it, for 
it is an easy thing to teach all the methods by which physicians effect the 
reductions, and the best manner of applying them. The strongest of 
those methods'should be used when the difficulty of reduction is particu- 
larly great. The strongest is the method to be last described. 
2. Those -who are subject to frequent dislocations at the shoulder-joint, 
1 The language of our author in this place puts it beyond all doubt that human 
dissection was practiced in his age. It may be interesting to see Galen's Com- 
mentary on this important passage. After giving an accurate description of the 
bones connected with the shoulder-joint, he goes on to say that Hippocrates, in 
this place, illustrates his views from anatomy, directing us to lay the acromion 
bare of its flesh, that is to say, to dissect with a scalpel down to the bones which 
form the articulation, and to lay bare the tendon which is situated there, and to 
lay bare the tendon in the armpit. He adds, there are three muscles situated 
there : first, that which derives its origin from the scapula and clavicle, called 
the deltoid, the fleshy part of which covers the whole joint, and the tendon of 
which is inserted down the arm ; theh the pectoral, inserted near the situation of 
the humeral vein ; and, last, the biceps, which arises by two heads, the one from 
the anchor-shaped apophysis of the scapula (the coracoid?), and the other from 
the high margin of the neck of the scapula (the glenoid cavity?). Our author's 
description of the brain in the treatise, On the Sacred Disease, is such as could 
not have been given by a person wholly unacquainted with human dissection. 
It is to this effect; the brain in man, as in all other animals, is double, and is 
separated in the middle by a thin membrane (the falx?).-Vol. i., p. 595, ed. Kuhn. 
The construction of the human heart is also briefly adverted to in the small 
treatise, On the Heart. Obscure allusions to the internal structure of the human 
body are also to be met with in other of the Hippocratic treatises, such as De 
Venis, tom. i., p. 276, ed. Lind.; de Ossibus, ibid.; de Carnibus, tom. i., p. 123. 
Now, even if it were denied that these works are genuine, it cannot be questioned 
that they are the productions of the age immediately succeeding Hippocrates, and 
preceding the brilliant epoch of the famous Alexandrian anatomists; so that it 
appears to me impossible to avoid the conclusion that human dissection had been 
practiced in the age of Hippocrates ; and if in his age, we are sure it was not 
neglected by him, who was the greatest ornament of the profession in his own 
days. On this subject see further the Argument. ARTICULATIONS 
87 
are for the most part competent to effect the reduction themselves; for, 
having introduced the knuckles of the other hand into the armpit, they 
force the joint upward, and bring the elbow toward the breast. The phy- 
sician might reduce it in the same manner, if having introduced his fin- 
gers into the armpit on the inside of the dislocated joint, he would force it 
from the ribs, pushing his own head against the acromion, in order to 
make counter-pressure, and with his knees applied to the patient's elbow 
pushing the arm to the sides. It will be of advantage if the operator has 
strong hands, or the physician may do as directed with his head and 
hands, while another person brings the elbow toward the breast. Re- 
duction of the shoulder may also be effected by carrying the fore-arm 
backward to the spine, and then with the one hand grasping it at the 
elbow, to bend the arm upward, and with the other to support it behind 
at the articulation. This mode of reduction, and the one formerly de- 
scribed, are not natural, and yet by rotating the bone of the joint, they 
force it to return.1 
3. Those who attempt to perform reduction with the hee], operate in 
a manner which is an approach to the natural. The patient must lie on 
the ground upon his back, while the person who is to effect the reduction 
is seated on the ground upon the side of the dislocation; then the opera- 
tor, seizing with his hand the affected arm, is to pull it, while with his 
heel in the armpit he pushes in the contrary direction, the right heel 
being placed in the right armpit, and the left heel in the left armpit. 
But a round ball of a suitable size must be placed in the hollow of the 
armpit; the most convenient are very small and hard balls, formed from 
several pieces of leather sewed together. For without something of the 
1 The methods of reducing dislocations at the shoulder-joint are, in general, 
described by Hippocrates so clearly and fully, that no one who reads the text 
carefully can have much difficulty in understanding the descriptions ; or if he 
has, he need only refer to the drawings which accompany the Latin translation 
of Galen's works by Vidus Vidius. They are also illustrated by the very full and 
sensible Commentary of Appollonius Citiensis, published by the late Dr. Dietz, 
Koningsburg, 1834. I shall only make a few remarks occasionally in explanation 
of any passage which may appear somewhat obscure, or in order to call attention 
to any subject of peculiar interest. Galen and Apollonius explain the reason why 
our author calls the method described in this paragraph not natural, to be, 
because the extension is rotatory and not direct. I may further mention in this 
place, that if the modern reader have any difficulty in comprehending the applica- 
tion of the different modes of reduction described by our author, he will find much 
illustration of the subject given by Desault in his Surgical Journal, vol. ii., p. 134, 
English edition. He gives a very interesting history of all the known methods 
of reduction, from Hippocrates down to his own time. The use of the pulleys, 
in this surgical case, would appear to be a modern invention ; Ambrose Pare, ac- 
cording to Desault, was the first to use them. The application of them is certainly 
distinctly described and delineated in his works. Petit joined the pulley to the 
ambe, and in this way formed a very powerful machine for reducing dislocations. 88 
GENUINE WORKS OF HIPPOCRATES. 
kind the heel cannot reach to the head of the humerus, since, when the 
arm is stretched, the armpit becomes hollow, the tendons on both sides 
of the armpit making counter-contraction so as to oppose the reduction. 
But another person should be seated on the other side of the patient to 
hold the sound shoulder, so that the body may not be dragged along when 
the arm of the affected side is pulled; and then, when the ball is placed in 
the armpit, a supple piece of thong sufficiently broad is to be placed round 
it, and some person taking hold of its two ends is to seat himself above 
the patient's head to make counter-extension, while at the same time he 
pushes with his foot against the bone at the top of the shoulder. The 
ball should be placed as much on the inside as possible, upon the ribs, and 
not upon the head of the humerus.1 
4. There is another method of reduction performed by the shoulder 
of a person standing. The person operating in this way, who should be 
tallei' than the patient, is to take hold of his arm and place the sharp 
point of his own shoulder in the patient's armpit, and push it in so that 
it may lodge there, and having for his object that the patient may be sus- 
pended at his back by the armpit, he must raise himself higher on this 
shoulder than the other; and he must bring the arm of the suspended 
patient as quickly as possible to his own breast. In this- position he 
should shake the patient when he raises him up, in order that the rest of 
the body may be a counterpoise to the arm which is thus held. But if the 
patient be very light, a light child should be suspended behind along with 
him. These methods of reduction are all of easy application in the pales- 
tra, as they can all be performed without instruments, but they may also 
be used elsewhere.3 
5. Those who accomplish the reduction by forcibly bending it round 
a pestle, operate in a manner which is nearly natural. But the pestle 
should be wrapped in a soft shawl (for thus it will be less slippery), and 
it should be forced between the ribs and the head of the humerus. And 
if the pestle be short, the patient should be seated upon something, so 
that his arm can with difficulty pass above the pestle. But for the most 
part the pestle should be longer, so that the patient when standing may 
1 The method of reduction here described is much commended by Sir Astley 
Cooper. He, however, generally tied a handkerchief immediately above the elbow, 
by which he made extension, and thereby found he could effect his purpose with less 
exertion than when he pulled by the arm. The advantage of pulling by some- 
thing attached above the elbow is, that it allows the biceps to be relaxed by bend- 
ing the fore-arm to a right angle with the os humeri. Verduc calls this method 
emphatically " very good." (A Treatise on Fractures, etc.) Some modern au- 
thorities who practice this method still prefer pulling by the hand. 
2 This method is simple, but cannot have been very efficacious. It is not men- 
tioned in our late works on surgery. It is described by Verduc, however, in near- 
ly the same terms as those of our author, and therefore I need not quote his de- 
scription of it. (A Treatise on Fractures, etc., p. 344.) ARTICULATIONS. 
89 
be almost suspended upon the piece of wood. And then the arm and 
fore-arm should be stretched along the pestle, whilst some person secures 
the opposite side of the body by throwing his arms round the neck, near 
the clavicle.1 
6. But the method with a ladder is another of the same kind, and still 
better, since by it the body can be more safely counterpoised on this side; 
and that, while in the method with the piece of wood resembling a pestle, 
there is danger of the body tumbling to either side. But some round 
thing should be tied upon the step of the ladder which may be fitted to 
the armpit, whereby the head of the bone may be forced into its natural 
place.2 
7. The following, however, is the strongest of all the methods of re- 
duction. We must get a piece of wood, five, or at least four inches broad, 
two inches in thickness, or still thinner, and two cubits in length, or a 
little less; and its extremity at one end should be rounded, aift. made 
very narrow and very slender there, and it should have a slightly project- 
ing edge (ambe) on its round extremity, not on the part that is to be 
applied to the side, but to the head of the humerus, so that it may be 
adjusted in the armpit at the sides under the head of the humerus; and 
a piece of soft shawl or cloth should be glued to the end of the piece of 
wood, so as to give the less pain upon pressure. Then having pushed the 
head of this piece of wood as far inward as possible between the ribs and 
the head of the humerus, the whole arm is to be stretched along this piece 
of wood, and is to be bound round at the arm, the fore-arm, and the 
wrist, so that it may be particularly well secured; but great pains should 
be taken that the extremity of this piece of wood should be introduced as 
far as possible into the armpit, and that it is carried past the head of the 
humerus. Then a cross-beam is to be securely fastened between two pil- 
1 This method consists in fixing a strong pole, here called a pestle (yirepov), in 
the ground, and having wrapped its upper extremity with some soft substance to 
apply it to the armpit of the patient and pull the affected arm along it. It should 
be so long as that the patients's armpit can barely get into it, and the arm is to be 
pulled along the pole. The pole or pestle, in this case, performs the same office 
as the heel of the surgeon in the other case. In a well-known line of Hesiod's 
Works and Days, the pestle of the domestic mortar is described as being three 
cubits in length (1. 421). 
2 This is evidently a very simple and ingenious method of accomplishing the 
reduction. Desault thus describes the methods with the pestle and the ladder: 
" The pestle was nothing else but the instrument of that name, or simply a stick, 
one end of which rested on the ground, or on a table; whilst the other, well guard- 
ed with linen, was placed in the cavity of the axilla, and served to push up the 
head of the bone; an extension was made on the arm, while an assistant kept the 
trunk fixed, pushing the shoulder down at the same time. The ladder was em- 
ployed on the same plan, after an eminence was formed, and sufficiently guarded 
to be adapted to the cavity of the axilla." (Surgical Journal, vol. ii., p. 134, 
English edition.) 90 
GENUINE WORKS OF HIPPOCRATES. 
lars, and afterward the arm with the piece of wood attached to it is to be 
brought over this cross-beam, so that the arm may be on the one side of it 
and the body on the other, and the cross-beam in the arm pit; and then 
the arm with the piece of wood is to be forced down on the one side of 
the cross-beam, and the rest of the body on the other. The cross-beam 
is to be bound so high that the rest of the body may be raised upon tip- 
toes. This is by far the most powerful method of effecting reduction of 
the shoulder; for one thus operates with the lever upon the most correct 
principles, provided only the piece of wood be placed as much as possible 
within the head of the humerus, and thus also the counter-balancing 
weights will be most properly adjusted, and safely applied to the bone of 
the arm. Wherefore recent cases in this way may be reduced more quickly 
than could be believed, before even extension would appear to be applied; 
and this is the only mode of reduction capable of replacing old disloca- 
tions, rfhd this it will effect, unless flesh has already filled up the (glenoid) 
cavity, and the head of the humerus has formed a socket for itself in the 
place to which it has been displaced; and even in such an old case of dis- 
location, it appears to me that we could effect reduction (for what object 
would a lever power properly applied not move ?), but it would not remain 
in its place, but would be again displaced as formerly.1 The same thing 
may be effected by means of the ladder, by preparing it in the same man- 
ner. If the dislocation be recent, a large Thessalian chair may be suffi- 
cient to accomplish this purpose; the wood, however, should be dressed 
up as described before; but the patient should be seated sideways on the 
chair, and then the arm, with the piece of wood attached to it, is to be 
brought over the back of the chair, and force is to be applied to the arm, 
with the wood on the one side, and to the body on the other side. The 
same means may be applied with a double door.2 One should always use 
what happens to be at hand.3 
1 This description, to any person who understands the construction of the ambe, 
must be so plain, that it would be superfluous to attempt any further explanation 
of it. Of late years the ambe has fallen completely into disuse, and none of the 
various modifications of it are now to be seen but in the cabinets of the curious. 
2 On the nature of the double doors of the ancients, the curious reader may 
find it interesting to consult the annotations of the editors of Erotian, under ch/c- 
AetJej. See the edition of Frantzius; also Galen's Glossary. 
3 These methods by a chair or a door are very simple, and from a late trial of 
the former I can declare it to be the most easy and effectual plan of reduction 
which I have ever tried. It would appear that this method of reduction, with a 
modification, is still practiced at the Bristol Infirmary, the surgeons of which de- 
clare that they have found it almost uniformly successful, as I can well believe, 
from my own experience of the method as recommended by Hippocrates. It is 
thus described in a late number of the Provincial Medical and Surgical Journal, 
July 26, 1848: "Without any preliminary treatment, the patient is seated side- 
ways on a firm chair, with his arm hanging over the back, which is well padded; 
one end of a double or reel towel is passed through the other end, so as to form a ARTICULATIONS. 
91 
8. Wherefore it should be known that one constitution differs much 
from another as to the facility with which dislocations in them may be 
reduced, and one articular cavity differs much from another, the one be- 
ing so constructed that the bone readily leaps out of it, and another less 
so; but the greatest difference regards the binding together of the parts 
by the nerves (ligaments?) which are slack in some and tight in others. 
For the humidity in the joints of men is connected with the state of the 
ligaments, when they are slack and yielding; for you may see many people 
who are so humid ( flabby ?) that when they choose they can disarticulate 
their joints without pain, and reduce them in like manner. The habit 
of the body also occasions a certain difference, for in those who are in a 
state of embonpoint and fleshy the joint is rarely dislocated, but is more 
difficult to reduce; but when they are more attenuated and leaner than 
usual, then they are more subject to dislocations which are more easily 
reduced. And the following observation is a proof that matters are so; 
for in cattle the thighs are most apt to be dislocated at the hip-joint, when 
they are most particularly lean, which they are at the end of winter, at 
which time then they are particularly subject to dislocations,1 (if I may 
noose, which is applied to the arm above the elbow. The loose depending part 
of the towel forms a stirrup, into which the surgeon places his foot, and gradually 
brings his whole weight to bear on the towel, as an extending power. One or 
two assistants are useful to press back the acromion, and keep the patient firmly 
in his seat. The reduction is effected almost immediately, and if due precaution 
be observed in properly padding the chair and the arm when the towel is applied, 
little or* no pain is felt, nor any subsequent inconvenience from the pressure." 
1 Upon making inquiry, I find that it is still a popular belief, in the rural dis- 
tricts of Scotland, that cattle are very subject to dislocations at the hip-joint 
when first turned out to graze in spring. I have been told by old farmers, who 
certainly would not intentionally have deceived me, that they have known such 
cases frequently occur. I have reason to think, however, that what they took 
for dislocations were most probably diseases of the joint; for an experienced far- 
rier informs me that actual dislocation at the hip-joint is very rarely met with in 
cattle. When cattle are very lean and feeble, the bones at the hip-joint protrude 
very much, so as to give them the appearance of having slipped out of the joint. 
M. Littr6's inquiries have led him to nearly the same conclusions; having ad- 
dressed a letter on the subject to Dr. Bixio, the publisher of the Journal d'Agri- 
culture Pratique, he received from him the following- answer: "Il arrive souvent 
que les animaux de Fespece bovine sont atteints d'une claudication des membres 
posterieurs, qui simule, a tromper parfaitement les yeux, une luxation de 1'arti- 
culation coxo-f6morale. Cette claudication est due an d'un muscle; 
on retablit instantanement la liberte des mouvements par la section de la branche 
musculaire deplacee. C'est sans doute cet accident frequent qu'Hippocrate aura 
observes et confondu avec la luxation. Je ne sais rien dans les membres anterieurs 
qui soit semblable; la luxation de 1'articulation scapulo-humerale est tres-rare et 
n est simulSe par rien. Maintenant le claudication du membre posterieur est-elle 
phis piquante chez les boeufs maigres que chez les boeufs gras? Je ne sais, 
mais je suis porte a le croire; 1'etat de vacuite des interstices musculaires de- 92 
GENUINE WORKS OF HIPPOCRATES. 
be allowed to make such an observation while treating of a medical sub- 
ject); and therefore Homer has well remarked, that of all beasts oxen 
suffer the most at that season, and especially those employed at the plow 
as being worked in the winter season. In them, therefore, dislocations 
happen most frequently, as being at that time most particularly reduced 
in flesh. And other cattle can crop the grass when it is short, but the 
ox cannot do so until it becomes long; for, in the others, the projection of 
the lip is slender, and so is the upper lip, but in the ox the projection of 
the lip is thick, and the upper jaw is thick and obtuse, and therefore they 
are incapable of seizing short herbs. But the soUdungula as having 
prominent teeth in both their front jaws, can crop the grass and grasp it 
with their teeth while short, and delight more in short grass than in rank; 
for, in general, short grass is better and more substantial than rank, as 
having not yet given out its fructification. Wherefore the poet has the 
following line: 
"As when to horned cattle dear the vernal season comes," 1 
oecause rank grass appears to be most sought after by them. But other- 
wise in the ox, this joint is slacker than in other animals, and, therefore, 
this animal drags his foot in walking more than any other, and especially 
when lank and old. For all these reasons the ox is most particularly sub- 
ject to dislocations; and I have made the more observations respecting 
him, as they confirm all that was said before on this subject. With re- 
gard, then, to the matter on hand, I say that dislocations occur more 
readily, and are more speedily reduced in those who are lean than in those 
who are fleshy; and in those who are humid and lank there is less inflam- 
mation than in such as are dry and fleshy, and they are less compactly 
knit hereafter, and there is more mucosity than usual in cases not attended 
with inflammation, and hence the joints are more liable to luxations; for, 
in the main, the articulations are more subject to mucosities in those who 
are lean than in those who are fleshy; and the flesh of lean persons who 
have not been reduced by a proper course of discipline abounds more with 
mucosity than that of fat persons. But in those cases in which the mu- 
cosity is accompanied with inflammation, the inflammation binds {braces 
the joint, and hence those who have small collections of mucosities arc 
not very subject to dislocations, which they would be if the mucosity had 
not been accompanied with more or less inflammation. 
9. In cases of dislocation those persons who are not attacked with in- 
flammation of the surrounding parts, can use the shoulder immediately 
vant necessairement permettre un deplacement plus facile de leurs faisceaux." 
(CEuvr. d'Hippocrat., tom. iv., p. 14.) 
1 It is certain that there is no such line in the works of Homer as they have 
come down to us, and it is singular that Galen takes no notice of it, so that it is 
impossible to explain how our author came to use it. ARTICULATIONS. 
93 
without pain,, and do not think it necessary to take any precautions with 
themselves; it is therefore the business of the physician to warn them 
beforehand that dislocation is more likely to return in such cases than 
when the tendons have been inflamed. This remark applies to all the 
articulations, but particularly to those of the shoulder and knee, for these 
are the joints most subject to luxations. But those who have inflamma- 
tion of the ligaments cannot use the shoulder, for the pain and the ten- 
sion induced by the inflammation prevent them. Such cases are to be 
treated with cerate, compresses, and plenty of bandages; but a ball of soft 
clean wool is to be introduced into the armpit, to fill up the hollow of it, 
that it may be a support to the bandaging, and maintain the joint in situ. 
The arm, in general, should be inclined upward as much as possible, for 
thus it will be kept at the greatest possible distance from the place at 
which the head of the humerus escaped. And when you bandage the 
shoulder you must fasten the arms to the sides with a band, which is to 
be carried round the body. The shoulder should be rubbed gently and 
softly. The physician ought to be acquainted with many things, and 
among others with friction;-for from the same name the same results are 
not always obtained; for friction could brace a joint when unseasonably 
relaxed, and relax it when unseasonably hard; but we will define what 
we know respecting friction in another place. The shoulder, then, in 
such a state, should be rubbed with soft hands; and, moreover, in a gen- 
tle manner, and the joint should be moved about, but not roughly, so as 
to excite pain. Things get restored sometimes in a greater space of time, 
and sometimes in a smaller. 
10. A dislocation may be recognized by the following symptoms:- 
Since the parts of a man's body are proportionate to one another, as the 
arms and the legs, the sound should always be compared with the un- 
sound, and the unsound with the sound, not paying regard to the joints 
of other individuals (for one person's joints are more prominent than 
another's), but looking to those of the patient, to ascertain whether the 
sound joint be unlike the unsound. This is a proper rule, and yet it 
may lead to much error; and on this account it is not sufficient to know 
this art in theory, but also by actual practice; for many persons from pain, 
or from any other cause, when their joints are not dislocated, cannot put 
the parts into the same positions as the sound body can be put into; one 
ought therefore to know and be acquainted beforehand with such an atti- 
tude.1 But in a dislocated joint the head of the humerus appears lying 
1 As Galen remarks in his Commentary, our author adverts to this subject in 
his work On Fractures. It is, no doubt, a very important practical observation 
that, although inability to place the limb in its accustomed attitudes be an insep- 
arable symptom of dislocations, it sometimes happens that patients, from pains 
or other causes, lose this faculty without there being any displacement of the 
bone. The symptoms of dislocation at the shoulder-joint, as given in the 
remainder of the paragraph, are remarkably accurate. 94 
GENUINE WORKS OF HIPPOCRATES. 
much more in the armpit than it is in the sound joint; and also, above, 
at the top of the shoulder, the part appears hollow, and the acromion is 
prominent, owing to the bone of the joint having sunk into the part be- 
low; there is a source of error in this case also, as will be described after- 
ward, for it deserves to be described; and also, the elbow of the dislo- 
cated arm is farther removed from the ribs than that of the other; but 
by using force it may be approximated, though with considerable pain; 
and also they cannot, with the elbow extended, raise the arm to the ear, 
as they can the sound arm, nor move it about as formerly in this direction 
and that. These, then, are the symptoms of dislocation at the shoulder. 
The methods of reduction and the treatment are as described. 
11. It deserves to be known how a shoulder which is subject to fre- 
quent dislocations should be treated. For many persons owing to this 
accident have been obliged to abandon gymnastic exercises, though other- 
wise well qualified for them; and from the same misfortune have become 
inept in warlike practices, and have thus perished.1 And this subject 
deserves to be noticed, because I have never known any physician treat 
the case properly; some abandon the attempt altogether, and others hold 
opinions and practice the very reverse of what is proper. For many phy- 
sicians have burned the shoulders subject to dislocation, at the top of the 
shoulder, at the anterior part were the head of the humerus protrudes, 
and a little behind the top of the shoulder; these burnings, if the dislo- 
cation of the arm were upward, or forward, or backward, would have been 
properly performed; but now, when the dislocation is downward, they 
rather promote than prevent dislocations, for they shut out the head of 
the humerus from the free space above. The cautery should be applied 
thus: taking hold with the hands of the skin at the armpit, it is to be 
drawn into the line, in which the head of the humerus is dislocated; and 
then the skin thus drawn aside is to be burnt to the opposite side. The 
burnings should be performed with irons, which are not thick nor much 
rounded, but of an oblong form, (for thus they pass the more readily 
through,) and they are to be pushed forward with the hand; the cauter- 
ies should be red-hot, that they may pass through as quickly as possible; 
for such as are thick pass through slowly, and occasion eschars of a greater 
breadth than convenient, and there is danger that the cicatrices may 
break into one another; which, although nothing very bad, is most un- 
seemly, or awkward. When you have burnt through, it will be sufficient, 
in most cases, to make eschars only in the lower part; but if there is no 
danger of the ulcers passing into one another, and there is a considerable 
piece of skin between them, a thin spatula is to be pushed through these 
holes which have been burned, while, at the same time, the skin is 
1 Our author, it will be recollected, applies this remark to the Nomadic Scyth- 
ians, in his work On Airs, Waters, etc. ARTICULATIONS. 
95 
stretched, for otherwise the instrument could not pass through; but 
when you have passed it through you must let go the skin, and then be- 
tween the two eschars you should form another eschar with a slender iron, 
and burn through until you come in contact with the spatula. The fol- 
lowing directions will enable you to determine how much of the skin of 
the armpit should be grasped; all men have glands in the armpit greater 
or smaller, and also in many other parts of the body. But I will treat in 
another work of the whole constitution of the glands, and explain what 
they are, what they signify, and what are their offices.1 The glands, then, 
are not to be taken hold of, nor the parts internal to the glands; for this 
would be attended with great danger, as they are adjacent to the most im- 
portant nerves. But the greater part of the substances external to the 
glands are to be grasped, for there is no danger from them. And this, 
also, it is proper to know, that if you raise the arm much, you will not 
be able to grasp any quantity of skin worth mentioning, for it is all taken 
up with the stretching; and also the nerves, which by all means you must 
avoid wounding, become exposed and stretched in this position; but if 
you only raise the arm a little, you can grasp a large quantity of skin, and 
the nerves which you ought to guard against are left within, and at a 
distance from the operation. Should not, then, the utmost pains be taken 
in the whole practice of the art to find out the proper attitude in every 
case ? So much regarding the armpit, and these contractions will be suffi- 
cient, provided the eschars be properly placed. Without the armpit there 
are only two places where one might place the eschars to obviate this 
affection; the one before and between the head of the humerus and the 
tendon at the armpit; and then the skin may be fairly burned through, but 
not to any great depth, for there is a large vein adjacent, and also nerves, 
neither of which must be touched with the heat. But externally, one 
may form another eschar considerably above the tendon at the armpit, 
but a little below the head of the humerus; and the skin must be burned 
fairly through, but it must not be made very deep, for fire is inimical to 
the nerves. Through the whole treatment the sores are to be so' treated, 
as to avoid all strong extension of the arm, and this is to be done moder- 
ately, and only as far as the dressing requires; for thus they wifi be less 
cooled (for it is of importance to cover up all sorts of burns if one would 
11 need scarcely remark here that the work, On the Glands, which we now 
possess, is not the promised work of our author. See an analysis of the other 
work in the second section of the Preliminary Discourse. Galen, in his Com- 
mentary on this passage, states distinctly that the work which is contained in the 
Hippocratic Collection is supposititious, and unworthy of our author. Those, he 
adds, who made out the Tables (of the Hippocratic treatises) do not recognize it. 
I may be allowed to remark again in this place, that if our author had not prac- 
ticed human dissection he could not have been so well acquainted, as he here 
shows him to be, with the situation of the blood-vessels, nerves, and glands, situa- 
ted in the axillary region. 96 
GENUINE WORKS OF HIPPOCRATES. 
treat them mildly), and then the lips of them will be less turned aside; 
there will be less hemorrhage and fear of convulsions. But when the 
sores have become clean, and are going on to cicatrization, then by all 
means the arm is to be bound to the side night and day; and even when 
the ulcers are completely healed, the arm must still be bound to the side 
for a long time; for thus more especially will cicatrization take place, and 
the wide space into which the humerus used to escape will become con- 
tracted. 1 
12. When attempts to reduce a dislocated shoulder have failed, if the 
patient be still growing, the bone of the affected arm will not increase 
like the sound one, for although it does increase in so far it becomes 
shorter than the other; and those persons called weasel-armed,2 become so 
from two accidents, either from having met with this dislocation m uterof 
1 For the other ancient authorities on this operation, see Paulus tEgineta, B. 
VI., 42. 
2 Galen professes not to think it worth his while to determine whether or not 
the term which is here translated weasel-armed (yaAtd/xuvef) be derived from 
ya'/j, (mustela vulgaris He adds there can be no doubt that it signifies " short- 
armed. " 
3 Our author here evidently alludes to congenita] dislocation at the shoulder- 
joint, a malformation which we know does occur, although I never met with a 
case of it. I have seen cases, however, of congenital dislocation at the hip-joint, 
and several such have been described of late years. Dr. Heine, of Stuttgart, has 
observed nine cases in female, aud two in male children. See Forbes's British 
and Foreign Medical Review, No. xxxii., p. 489. Baron Dupuytren has also 
treated of this subject with his usual ability, in his work, On Fractures and Dis- 
locations, lately reprinted by the Sydenham Society. In this work, he gives an 
interesting case of congenital dislocation of the upper extremity of the radius on 
the humerus (p. 117). He makes no mention, however, of congenital dislocation 
at the shoulder-joint. By far the most interesting and instructive account of this 
subject which we possess, is that given by Dr. R. W. Smith, in the Dublin Jour- 
nal, Vol. xv., p. 236. He notices two kinds of congenital dislocations, viz., the 
subcoraccyid andjthe subacromial dislocation. A few extracts from his description 
of the former of these, will show how well it agrees with that given by Hippocrates. 
" In the congenital subcoracoid dislocation, the head of the upper-arm bone, when 
the arm hangs down on the side, is situated beneath the coracoid process, and the 
outer part of the glenoid cavity can be felt beneath the projecting acromion; if 
the elbow be drawn forward over the chest, the head of the upper-arm bone slips 
backward over the acromion, and completely leaves the unnatural part of the 
articular surface, which can now be distinctly felt; the shoulder has not its 
natural rounded form, but is flattened. The muscles of the shoulder and arm are 
much shrunk, and also the muscles passing- from the chest to the blade-bone and 
upper-arm, only the m. trapesius shows the least of this, and seems to be almost 
the only muscle, which still acts upon and moves the blade-bone, the diseased 
arm is nearly half an inch shorter. The motions of the arm are very much re- 
duced: elevation and abduction are not possible, and even the forward and back- 
ward motions cannot be performed without a correspondent movement of the 
blade-bone." See, further, Chelius's System of Surgery, (Vol. I., p. 786.) The ARTICULATIONS. 
97 
or from another accident, which will be described afterward. But those 
who while they were children have had deep-seated suppurations about 
the head of the bone, all become weasel-armed; and this, it should be well 
known, will be the issue, whether the abscess be opened by an incision 
or cautery, or whether it break spontaneously. Those who are thus 
affected from birth are quite able to use the arm, yet neither can they raise 
the arm to the ear, by extending the elbow, but they do this much less 
efficiently than with the sound arm. But in those who have had the 
shoulder dislocated after they were grown up, and when it has not been 
reduced, the top of the shoulder becomes much less fleshy, and the habit 
of body at that part is attenuated; but when they cease to have pain, 
whatever they attempt to perform by raising the elbow from the sides 
obliquely, they can no longer accomplish as formerly; but whatever acts 
are performed by carrying the arm around by the sides, either backward 
or forward, all those they can perform; for they can work with an auger 
or a saw, or with a hatchet, and can dig, by not raising the below too 
much, and do all other kinds of work which are done in similar attitudes. 
13. In those cases where the acromion has been torn off, the bone 
which is thus separated appears prominent. The bone is the bond of con- 
nection between the clavicle and scapula, for in this respect the constitu- 
tion of man is different from that of other animals; physicians are particu- 
larly liable to be deceived in this accident (for as the separated bone pro- 
trudes, the top of the shoulder appears low and hollow), so that they 
make preparations as if for dislocation of the shoulder; for I have known 
many physicians, otherwise not inexpert at the art, who have done much 
mischief by attempting to reduce such shoulders, thus supposing it a case 
of dislocation; and they did not desist until they gave over hopes of suc- 
ceeding, or committed the mistake of supposing that they had reduced 
the shoulder. The treatment, in these cases, is similar to that which is 
applicable in others of a like kind, namely, cerate, compresses, and suita- 
able bandaging with linen cloths. The projecting part must be pushed 
down, and the greater number of compresses are to be placed on it, and 
most compression is to be applied at that part, and the arm being fastened 
to the side is to be kept elevated; for thus the parts which had been torn 
asunder are brought into closest proximity with one another. All this, 
should be well known, and if you choose you may prognosticate safely that 
no impediment, small or great, will result from such an injury at the 
same subject is treated of in a very ingenious and interesting manner by Dr. R. 
M. Smith, in his recent publication "A Treatise of Fractures in the Vicinity of 
Joints," Dublin, 1847. He gives the histories of several cases of congenital luxa- 
tion at the shoulder-joint, which, in the main, agree very well with the characters 
of this abnormal conformation as given by Hippocrates. M. Guerin has also re- 
cently written on this interesting subject. (Recherches sur les Luxations Congen- 
itales.) 
Vol. II.-7. 98 
GENUINE WORKS OF HIPPOCRATES. 
shoulder, only there will be a deformity in the place, for the bone cannot 
be properly restored to its natural situation, but there must necessarily be 
more or less tumefaction in the uppei- part. For neither can any other 
bone be made exactly as it was, which having becoming incorporated with 
another bone, and having grown to it as an apophysis, has been torn from 
its natural situation. If properly bandaged, the acromion becomes free 
of pain in a few days.1 
14. When a fractured clavicle is fairly broken across it is more easily 
treated, but when broken obliquely it is more difficult to manage. Mat- 
ters are different in these cases from what one would have supposed; for a 
bone fairly broken across can be more easily restored to its natural state, 
and with proper care the upper part may be brought down by means of 
suitable position and proper bandaging, and even if not properly set, the 
projecting part of the bone is not very sharp. But in oblique fractures 
the case is similar to that of bones which have been torn away, as for- 
merly described; for they do not admit of being restored to their place, 
and the prominence of the bone is very sharp. For the most part, then, 
it should be known, no harm results to the shoulder or to the rest of the 
body from fracture of the clavicle, unless it sphacelate, and this rarely 
1 This subject has been so fully treated of in the Commentary on Paulus 
JEgineta (B. VI., 113), that I need not say much upon it in this place. See, 
further, Eustachius (Oss. Exam., p. 175); Riolanus (Comment, de Oss., p. 503). 
Apparently the case must have been dislocation of the scapular end of the 
clavicle from the acromion, which all our best authorities on surgery describe 
as being an accident of occasional occurrence. See Sir Astley Cooper and 
Liston's works. It is marked by a projection of the end of the clavicle, under 
the skin covering the acromion, and a depression of the shoulder. All our 
modern authorities confirm Galen's statement, and our author's, as to the 
difficulty of treating this case without leaving some deformity. Mr. Liston says 
"the cure is slow and imperfect. The bone, however, in time, contracts adhe- 
sions, and the limb regains its power and mobility." See, also, Cooper's Surgical 
Dictionary (p. 382), fifth edition. Galen, who met with this accident in his own 
person while wrestling in the palestra, made a complete recovery without defor- 
mity; but he says he had rarely found this to be the case except in young persons, 
(t. v., p. 594, ed. Basil.) While upon this subject, I shall quote what is said on 
this accident which befel Galen, by Verduc, who may be called the Simia Hippo- 
cratis, and therefore his views are interesting, as they tend to confirm those which 
I had adopted before meeting with his work. "Though the channel-bones are 
articulated with the acromion-process of the shoulder-blade and the sternum by 
very close and tig'ht cartilages and ligaments, yet Galen says that he underwent 
a dislocation of the clavicula, which created insufferable pain; that he bore such 
a tight bandage as no man else could have borne; and after having the bandage 
upon him for a long while, was cured at last." (A Treatise on Fractures, p. 339.) 
It remains to be mentioned, as further tending to illustrate the case now under 
consideration, that dislocation of the clavicle, at its outer extremity, is sometimes 
complicated with the fracture of the acromion. This variety is described by Sir 
Charles Bell, Sir Astley Cooper, and by Chelius, in his late publication (Vol. i., p. 
548). All agree that it has a great resemblance to dislocation of the humerus. ARTICULATIONS. 
99 
happens. A deformity, however, may arise from fracture of the clavicle, 
and in these cases it is very great at first, but by and by it becomes less.1 
A fractured clavicle, like all other spongy bones, gets speedily united; for 
all such bones form callus in a short time. When, then, a fracture has 
recently taken place, the patients attach much importance to it, as sup- 
posing the mischief greater than it really is, and the physicians bestow 
great pains in order that it maybe properly bandaged; but in a little time 
the patients, having no pain, nor finding any impediment to their walk- 
ing or eating, become negligent; and the physicians finding they cannot 
make the parts look well, take themselves oft, and are not sorry at the 
neglect of the patients, and in the meantime the callus is quickly formed.2 
The method of dressing which is most appropriate, is similar to that used 
in ordinary cases, consisting of cerate, compresses, and bandages; and it 
should be most especially known in this operation, that most compresses 
should be placed on the projecting bone, and that the greatest pressure 
should be made there. There are certain physicians who make a show of 
superior skill by binding a heavy piece of lead on the part in order to de- 
press the projecting bone; but this mode of treatment does not apply to 
the clavicle, for it is impossible to depress the projecting part to any ex- 
tent worth mentioning. There are others who, knowing the fact that the 
bandages are apt to slip off, and that they do not keep the projecting 
parts in their place, apply compresses and bandages like the others, and 
then having girt the patient with a girdle, where it is usually applied with 
most effect, they make a heap of the compresses upon the projecting bone 
1 As stated by Galen, in his Commentary, this is no doubt an important re- 
mark, as a person unacquainted with this fact would be liable to overrate the de- 
formity on its first appearance. How often have I benefited by the knowledge 
thus derived from Hippocrates, more especially in the case of children, in being 
able to assure parents, and others interested in the matter, that a deformity,which 
at the time was creating great uneasiness, would disappear in the course of a few 
months ! 
2 What our author here says regarding neglected cases of fractured clavicle, is 
entirely consonant to my own experience. I have known persons who, having 
met with the accident, gave themselves no trouble, applied no bandages, and even 
continued their work as agricultural laborers, and yet it was surprising how well 
they got round. Having stated this to the late Mr. Liston, he confirmed what I 
said, by mentioning similar cases which he had known. M. Velpeau, in like 
manner, holds that the fears generally entertained of the pieces of bone not unit- 
ing regularly, are quite unfounded. Our author's account of the symptoms and 
treatment of fractured clavicle bespeak an intimate acquaintance with the sub- 
ject. The lapse of more than twenty centuries has added nothing to our knowl- 
edge of it. If the reader will compare the account of this accident given by 
Chelius, and his English editor, South, with what our author has written on the 
subject, he will admit the truth of this remark. Yet it is lamentable, even at the 
present day, to see how some fashionable doctors torment their patients, in cases 
of fractured clavicle, with tight bandages, which, after all, have little or no power 
in keeping the bones in situ. 100 
GENUINE WORKS OF HIPPOCRATES. 
when they apply them, and having fastened the head of the bandage to 
the girdle in front, they apply it so as to bring the turns of it into the 
line of the clavicle, carrying them to the back, and then bringing them 
around the girdle they carry them to the fore part and again backward. 
There are others who do not apply the bandage round the girdle, but 
carry the rounds of it by the perineum and anus, and along the spine, so 
as to compress the fracture. To an inexperienced person these methods 
will appear not far from natural, but when tried, they will be found of no 
service; for they do not remain firm any length of time, even if the pa- 
tient keep his bed, although in this position they answer best; and yet 
even when lying in bed, should he bend his leg, or should his trunk be 
bent, all the bandages will be displaced; and, moreover, the bandaging 
is inconvenient, inasmuch as the anus is comprehended by it, and many 
turns of the bandage are crowded there in a narrow space. And in the 
method with the girdle, the girdle cannot be so firmly girt around, but 
that the turns of the bandage force the girdle to ascend, and hence of 
necessity all the other bandages must be slackened. He would seem to 
me to come nearest his purpose, although after all he effects but little, 
who would take a few turns round the girdle, but would use the bandage 
principally to secure the former bandaging; for in this manner the band- 
ages would be most secure, and would mutually assist one another. Every 
thing now almost has been said which applies to fracture of the clavicle. 
But this also should be known, that in fractures of the clavicle, it is the 
part attached to the breast which is uppermost, and that the piece attached 
to the acromion is the lowermost. Thecause of this is, that for the most 
part the breast can neither be depressed nor raised, there being but a 
slight movement of the joint at the breast, for the sternum is connected 
together on both sides with the spine. The clavicle admits of most motion 
at the joint of the shoulder, and this arises from its connection with the 
acromion. And, moreover, when broken, the part which is connected 
with the sternum flies upward, and is not easily forced downward; for it 
is naturally light, and there is more room for it above than below. But 
the shoulder, the arm, and the parts connected with them, are easily 
moved from the sides and breast, and, on that account, they admit of be- 
ing considerably elevated and depressed. When, therefore, the clavicle is 
broken, the fragment attached to the shoulder inclines downward, for it 
inclines much more readily with the shoulder and arm downward than 
upward. Matters being as I have stated, they act imprudently who think 
to depress the projecting end of the bone. But it is clear that the under 
part ought to be brought to the upper, for the former is the movable 
part, and that which has been displaced from its natural position. It is 
obvious, therefore, that there is no other way of applying force to it (for 
the bandages no more force it to than they force it from); but if one will 
push the arm when at the sides as much as possible upward, so that the ARTICULATIONS. 
101 
shoulder may appear as sharp as possible, it is clear that in this way it 
will be adjusted to the fragment of the bone connected with the breast 
from which it was torn. If one then will apply a bandage, secundum 
artem, for the purpose of promoting a speedy cure, and will reckon every- 
thing else of no value, except the position as described, he will form a 
correct opinion of the case, and will effect a cure in the speediest and 
most appropriate manner. It is of great importance, however, that the 
patient should he in a recumbent posture. Fourteen days will be suffi- 
cient if he keep quiet, and twenty at most. 
15. But if the clavicle be fractured in the opposite manner (which 
does not readily happen), so that the fragment of bone connected with 
the breast is depressed, while the piece connected with the acromion is 
raised up and rides over the other, this case does not require much man- 
agement, for if the shoulder and arm be let go, the fragments of the bone 
will be adjusted to one another, and an ordinary bandage will suffice, and 
the callus will be formed in the course of a few days. 
16. If the fracture be not thus, but if it incline either forward or 
backward, it may be restored to its natural position, by raising the shoulder 
with the arm as formerly described, and brought back to its natural 
place, when the cure will be speedily accomplished. Most of the varieties 
of displacement may be rectified by raising the arm upward. When the 
upper bone is displaced laterally or downward, it would favor the adapta- 
tion of the parts if the patient would lie on his back, and if some elevated 
substance were placed between the shoulder-blades, so that the breast 
may be depressed as much as possible upon the two sides; and if, while 
another person raised the arm extended along the sides, the physician, 
applying the palm of the one hand to the head of the bone, would push 
it away, and with the other would adjust the broken bones, he would thus 
reduce the parts most readily to their natural position. But, as formerly 
stated, the upper bone (sternal fragment f) is rarely depressed downward. 
In most cases, after the bandages have been applied, that position is 
beneficial in which the elbow is fixed to the same side, and the shoulder is 
kept elevated; but in certain cases, the shoulder is to be raised, as has 
been directed, and the elbow is to be brought forward to the breast, and the 
hand laid on the acromion of the sound side. If the patient has the reso- 
lution to lie in bed, something should be placed so as to support the shoul- 
der, and keep it as much elevated as possible. But if he walk about, the 
arm should be slung in a shawl, which embraces the point of the elbow, 
and is passed round the neck. 
17. When the elbow-joint is displaced or dislocated to the side or out- 
ward, while its sharp point (olecranon remains in the cavity of the hu- 
merus, extension is to be made in a straight line, and the projecting part 
is to be pushed backward and to the side.1 
1 This would seem to be partial dislocation of the elbow-joint, with displace- 102 
GENUINE WORKS OF HIPPOCRATES. 
18. In complete dislocations toward either side, extension is to be made 
as in bandaging fracture of the arm; for thus the rounded part of the 
elbow will not form an obstacle to it. Dislocation, for the most part, 
takes place toward the sides (inwardly ?). Reduction is to be effected by 
separating (the bones) as much as possible, so that the end (of the hume- 
rus) may not come in contact with the olecranon, and it is to be carried 
up, and turned round, and not forced in a straight line, and, at the same 
time, the opposite sides are to be pushed together, and propelled into their 
proper place. It will further assist if rotation of the fore-arm be made 
at the elbow, sometimes turning it into a supine position, and sometimes 
into a prone. The position for the treatment consists in keeping the 
hand a little higher than the elbow, and the arm at the sides; then it may 
either be suspended or laid at rest, for either position will answer; and 
nature and the usage of common means will accomplish the cure, if the 
callus does not form improperly: it is formed quickly. The treatment is 
to be conducted with bandages according to the rule for bandaging articu- 
lations, and the point of the elbow is to be included in the bandage.1 
19. Dislocations at the elbow give rise to the most serious consequen- 
ces, such as fevers, pain, nausea, vomitings of pure bile, and more espe- 
cially when the humerus is displaced backward from pressure on the 
nerve, which occasions numbness; next to it is the dislocation forward; 
the treatment is the same; reduction in dislocation backward is by exten- 
sion and adaptation; the symptom of this variety-loss of the power of 
extension; of dislocation forward-loss of the power of flexion, and in 
this case reduction is to be accomplished by placing a hard ball (in the 
bend of the elbow), and bending the fore-arm about it, along with sudden 
extension.2 
ment of the radius either to the side or behind. It is to be borne in mind, that our 
author always supposes the arm in a state intermediate between pronation and 
supination. Outwards, then, with him, has the same sense as backwards in the 
modern interpretation, where the arm is supposed to be in a state of supination. 
The description of the method of reduction is obscure, and the Commentaries of 
Apollonius Citiensis and Galen throw little or no light on it. There is a consider- 
able difference between M. Littr6's mode of interpreting this passage and my 
own, as I have stated in my Notes, § 39 of Fractures. 
1 This is evidently complete lateral luxation of the fore-arm. The same sub- 
ject is resumed in § 22. Though there are some obscurities in particular expres- 
sions which occur in this paragraph, the directions, in the main, must be quite 
intelligible to any person who is acquainted with the construction of parts con- 
cerned in the dislocation. The principal object which the surgeon must keep in 
view while attempting to effect the reduction, evidently is to prevent the end of 
the ulna from getting entangled in the condyle of the humerus while passing 
over to its place. See below, § 22, where the same directions are repeated. 
2 This would seem to be complete luxation of the fore-arm, forwards and back- 
wards. The symptoms and treatment, though apparently laid down correctly, 
are given with such brevity as to create considerable obscurity. See On Fract- 
ures, § 39, 40, 41. ARTICULATIONS. 
103 
20. Diastasis of the bones may be recognized by examining the part 
where the vein that runs along the arm divides.1 
21. In those cases callus is quickly formed. In congenital dislocations 
the bones below the seat of the injury are shorter than natural, and, 
mostly, those nearest to the place; namely, the bones of the fore-arm, 
next those of the hand; and, third, those of the fingers. The arm and 
shoulder are stronger, owing to the nourishment which they receive, and 
the other arm, from the additional work which it has to perform, is still 
more strong. Wasting of the flesh takes place on the inside if the dislo- 
cation be on the outside; or otherwise, on the side opposite the disloca- 
tion.2 
22. When the elbow is dislocated either inward or outward, extension 
is to be made with the fore-arm at a right angle to the arm; the arm, sus- 
pended by means of a shawl passed through the armpit, and a weight at- 
tached to the extremity of the elbow; or force may be applied with the 
hands; when the articular extremity has been cleared, the displaced parts 
are to be rectified with the palms of the hand, as in dislocations of the 
hands. It is to be bandaged, suspended in a sling, and placed while in 
this attitude.3 
23. Dislocations backward are to be rectified by the palms of the hands, 
along with sudden extension; the two acts are to be performed together, 
as in other cases of the kind. But in dislocation forward the arm is to 
be bent around a ball of cloth of proper size, and at the same time replaced.4 
24. But if the displacement be on the other side, both these opera- 
tions are to be performed in effecting the adjustment. For conducting 
the treatment, the position and bandaging are the same as in the other 
cases. But all these cases may be reduced by ordinary distention.5 
25. Of the methods of reduction, some operate by raising up the part, 
some by extension, and some by rotation: the last consists in rapidly turn- 
ing the fore-arm to this side and that.0 
1 This is evidently an abridgment of § 44 of the work On Fractures, and applies 
principally to the separate luxation of the radius. Apollonius Citiensis mentions 
the separate dislocation of the radius, but throws no light on it. 
2 In the note on § 12 reference is made to an interesting case of congenital luxa- 
tion of the radius, related by Dupuytren. See p. 117 of the Syd. Soc. edition of 
his works. 3 Compare § 18. 4 This is much the same as § 19. 
5 This is the same as the accident described in § 17. This passage is very ob- 
scure, and may be referred either to sub-luxations of the fore-arm backward, or 
luxation of the radius persisting after dislocation of the whole arm backward, 
or luxation of the radius forward or backward. The last appears to me the 
most plausible conjecture. 
6 This enumeration of the methods of reduction is evidently incomplete. By 
raising up the part, he would appear to allude to the process of raising up the end 
of the ulna, so that the olecranon may not get entangled with the extremity of 
the humerus. This process is particularly alluded to in § 19. 104 
GENUINE WORKS OF HIPPOCRATES. 
26. The joint of the hand is dislocated either inward or outward, 
most frequently inward. The symptoms are easily recognized: if inward, 
the patient cannot at all bend his fingers; and if outward, he cannot ex- 
tend them. With regard to the reduction,-by placing the fingers above 
a table, extension and counter-extension are to be made by other persons, 
while with the palm or heel of the hand on the projecting bone one pushes 
forward, and another from behind on the other bone; some soft substance 
is to be applied to it, and the arm is to be turned to the prone position if 
the dislocation was forward, but to the supine, if backward. The treat- 
ment is to be conducted with bandages.1 
27. The whole hand is dislocated either inward or outward, or to this 
side or that, but more especially inward; and sometimes the epiphysis is 
displaced, and sometimes the other of these bones is separated.2 In these 
cases strong extension is to be applied, and pressure is to be made on the 
projecting bone, and counter-pressure on the opposite side, both at the 
same time, behind and at the side, with the hands upon a table, or with 
the heel. These accidents give rise to serious consequences and deformi- 
ties; but in the course of time the part gets strong, and admits of being 
used. The cure is with bandages, which ought to embrace both the hand 
and fore-arm; and splints are to be applied as far as the fingers; and 
when they are used they should be more frequently unloosed than in fract- 
ures, and more copious affusions of water should be used.3 
28. In congenital dislocations (at the wrist) the hand becomes short- 
ened, and the atrophy of the flesh occurs, for the most part, on the side 
1 M. Littre inclines, after mature consideration of the subject, to refer the case 
here described to sub-luxations of the carpal bones. Now, although such acci- 
dents have been described, even in recent times, I must say that I look upon them 
as being, in a great measure, ideal. Unless by sub-luxation is meant the lateral 
subluxation, I can scarcely conceive how such an accident can occur at all. 
2 The case here treated of, in the latter clause of this sentence, would appear 
to me to be dislocation of the radius, and of the ulna forward and backward. 
See Oribasius, de Machin, (xiv). The dislocation forward is distinctly described 
by Sir Astley Cooper, but he was unacquainted with the other. (On Dislocations, 
p. 503.) Dislocation backward is described by Desault (t. i). I do not mean to 
dispute the reality of this accident; but I must say, that judging from what I 
have observed in my own practice, I am much inclined to agree with Dupuytren 
in thinking that many of the cases which have been taken for dislocation of 
the radius, or of the hand, have been fractures of the lower extremity of the 
radius. Nothing- is more common than fracture, and nothing- more rare than dis- 
location, in that part of the body. 
3 That complete dislocations of the hand at the wrist are here meant to be de- 
scribed seems quite evident. Most of the other ancient authorities only admitted 
the reality of dislocations forward and backward. See the authorities quoted 
at Paulus ASgineta B. VI., 116, Syd. Soc. edition. All the four varieties here de- 
scribed by our author are recognized by our latest authorities, but those to the 
side are held to be partial. See Mr. Bransby Cooper's Lectures and the Argu- 
ment. ARTICULATIONS. 
105 
opposite to the dislocation. In an adult the bones remain of their natural 
size.1 
29. Dislocation at the joint of a finger is easily recognized. Reduc- 
tion is to be effected by making extension in a straight line, and applying 
pressure on the projecting bone, and counter-pressure on the opposite side 
of the other. The treatment is with bandages. When not reduced, cal- 
lus is formed outside of the joint. When the dislocation takes place at 
birth, during adolescence the bones below the dislocation are shortened, 
and the flesh is wasted rather on the opposite than on the same side with 
the dislocation. When it occurs in an adult the bones remain of their 
proper size.2 
30. The jaw-bone, in few cases, is completely dislocated, for the zygo- 
matic process formed from the upper jaw-bone (malar and the bone be- 
hind the ear (temporal ?) shuts up the heads of the under jaw, being above 
the one (condyloid process ?), and below the other (coronoid process Of 
these extremities of the lower jaw, the one, from its length, is not much 
exposed to accidents, while the other, the coronoid, is more prominent 
than the zygoma, and from both these heads nervous tendons arise, with 
which the muscles called temporal and masseter are connected; they have 
got these names from their actions and connections; for in eating, speak- 
ing, and the other functional uses of the mouth, the upper jaw is at rest, 
as being connected with the head by synarthrosis, and not by diarthrosis 
(enarthrosis?')'. but the lower jaw has motion, for it is connected with 
the upper jaw and the head by enarthrosis. Wherefore, in convulsions 
and tetanus, the first symptom manifested is rigidity of the lower jaw; 
and the reason why wounds in the temporal region are fatal and induce 
coma, will be stated in another place.3 These are the reasons why com- 
plete dislocation does not readily take place, and this is another reason, 
because there is seldom a necessity for swallowing so large pieces of food 
as would make a man gape more than he easily can, and dislocation could 
not take place in any other position than in great gaping, by which the 
jaw is displaced to either side. This circumstance, however, contributes 
to dislocation there; of nerves (ligaments?) and muscles around joints, or 
connected with joints, such as are frequently moved in using the member 
1 The most interesting account which I have met with of congenital dislocation 
at the wrist-joint, is that given by Dr. R. Smith. The drawings which he gives 
of this monstrosity are very curious. (On Fractures, etc., p. 239.) Nothing can 
show more remarkably the attention which our author must have paid to this 
subject, than his being acquainted with a case of such rarity as the present one. 
2 This is only an abridgment of the fuller exposition of the subject given in 
§ 80. Apollonius, in his Commentary on this passage, mentions that Diodes, in 
commenting upon it, describes four varieties of dislocation at the joints of a finger, 
and directs them to be reduced by wrapping a cord or string round the ends of 
the fingers, and making counter-extension with the hand. 
3 He seems to allude here to the work, On Injuries of the Head, § 13. 106 
GENUINE WORKS OF HIPPOCRATES. 
are the most yielding to extension, in the same manner as well-dressed 
hides yield the most. With regard, then, to the matter on hand, the 
jaw-bone is rarely dislocated, but is frequently slackened {partially dis- 
placed in gaping, in the same manner as many other derangements of 
muscles and tendons arise.1 Dislocation is particularly recognized by 
these symptoms: the lower jaw protrudes forward, there is displacement 
to the opposite side, the coronoid process appears more prominent than 
natural on the upper jaw, and the patient cannot shut his lower jaw but 
with difficulty. The mode of reduction which will apply in such cases is 
obvious: one person must secure the patient's head, and another, taking 
hold of the lower jaw with his fingers within and without at the chin, 
while the patient gapes as much as he can, first moves the lower jaw 
about for a time, pushing it to this side and that with the hand, and di- 
recting the patient himself to relax the jaw, to move it about, and (yield 
as much as possible; then all of a sudden the operator must open the- 
1 Galen, in his Commentary on this passage, explains it as applying to displace- 
ment of the muscles. It would seem to be the species of incomplete displacement, 
described by Sir Astley Cooper. M. Berard, however, as quoted by M. Littre, 
gives a somewhat different explanation of the case, as follows: " L'expression de 
luxation incomplete ne pent jamais s'appliquer aux deplacements de la machoire. 
Il ne semble pas possible, en effet, que le condyle de la machoire s'arrete sur le 
rebord de la cavity glenoide, c'est-a-dire sur la racine transverse de 1'arcade zygo- 
matique; il doit ou retomber dans la cavite, ou passer au-devantde cette saillie. 
Cependant A. Cooper (CEuvres Chirurgicales, traduction de MM. Chassaignac et 
Michelot, p. 127) admet une luxation incomplete, due au transport du condyle au- 
dessous de la racine transverse, tandis que le menisque inter-articulaire reste au 
fond de la cavite glenoide. Ce genre de luxation reconnait pour cause le ralache- 
ment des ligaments; les symptomes en sont: un 6cartement leger des machoires, 
l'impossibilit6 de fermer la bouche, qui survient brusquement et s'accompagne 
d'une IGgere douleur du cote luxe. D'ordinaire, de simples efforts musculaires 
suffisent pour en amener la reduction; nGanmoins A. Cooper l'a vue persister 
tres-longtemps; et cependant, dit-il, la mobility de la machoire, ainsi que la faculty 
de fermer la bouche, ont. ete recouvrees. Cette description est trop peu detail lee 
pour qu'on puisse se former une bonne id6e du genre d'accident dont parle A. 
Cooper. Mais, comme aucun fait anatomique n'est invoqu6 en faveur de la 
maniere de voir du celebre chirurgien anglais, nous conservons de tres-grands 
doutes sur la cause que A. Coopei' assigne aux desordres fonctionnels dont il parle. 
Le relachement des ligaments est une chose bien rare, et qui ne se comprend 
guere a 1'articulation temporo-maxillaire; quant au glissement du condyle sur le 
menisque inter-articulaire, la chose nous parait tout-a-fait impossible. On sait 
que le tendon du muscle pterygoidien externe se fixe a la fois sur le col du condyle 
et sur le cartilage inter-articulaire, de telle sorte que ces deux parties se meuvent 
toujours simultanGment lors des glissements du condyle de la machoire sur 1'os 
temporal. (A. B6rard, Diet, de Mddecine, art. Machoire, 2e 6d. t. 18, p. 409.) 
Both Chelius and his English editor, South, admit a case " of subluxation of the 
lower-jaw, when, from great laxity of the ligaments, the condyles escape over 
the edge of the inter-articular cartilages in the sockets of the temporal bones, and 
fix the jaw with the mouth somewhat open,'-' (Vol. i., p. 772.) ARTICULATIONS. 
107 
mouth, while he attends at the same time to three positions: for the lower 
jaw is to be moved from the place to which it is dislocated to its natural 
position; it is to be pushed backward, and along with these the jaws are 
to be brought together and kept shut. This is the method of reduction, 
and it cannot be performed in any other way. A short treatment suffices, 
a waxed compress is to be laid on, and bound with a loose bandage. It is 
safer to operate with the patient laid on his back, and his head supported 
on a leather cushion well filled, so that it may yield as little as possible, 
but some person must hold the patient's head. 
31. When the jaw is dislocated on both sides, the treatment is the 
same. The patients are less able to shut the mouth than in the former 
variety; and the jaw protrudes farther in this case, but is not distorted; 
the absence of distortion may be recognized by comparing the correspond- 
ing rows of the teeth in the upper and lower jaws. In such cases reduc- 
tion should be performed as quickly as possible; the method of reduction 
has beei? described above. If not reduced, the patient's life will be in 
danger from continual fevers, coma attended with stupor (for these mus- 
cles, when disordered and stretched preternaturally, induce coma); and 
there is usually diarrhoea attended with bilious, unmixed, and scanty de- 
jections; and the vomitings, if any, consist of pure bile, and the patients 
commonly die on the tenth day.1 
32. In fracture of the lower jaw, when the bone is not fairly broken 
across, and is still partially retained, but displaced, it should be adjusted 
by introducing the fingers at the side of the tongue, and making suitable 
counter-pressure on the outside; and if the teeth at the wound be dis- 
torted and loosened, when the bone is adjusted, they should be connected 
together, not only two, but more of them, with a gold thread, if possible, 
but otherwise, with a linen thread, until the bone be consolidated,2 and 
then the part is to be dressed with cerate, a few compresses, and a few 
bandages, which should not be very tight, but rather loose. For it should 
be well known that in fracture of the jaw, dressing with bandages, if 
properly performed, is of little advantage, but occasions great mischief if 
1 Our author's description of dislocation of the lower jaw is copied by all the 
subsequent authorities in ancient times. See the Commentary on Paulus aEgi- 
neta, B. VI., 112, where I mention a case which proved fatal in consequence of 
reduction not being performed in time. 
2Chelius says, respecting this practice: " Wallner applies (as did previously 
Hippocrates, Ryff, and others), in fracture of the lower jaw, instead of the usual 
apparatus, a silver thread around the front teeth, which, without inconveniencing 
the patient, may be continued for three weeks, till the divided parts are perfectly 
united." (Vol. i., p. 530.) I once used a strong silk thread in a case of severe 
fracture of the lower jaw, in which it was found difficult to keep the parts in situ. 
In general, however, these accidents are very easily managed without the ligature 
or any complex bandaging. Professor Syme's observations on the treatment of 
this accident are very much to the purpose. 108 
GENUINE WORKS OF HIPPOCRATES. 
improperly done. Frequent examinations should be made about the 
tongue, and prolonged pressure should be applied with the fingers, in 
order to rectify the displaced bone.1 It would be best if one could do so 
constantly, but that is impossible. 
33. But if the bone be fairly broken across (this, however, rarely hap- 
pens), it is to be set in the manner now described. When adjusted, the 
teeth are to be fastened together as formerly described, for this will con- 
tribute much toward keeping the parts at rest, especially if properly fas- 
tened, and the ends of the thread secured with knots. But it is not easy 
to describe exactly in writing the whole manipulation of the case; but the 
reader must figure the thing to himself from the description given. Then 
one must take a piece of Carthaginian leather; if the patient be a younger 
person, it will be sufficient to use the outer skin, but if an adult, the 
whole thickness of the hide will be required; it is to be cut to the breadth 
of about three inches, or as much as will be required, and having smeared 
the jaw with a little gum (for thus it sticks more pleasantly), tlw end of 
the skin is to be fastened with the glue near the fractured part of the jaw, 
at the distance of an inch or a little more, from the wound. This piece 
is to be applied below the jaw; but the thong should have a cut in it, in 
the direction of the chin, so that it may go over the sharp point of the 
chin. Another piece of thong like this, or somewhat broader, is to be 
glued to the upper part of the jaw, at about the same distance from the 
wound as the other thong; this thong should be so cut as to encircle the 
ear. The thongs should be sharp-pointed at the part where they unite, 
and in gluing them, the flesh of the thong should be turned to the 
patient's skin, for in this way it will be more tenacious; then we must 
stretch this thong, but still more so the one at the chin, in order to pre- 
vent the fragments of the jaw from riding over each other, and the thongs 
are to be fastened at the vertex, and then a bandage is to be bound round 
the forehead, and a proper apparatus is to be put over all, to prevent the 
bandages from being displaced. The patient should lie upon the sound 
side of the jaw, not resting upon the jaw, but upon the head. He is to 
be kept on a spare diet for ten days, and then nourished without delay. 
If there be no inflammation during the first days, the jaw is consolidated 
in twenty days; for callus quickly forms in this, as in all the other porous 
bones, provided there be no sphacelus (exfoliation P). But much remains 
to be said on the sphacelus of bones in another place. This method of dis- 
tention with glued substances is mild, of easy application, and is useful 
for many dislocations in many parts of the body. Those physicians who 
have not judgment combined with their dexterity, expose themselves in 
fractures of the jaws, as in other cases, for they apply a variety of band- 
1 Galen, in his Commentary, explains that our author means all this is to be 
done by the patient, and not by the physician. ARTICULATIONS. 
109 
ages to a fractured jaw-bone, sometimes properly, and sometimes improp- 
erly. For all such bandaging of a fractured jaw-bone has a tendency rather 
to derange the bones connected with the fracture, than to bring them 
into their natural position. 
34. But if the lower jaw be disjointed at its symphysis in the chin 
(there is but one symphysis in the lower jaw, but there are several in the 
upper; but I am unwilling to digress from the subject, as these matters 
will have to be touched upon in other kinds of disease)-if, then, the 
symphysis be separated at the chin, it is the work which anybody can 
perform, to rectify it; for the part which protrudes is to be pushed inward 
by pressure with the fingers, and the part that inclines inward is to be 
forced outward by pushing with the fingers from within. It is after hav- 
ing applied extension to separate the fragments that this is to be done, 
for they will thus be more easily restored to their natural position, than 
if one should bring them together by using force. This is proper to be 
known as applying to all such cases. When you have set the parts, you 
must fasten the teeth on both sides to one another, as formerly directed. 
The treatment is to be accomplished with cerate, a few compresses, and 
bandages. This part, in particular, requires a short but complex (?) band- 
aging, for it is nearly cylindrical, though not exactly so; but the turn of 
the bandage is to be made, if the right jaw was dislocated, to the right 
hand (that is said to be to the right hand when the right hand conducts 
the bandaging); but if the other jaw be the seat of the dislocation, the 
bandaging is to be made in the other direction. And if matters be prop- 
erly adjusted, and the patient keep quiet, there will be a speedy recov- 
ery, and the teeth will be uninjured; but if not, the recovery will be more 
protracted, the teeth will be distorted, will give trouble, and become use- 
less. 
35. Of fractures of the nose there are more than one variety, but those 
who, without judgment, delight in fine bandagings,1 do much mischief, most 
especially in injuries about the nose. For this is the most complex of all 
the forms of bandaging, having most of the turns of the bandage called 
" ascia," and rhomboidal intervals and uncovered spaces of the skin.2 As 
1 Galen properly remarks, that our author here speaks ironically. The forms 
of bandaging here noticed are briefly described in the work, On the Surgery. The 
terms are further explained in the Commentary of Galen. I need scarcely re- 
mark that, in the account which our author gives of fracture of the nose, he sur- 
passes all the medical authorities ancient and modern. He had, no doubt, ample 
opportunities of seeing cases of injuries of the nose and ears in the persons of the 
athletae, who boxed with the cestus. But why this account of fractures of the 
bones of the nose is inserted here, and not in the treatise On Fractures, I am at a 
loss to explain. Indeed why the subject-matters of these two works are so mixed 
up together has always been reckoned a puzzle. See the Argument. 
2 On the meaning of the terms which occur in this passage, the reader may find 
it advantageous to consult the note of Frantzius, in his edition of Erotian, under 110 
GENUINE WORKS OF HIPPOCRATES. 
lias been said, those who practice manipulation without judgment are fond 
of meeting with a case of fractured nose, that they may apply the band- 
age. For a day or two, then, the physician glories in his performance, 
and the patient who has been bandaged is well pleased, but speedily the 
patient complains of the incumbrance of the bandage, and the physician 
is satisfied, because he has had an opportunity of showing his skill in ap- 
plying a complex bandage to the nose. Such a bandaging does everything 
the very reverse of what is proper; for, in the first place, those who have 
their nose flattened by the fracture, will clearly have the part rendered 
still more flat, if pressure above be applied to it; and further, those cases 
in which the nose is distorted to either side, whether at the cartilage or 
higher up, will evidently derive no benefit from bandaging above it, but 
will rather be injured; for it will not admit of having compresses properly 
arranged on either side of the nose, and indeed, persons applying this 
bandage do not seek to do this. 
36. This bandaging would appear to me to answer best when the skin 
surrounding the bone is contused on its ridge near the middle, or if the 
bone itself have sustained some injury, but not a great one, in such cases, 
redundant callus forms in the nose, and the part becomes a little too 
prominent; and yet, even in these cases, the bandaging need not require 
much trouble, if, indeed, any bandage be applied at all; for it is enough 
if one lay a waxed compress on the contusion, and then apply the double- 
headed bandage, thus taking one turn with it. The best application to 
such accidents is a small cataplasm of wheaten flour, washed, and mixed 
up into a viscid mass. If the flour be made from good wheat, and if it be 
glutinous, it should be used alone for all such cases, but if it be not very 
glutinous, a little of the manna of frankincense, well pulverized, is to be 
moistened with water, and the flour is to be mixed up with it, or a very 
little gum may be mixed in like manner.1 
37. In those cases in which the fractured portions are depressed and 
flattened, if it is depressed in front at the cartilage, something may be in- 
troduced into the nostrils to rectify the parts. If not, all such deformi- 
ties may be restored by introducing the fingers into the nostrils, if this 
can be managed, but if not, a thick spatula2 is to be introduced with the 
fingers, not to the fore part of the nose, but to the depressed portion, and 
1 Galen gives an interesting- account of the grain here recommended as an in- 
gredient in the paste to be applied to a fractured nose, and of the mode of pre- 
paring it here described by our author. For all practical purposes, it is sufficient 
to know that the preparation was a sort of glutinous paste made of flour, with 
the addition of some fine frankincense and gum. 
2 Galen, in his Commentary, informs us that these spatulas were of all shapes 
and sizes, to suit for a variety of purposes. I need scarcely remark that a female 
catheter is the instrument recommended in modern works for this purpose. As 
explained by Galen, any instrument used on the occasion is for the purpose of 
acting as a lever in raising a depressed part of bone. ARTICULATIONS. 
111 
the physician is to take hold of the nose externally on both sides, and at 
the same time raise it up. And if the fracture be much in the fore part 
one may introduce into the nostrils as already stated, either caddis scraped 
from a linen towel, or something such wrapped up in a piece of cloth, or 
rather stitched in Carthaginian leather, and moulded into a shape suitable 
to the place into which it is to be introduced. But if the fracture be at 
a greater distance, it is not possible to introduce anything within, for if 
it was irksome to bear anything of the kind in the fore part, how is it not 
to be so when introduced farther in ?1 At first, then, by rectifying the 
parts from within, and sparing no pains upon them from without, they 
are to be brought to their natural position, and set. A fractured nose 
may be readily restored to shape, especially on the day of the accident, or 
even a little later, but the physicians act irresolutely, and touch it more 
delicately at first than they should; for the fingers should be applied on 
both sides along the natural line of the nose, and it is to be pushed down- 
ward, and thus, with pressure from within, the displacement is to be rec- 
tified. But for these purposes no physician is equal to the index-fingers 
of the patient himself, if he will pay attention and has resolution, for they 
are the most natural means. Either of the fingers is to be placed firmly 
along the whole nose, and thus it is to be gently held, and steadily, if pos- 
sible until it become firm, but if not, he himself is to hold it for as long a 
time as possible, in the manner described; or if he cannot, a child or 
woman should do it, for the hands ought to be soft. Thus may a fract- 
ure of the nose, attended with depression, and not with displacement to 
the side, but in a straight line, be most properly treated. I have never 
seen a case of fractured nose which could not be rectified when attempted, 
before callus is formed, provided the treatment be properly applied. But 
although men would give a great price to escape being deformed, yet at 
the same time they do not know how to take care, nor have resolution, 
if they do not experience pain, nor fear death, although the formation of 
callus in the nose speedily takes place, for the most part is consolidated in 
ten days, provided sphacelus do not take place. 
38. When the fractured bone is displaced laterally, the treatment is 
the same, but it is obvious that the reduction is to be made, not by apply- 
ing equal force on both sides, but by pushing the displaced portion into 
its natural position, and pressing on it from without, and introducing 
something into the nostrils, and boldly rectifying the fragments which 
incline inward, until the whole be properly adjusted, well knowing that if 
11 may mention that most modern authorities disapprove of introducing any 
substances into the nostrils to support the broken bone, as fancying that they are 
a source of irritation, and that they are not required. See Bell's Operative Sur- 
gery, vol. ii., p. 222. Chelius admits them only in cases in which the broken ends 
are again displaced, (Surgery, vol. i., p. 527,) Like our author, he disapproves 
of bandages. On the caddis, see the note on the Mochlicus. 112 
GENUINE WORKS OF HIPPOCRATES. 
yon do not restore the parts at once, it is impossible but that the nose 
must be distorted. But when you restore the parts to their natural posi- 
tion, either the patient himself, or some other person, is to apply one fin- 
ger or more to the part which protrudes, and keep it in position until the 
fracture be consolidated; but the little finger is, from time to time, to be 
pushed into the nostril, to rectify the parts which incline inward. When 
any inflammation supervenes, dough must be used, but attention must 
still be equally paid to the application of the fingers, although the dough 
be on the part. But if the fracture be in the cartilage, with lateral dis- 
placement, the end of the nose must necessarily be distorted. In such 
cases some of the aforementioned means of reduction, or whatever suits, 
is to be introduced into the nostril; but there are many convenient things 
to be found which have no smell, and are appropriate in other respects; 
thus, on one occasion, I introduced a slice of sheep's lung, as it happened 
to be at hand; for sponges, if introduced, imbibe humidities. Then the 
outer skin of Carthaginian leather is to be taken, and a piece of the size 
of the thumb, or what will answer, is to be cut off and glued to the out- 
side of the nostril which is turned aside, and then this piece of thong is 
to be stretched to the proper degree, or rather a little more than what 
will be sufficient to make the nose straight and regular.1 Then (for the 
thong must be long) it is to be brought below the ear and round the head, 
and the end of the thong may either be glued to the forehead, or a still 
longer one may be carried all round the head, and secured. This is a 
natural mode of setting the nose, is of easy application, and is calculated 
to enable the counter-extension on the nose to be made greater or less, 
as you may incline. In a case where the fractured nose is turned to the 
side, the treatment is to be conducted otherwise, as already described; 
and in most of them the thong ought to be glued to the end of the nose, 
in order to make extension in the opposite direction. 
39. When the fracture is complicated with a wound, one need not be 
troubled on that account, but pitch-cerate or any of the applications for 
fresh wounds is to be applied to the sores; for, in general, they admit of 
easy cure, even when there is reason to apprehend that pieces of bone will 
come out. The parts, at first, are to be adjusted fearlessly, taking care 
that nothing is omitted, and, subsequently, they are also to be adjusted 
with the fingers; more softly, indeed, but still it must be done; and of 
1 The use of the piece of skin in bandaging a fractured nose is adverted to by 
Paulus JEgineta; but, lie says, it was not much approved of by recent authorities 
in his time. (B. VI., 92, Syd. Soc. edit.) See the authorities there quoted. Cel- 
sus describes the mode of treatment recommended by Hippocrates in the follow- 
ing terms:-" Extrinsecus autem circumdanda habena est mollis, medio illita 
mistis inter se simila et thuris fuligine, eaque ultra aures ducenda, et fronti duobus 
capitibus agglutinanda est. Id enim corpori quasi gluten inhaerescit, et cum in- 
duruit, nares commode continet." viii., 5. ARTICULATIONS. 
113 
all parts of the body the hose is modeled with the greatest ease. And 
there is nothing to prevent us from having recourse to the practice of 
gluing on the thongs, and drawing the nose to the opposite side, even 
if there be a wound or the parts be inflamed, for these thongs give no 
pain. 
40.[In fractures of the ear all sorts of bandages do harm.1 For one 
would not think of applying it quite loose, and if applied more tightly, it 
only does the more harm, for even the sound ear, when confined with a 
bandage, becomes painful, throbs, and gets into a febrile state. With re- 
gard to cataplasms, the heaviest, on the whole, are the worst; but almost 
all kinds are bad, form abscesses, occasion an increase of humors, and 
afterward troublesome suppurations; and a fractured ear stands in less 
need of such applications than any other part; the most ready, if required, 
is the paste of meal, but neither should it have weight. It should touch 
as little as possible; for it is a good remedy sometimes to apply nothing 
at all, both to the ear and to many other cases. Attention must be paid 
to the patient's position during sleep. And the body must be reduced, 
more especially if there be danger lest the ear suppurate; it will also be 
better to open the bowels, and if the patient can be readily made to 
vomit, this may be accomplished by means of the syrmaism.2 If the part 
come to suppuration, it should not be hastily opened; for often when 
11 have stated under a former head, that fractures of the nose and ears were 
very common in ancient times, as the necessary results of the boxing-matches 
with the formidable cestus. It consisted of thongs of leather studded with large 
iron nails, with which the hands of the boxers were firmly bound. That the com- 
bat with the cestus was a favorite amusement of the ancients, is obvious from its 
being described by their greatest and most popular poets; for example, by Homer, 
Apollonius Rhodius, Theocritus, Virgil, and Valerius Flaccus. Indeed this may 
be said to have been one of the loci communes of the ancient poets. That a blow 
about the ears was reckoned a master-stroke is evident from Theocritus's descrip- 
tion, who represents Amycus, when he appears in the ring with Pollux, as being 
Aetvoc kkZv, OKkr/pdicL reO?MopevoQ ovara Trvy/zatj. (Idyll. 23.) 
And Apollonius Rhodius describes Amycus as having received the fatal stroke at 
last in the same region: 
Koi/>e peT(uy6r)v v~ep ovaroc ocrea ft etcu 
'Pt/gev 6 <T a/z' bdvvy yvif f/piirev ol <T 
'Hpuef Mzvioz- rov d' aOpdoc; euxvro dvpbc;. (Argonaut, ii., 95.) 
Plato makes allusion in his Gorgias to persons with fractured ears, from the 
sports of the palaestra. 
2 By syrmaism was meant the process of producing vomiting by loading the 
stomach with heavy things, such as honey and strong hydromel, along with rad- 
ishes and the bulbous roots of the narcissus, when these were found necessary. 
The subject is fully discussed in the Commentary on Paulus JEgineta, B. I., 42. 
One may further consult the editors of Erotian, as given in the edition of his works 
by Frantzius, under curb cvppdicyov. All their learned discussions, however, amount 
to no more than what we have given above in few words. 
Vol. II.-8. 114 
GENUINE WORKS OF HIPPOCRATES. 
matter appears to be formed it is absorbed again, even when no cataplasm 
is applied. But if forced to open it, the part will get soonest well if trans- 
fixed with a cautery, and yet it should be well understood that the ear 
gets maimed, and is less than the other if burned through. If not burned 
through, an incision, and not a very small one, should be made on the 
upper side; for the pus is found to be surrounded with a thicker covering 
than one would have supposed; and it may be said, in general, that all 
parts of a mucous nature and which form mucus, as being all viscid, when 
touched, slip from below the fingers to either side; and on that account 
the physician, in such cases, finds that he has to pass his instrument 
through a thicker substance than he supposed; and in certain ganglionic 
cases, when the skin is flabby and mucous, many physicians open them, 
expecting to find a collection in them; here the physician forms a wrong 
judgment, but by such a procedure no great harm results to the patient 
from having had the part opened. But with regard to watery parts, and 
such as are filled with mucus, and which are situated in regions where 
every one of the parts, if opened, will occasion death or some other in- 
jury, these will be treated of in another work. When, therefore, incision 
is made in the ear, all sorts of cataplasms and pledges should be avoided, 
and it is to be treated either with applications for recent wounds, or any- 
thing else which is neither heavy nor will occasion pain, for if the carti- 
lage be laid bare and abscesses form, the case will be troublesome;1 this 
happens from such modes of treatment. In all aggravated cases, the most 
effectual remedy is the transfixing of the part with a hot iron. 
41.2 (The vertebrae of the spine when contracted into a hump behind 
from disease, for the most part cannot be remedied, more especially when 
the gibbosity is above the attachment of the diaphragm to the spine. 
Certain of those below the diaphragm are carried oft by varices in the 
legs, more especially by such as occur in the vein at the ham; and in those 
cases where the gibbosities are removed, the varices take place also in the 
groin; and some have been carried off by a dysentery when it becomes 
chronic.3 And when the gibbosity occurs in youth before the body has 
1 M. Littre certainly improves the text in this place. See the Lectiones vari- 
antes. 
2 In addition to his Commentary, Galen gives many importment remarks on 
the paragraph relating to curvatures of the spine in his work, De Locis Affectis 
(iv., 6). As he remarks, Hippocrates divides curvatures of the spine into gibbosity 
or the posterior projection, the anterior projection, and the lateral curvature. 
His terms cyphosis, lordosis, and scoliosis, are adopted by modern authorities, as, 
for example, Chelius. It is proper to remark that our author, however, does not 
restrict scoliosis to lateral curvature, but sometimes applies it indiscriminately to 
the others. 
3 It does not appear clear what has lead our author to consider varices in the 
lower extremities as being a natural cure of curvature of the spine. Perhaps his 
opinion had originated in observing- that the compression of the veins at the top ARTICULATIONS. 
115 
attained its full growth, in these cases the body does not usually grow 
along the spine, but the legs and the arms are fully developed, whilst the 
parts (about the back) are arrested in their development. ) And in those 
cases where the gibbosity is above the diaphragm, the ribs do not usually 
expand properly in width, but forward, and the chest becomes sharp- 
pointed and not broad, and they become affected with difficulty of breath- 
ing and hoarseness; for the cavities which inspire and expire the breath 
do not attain their proper capacity. And they are under the necessity of 
keeping the neck bent forward at the great vertebra,1 in order that their 
head may not hang downward; this, therefore, occasions great contraction 
of the pharynx by its inclination inward; for, even in those who are erect 
in stature, dyspnoea is induced by this bone inclining inward, until it be 
restored to its place. From this frame of persons appear to 
have more prominent necks than persons in good health, and they gener- 
ally have hard and unconcocted tubercles in the lungs,2 for the gibbosity 
and the distension are produced mostly by such tubercles) with which the 
neighboring nerves communicate. When the gibbosity is below the dia- 
phragm, in some of these cases nephritic diseases and affections of the 
bladder supervene, but abscesses of a chronic nature, and difficult to cure, 
occur in the loins and groins)) and neither of these carries off the gibbos- 
ity; 3 and in these cases the hips are more emaciated than when the gib- 
bosity is seated higher up; but the whole spine is more elongated in them 
than in those who have the gibbosity seated higher up, the hail- of the 
pubes and chin is of slower growth and less developed, and they are less 
capable of generation than those who have the gibbosity higher up.4 
When the gibbosity seizes persons who have already attained their 
full growth, it usually occasions a crisis of the then existing disease, but 
in the course of time some of them attack, as in the case of younger per- 
sons, to a greater or less degree; but, for the most part, all these diseases 
are less malignant. And yet many have borne the affection well, and 
of the thigh had given rise to enlargement of the veins below. Those cases in 
which the disease is said to be carried off by dysentery were, no doubt, of a rheu- 
matic nature, and not connected with organic disease of the vertebrae. Galen, in 
his Commentary, refers the cure to metastasis of the morbific humors to the veins, 
in the one case, and to the intestinal canal in the other. 
1 By the great vertebra, in this place, our author appears to mean the second, 
oi' vertebra dentata. See Galen's Commentary. 
2 Galen shrewdly remarks, that when the curvature is high up in the spine, 
the evacuation of matter usually takes place in the lungs. 
3 The reader will readily remark that psoas and lumbar abscesses are here de- 
scribed. It is well known that, as represented by our author, these cases are of a 
very intractable nature. 
4 Galen ascribes these symptoms to sympathy with the spine. This may 
naturally be supposed to vary according to the seat of the disease in the vertebral 
column. 116 
GENUINE WORKS OF HIPPOCRATES. 
have enjoyed good health until old age, more especially those persons 
whose body is inclined to be plump and fat; and a few of them have lived 
to beyond sixty years of age, but the most of them are more short-lived. 
In some cases the curvature of the spine is lateral, that is to say, either 
to the one side or the other; the most of such cases are connected with 
tubercles (abscesses within the spine; and in some, the positions in which 
they have been accustomed to lie co-operate with the disease.1 But these 
will be treated of among the chronic affections of the lungs;2 for these 
the most suitable prognostics of what will happen in these cases are given. 
42. When the spine protrudes backward, in consequence of a fall, it 
seldom happens that one succeeds in straightening it. Wherefore succus- 
sion on a ladder has never straightened anybody, as far as I know, but it 
is principally practiced by those physicians who seek to astonish the mob 
-for to such persons these things appear wonderful, for example, if they 
see a man suspended- or thrown down, or the like; and they always ex- 
tol, such practices, and never give themselves any concern whatever may 
result from the experiment, whether bad or good. But the physicians 
who follow such practices, as far as I have known them, are all stupid. 
The device, however, is an old one, and I give great praise to him who 
first invented this, and any other mechanical contrivance which is accord- 
ing to nature. For neither would I despair, but that if succussion were 
properly gone about, the spine, in certain cases, might be thereby recti- 
fied. But, indeed, for my own part, I have been ashamed to treat all 
such cases in this way, because such modes of procedure are generally 
practiced by charlatans. 
43. Those cases in which tfie gibbosity is near the neck, are less likely 
to be benefited by these succussions with the head downward, for the 
weight of the head, and tops of the shoulders, when allowed to hang down, 
is but small; and such cases are more likely to be made straight by suc- 
cussion applied with the feet hanging down, since the inclination down- 
ward is greater in this way. When the hump is lower down, it is more 
likely in this case that succussion with the head downward should do good. 
If one, then, should think of trying succussion, it may be applied in the 
following manner:-The ladder is to be padded with leather or linen cush- 
ions, laid across, and well secured to one another, to a somewhat greater 
extent, both in length and breadth, than the space which the man's body 
'It is now well ascertained that position and habit have much to do with the 
formation of lateral curvature of the spine. See Hare on Spinal Disease (c. iv.), 
and Chelius (vol. ii., p. 160). Zint, in particular, maintains strongly that position 
in bed is the main cause of lateral curvature of the spine. See British and Foreign 
Medical Review, vol. xix., p. 370. 
2 Galen, in his Commentary, states that this portion of the work, if ever writ- 
ten, had not been preserved; but that this disease is treated of in the work, On 
the Affections, and in the work, On Diseases. He does not add whether he regards 
these as genuine or not. ARTICULATIONS. 
117 
will occupy; he is then to be laid, on the ladder upon his back, and the 
feet, at the ankles, are to be fastened, at no great distance from one an- 
other, to the ladder, with some firm but soft band; and he is further to 
be secured, in like manner, both above and below the knee, and also at 
the nates; and at the groins and chest loose shawls are to be put round in 
such a fashion as not to interfere with the effect of the succussion; and 
his arms are to be fastened along his sides to his own body, and not to 
the ladder. When you have arranged these matters thus, you must hoist 
up the ladder, either to a high tower or to the gable-end of a house; but 
the place where you make the succussion should be firm, and those who 
perform the extension should be well instructed, so that they may let go 
their hold equally to the same extent, and suddenly, and that the ladder 
may neither tumble to the ground on either side, nor they themselves fall 
forward. But, if the ladder be let go from a tower, or the mast of a ship, 
fastened into the ground with its cordage, it will be better, so that the 
ropes run upon a pulley or axle-tree. But it is disagreeable even to en- 
large upon these matters; and yet, by the contrivances now described, 
the proper succussion may be made.1 
44. But if the hump be situated very high up, and if succusion be 
by all means to be used, it will be better to do it with the feet downward, 
as has been said, for the force downward will be the greater in this case. 
The patient is to be well fastened to the ladder by cords at the breast, at 
the neck by means of a very loose shawl so as merely to keep the part 
properly on the ladder, and the head is to be fastened to the ladder at the 
forehead, the arms are to be stretched along and attached to the patient's 
body, and not to the ladder, and the rest of the body is not to be bound, 
except so as to keep it in place by means of a loose shawl wrapped round 
it and the ladder; attention, moreover, should be paid that these ligatures 
do not interfere with the force of the succussion, and the legs are not to 
be fastened to the ladder, but should be placed near one another, so as to 
be in line with the spine. These matters should be thus arranged, if 
recourse is to be had at all to succussion on a ladder; for it is disgraceful 
in every art, and more especially in medicine, after much trouble, much 
display, and much talk, to do no good after all. 
45. In the first place, the structure of the spine should be known, for 
this knowledge is requisite in many diseases/' Wherefore, on the side 
turned to the belly (the anterior?} the vertebrae are in a regular line, and 
1 The description of succussion upon a ladder, here given, is remarkably lucid, 
especially when compared with a proper drawing, as given by Vidus Vidius in 
the Venice edition of the works of Galen. A copy of V. Vidius's drawing is given 
among Plates at the end of this volume. 
2 Galen, in his Commentary on this passage, inveighs against the Empirics, 
who claimed Hippocrates as belonging to their sect, while in truth he avails him- 
self on all proper occasions of logic, and, as in the present occasion, of anatomy, 
to the study of which he was much devoted. 118 
GENUINE WORKS OF HIPPOCRATES. 
are united together by a pulpy and nervous band of connection, originating 
from the cartilages, and extending to the spinal marrow.1 There are 
certain other nervous cords which decussate, are attached (to the vertebrae?), 
and are extended from both sides of them.2 But we will describe in 
another work the connections of the veins and arteries, their numbers, 
their qualities, their origin, their functional offices in particular parts, in 
what sort of sheaths the spinal marrow is inclosed, where they arise, 
where they terminate, how they communicate, and what their uses.3 On 
the opposite side (behind ?) the vertebrae are connected together by a 
ginglymoid articulation. Common cords (nerves ?) are extended to all 
parts, both those within and without.4 There is an osseous process from 
the posterior part of all and each of the vertebrae, whether greater or 
smaller; and upon these processes there are cartilaginous epiphyses, and 
from them arise nervous productions (ligaments /), akin to the external 
nerves (rovoi).'a The ribs are united to them, having their heads inclined 
rather to the inside than the out, and every one of them is articulated with 
the vertebrae; and the ribs in man are very curved, and, as it were, arched.6 
The space between the ribs and the processes of the vertebrae is filled on 
both sides by muscles, which arise from the neck and extend to the loins. 
(?) 7 The spine, longitudinally, is a straight line slightly curved; from 
the os sacrum to the great vertebra which is connected with the articula- 
tion of the femur, the spine inclines backward, for the bladder, the organs 
of generation, and the loose portion of the rectum, are situated there.8 
1 By this description is meant, apparently, the intervertebral substance, which 
is of a fibro-cartilaginous nature, and retains all the vertebrie together. 
2 Galen, in his Commentary, understands by "nervous cords" the spinal 
nerves. M. Littre, however, understands by them the anterior common ligament 
and the posterior common ligament. 
3 It will be remarked, from this passage, that our author had devoted an es- 
pecial work to anatomy. How singular, after all this, that he should have been 
represented as being both ignorant and regardless of anatomical science ! 
4 Ruffus Ephesius divides the nerves into classes, as follows: Nevpa pev, ra /iev 
art' Kat vuTtaiov, TrpaKTiKa Kat Kat irpoatpertKa, Kai r6vot. (De Part. 
Horain.) He makes a distinction, then, between the nerves of election (voluntary 
motion and the tovol. Galen, however, in his Commentary, rather inclines to 
the opinion that they are the same. 
5 Some parts of this description are obscure, and unfortunately the Commen- 
tary of Galen is imperfect. 
6 According to Galen, the ribs in man are more curved than in any other 
animal, and next to man those of the monkey. The reading in the latter clause 
of this sentence is in a very unsettled state. See Galen, Littr6, and Foes. 
7 Galen finds considerable difficulty in reconciling this description with the 
actual appearances on dissection. As far as I can see, after weighing the remarks 
of Galen and Littre, the description applies to the muscles of the back, which run 
along the spine. 
8 By the great vertebra would seem to be meant the fifth lumbar vertebra. 
See Galen's Commentary, and LittrG's note on this passage. Mention is made of 
it also in the Mochlicus. On other matters connected with this sentence, the philo- ARTICULATIONS. 
119 
From this, to the attachment of the diaphragm, the spine inclines inward, 
and this portion alone, from the internal parts, gives origin to muscles, 
which are called psoce. From this to the great vertebra {seventh cervical ?) 
which is above the tops of the shoulders, it is convex behind lengthways; 
but it is more in appearance than it really is, for the spinous processes 
are highest in the middle, and less so above and below.1 The region of 
the neck is convex before. 
46. In cases of displacement backward along the vertebrae, it does not 
often happen, in fact, it is very rare, that one or more vertebrae are torn 
from one another and displaced. For such injuries do not readily occur, 
as the spine could not easily be displaced backward but by a severe injury 
on the fore part through the belly2 (which would prove fatal), or if a 
person falling from a height should pitch on the nates, or shoulders (and 
even in this case he would die, but not immediately); and it also would 
not readily happen that such a displacement could take place fprward, 
unless some very heavy weight should fall upon it behind; for each of the 
posterior spinal processes is so constructed, that it would sooner be broken 
than undergo any great inclination forward from a force which would 
have to overcome the ligaments and the articulations mutually connecting 
them. And the spinal marrow would suffer, if from the displacement of 
a vertebra it were to be bent even to a small extent; for the displaced 
vertebra would compress the spinal marrow, if it did not break it; and if 
compressed and strangled, it would induce insensibility of many great and 
important parts, so that the physician need not give himself any concern 
about rectifying the displacement of the vertebra, accompanied, as it is, 
by many other ill consequences of a serious nature. It is evident, then, 
that such a case could not be reduced either by succussion or by any 
other method, unless one were to cut open the patient, and then, having 
introduced the hand into one of the great cavities, were to push outward 
from within, which one might do on the dead body, but not at all on the 
living.3 Wherefore, then, do I write all this? Because certain persons 
fancy that they have cured patients in whom the vertebra had undergone 
complete dislocation forward. Some, indeed, suppose that this is the 
easiest of all these dislocations to be recovered from, and that such cases 
do not stand in need of reduction, but get well spontaneously. Many are 
ignorant, and profit by their ignorance, for they obtain credit from those 
logical reader may find it interesting to consult Erotian, under yovr/, in the edition 
of Frantzius. 
1 The great vertebra above the tops of the shoulders can mean only the seventh 
cervical vertebra. 
2 The term belly (KoMrf) is applied by our author both to the thoracic and ab- 
dominal cavity. See Erotian. in voce koMtj; and Th. Bartholinus, Anatom, ii. 
3 From the manner in which our author here expresses himself, it must be 
pretty obvious that he had no repugnance to human dissection. 120 
GENUINE WORKS OF HIPPOCRATES. 
about them. These are deceived in this way, for they suppose the spinous 
processes to be the vertebrae themselves, because every one of them appears 
round to the touch, not knowing that these bones are processes from the 
vertebrae, as formerly stated; but the vertebrae are at a considerable 
distance before them; for of all animals, man, in proportion to his bulk, 
has the belly (internal cavity f) the narrowest from behind to before, 
especially at the breast. When, therefore, any of these processes are 
severely fractured, whether one or more, the part there appears lower 
than on eithei- side, and for that reason they are deceived, supposing that 
the vertebra; are displaced inward. And the attitudes of the patient con- 
tribute also to deceive them; for if they attempt to put themselves into a 
bent position, they are pained, from the skin being stretched at the seat 
of the injury, and at the same time the fragments of the bones wound the 
skin still more; but if they bend forward, they feel easier, for the skin at 
the wound is thus relaxed, and the bones are less disposed to hurt them; 
and if touched, they shrink and bend forward, and the part which is 
touched appears empty and soft. All the circumstances now mentioned 
contribute to deceive the physician. Such patients speedily get well 
without any bad effects, for callus readily forms in all such bones as are 
porous.1 
47. There are many varieties of curvature of the spine even in persons 
who are in good health; for it takes place from natural conformation and 
from habit, and the spine is liable to be bent from old age, and from 
pains. Gibbosities (or projections backward) from falls generally take 
place when one pitches on the nates, or falls on the shoulders. In this 
case some one of the vertebra? must necessarily appear higher than natural, 
and those on either side to a less degree; but yet no one generally 
has started out of the line of the others, but every one has yielded a 
little, so that a considerable extent of them is curved. On this account 
the spinal marrow easily bears such distortions, because they are of 
a circular shape, and not angular. The apparatus for the reduction 
in this case must be managed in the following manner:2 a strong and 
broad board, having an oblong furrow in it, is to be fastened in the 
ground, or, in place of the board, we may scoop out an oblong fur- 
1 It is singular that recent authorities are divided in opinion respecting the 
comparative frequency of fracture of the spinous processes, and of the body of the 
vetebrse. Thus Chelius, like Hippocrates, holds that the spinous processes, 
are most subject to fracture ; while his English editor, Mr. South, maintains, on 
the other hand, that fracture of the processes alone is of much less frequency than 
fracture of the body of the vertebrae. I have seen both, but cannot pretend to de- 
cide as to their comparative frequency. 
2 The description here given of the process of applying extension and counter- 
extension to the spine is remarkably clear, and easily understood when illustrated 
by a proper drawing. See Vidus Vidius and Littre ; also Paulus B. 
VI., 117. ARTICULATIONS. 
121 
row in the wall, about a cubit above the floor, or at any suitable height, 
and then something like an oaken bench, of a quadrangular shape, 
is to be laid along (the wall ?) at a distance from the wall, which will 
admit of persons to pass round if necessary, and the bench is to be covered 
with robes, or anything else which is soft, but does not yield much; and 
the patient is to be stoved with vapor, if necessary, or bathed with much 
hot water, and then he is to be stretched along the board on his face, with 
his arms laid along and bound to his body; the middle, then, of a thong 
which is soft, sufficiently broad and long, and composed of two cross 
straps of leather, is to be twice carried along the middle of the patient's 
breast, as near the armpits as possible, then what is over of the thongs at 
the armpits is to be carried round the shoulders, and afterward the ends 
of the thong are to be fastened to a piece of wood resembling a pestle; 
they are to be adapted to the length of the bench laid below the patient, 
and so that the pestle-like piece of wood resting against this bench may 
make extension. Another such band is to be applied above the knees 
and the ankles, and the ends of the thongs fastened to a similar piece of 
wood; and another thong, broad, soft, and strong, in the form of a 
swathe, having breadth and length sufficient, is to be bound tightly round 
the loins, as near the hips as possible; and then what remains of this 
swathe-like thong, with the ends of the thongs, must be fastened to the 
piece of wood placed at the patient's feet, and extension in this fashion is 
to be made upward and downward, equally and at the same time, in a 
straight line. For extension thus made could do no harm, if properly 
performed, unless one sought to do mischief purposely. But the physi- 
cians, or some person who is strong, and not uninstructed, should apply 
the palm of one hand to the hump, and then, having laid the other hand 
upon the former, he should make pressure, attending whether this force 
should be applied directly downward, or toward the head, or toward the 
hips. This method of applying force is particularly safe; and it is also 
safe for a person to sit upon the hump while extension is made, and 
raising himself up, to let himself fall again upon the patient. And there 
is nothing to prevent a person from placing a foot on the hump, and 
supporting his weight on it, and making gentle pressure; one of the men 
who is practiced in the palestra would be a proper person for doing this in 
a suitable manner. But the most powerful of the mechanical means is 
this: if the hole in the wall, or in the piece of wood fastened into the 
ground, be made as much below the man's back as may be judged proper, 
and if a board, made of lime-tree, or any other wood, and not too narrow, 
be put into the hole, then a rag, folded several times or a small leather 
cushion, should be laid on the hump; nothing large, however, should be 
laid on the back, but just as much as may prevent the board from giving 
unnecessary pain by its hardness; but the hump should be as much as 
possible on a line with the hole made in the wall, so that the board intro- 122 
GENUINE WORKS OF HIPPOCRATES. 
duced into it may make pressure more especially at that spot. When 
matters are thus adjusted, one person, or two if necessary, must press 
down the end of the board, whilst others at the same time make extension 
and counter-extension along the body, as formerly described. Extension 
may also be made with axles, which may either be fastened in the ground 
beside the bench, or the post of the axles may be attached to the bench 
itself, if you will make them perpendicular and overtopping (the bench ? ) 
a little at both ends, or at either end of the bench. These powers are 
easily regulated, so as to be made stronger or weaker, and they are of such 
force, that if one were to have recourse to them for a mischievous 
purpose, and not as a remedy, they would operate strongly in this way also; 
for by making merely extension and counter-extension longitudinally, 
without any additional force, one might make sufficient extension; and 
if, without making extension at all, one were only to press down properly 
with the board, sufficient force might be applied in this way. Such 
powers, then, are excellent which admit of being so regulated, that they 
can be made weaker and stronger as required. And the forces are applied 
in the natural way; for the pressure above forces the displaced parts into 
their place. Natural extension restores parts which have come too near 
one another to their natural position. I, then, am acquainted with no 
powers which are better or more appropriate than these; for extension 
along the spine downward has no proper hold at the bone called the os 
sacrum; and extension upward, along the neck and head, has indeed a 
hold; but extension thus made is unseemly to behold, and, besides, if 
increased, may occasion much mischief otherwise. I once made trial of 
the following plan. Having placed the patient on his back, I put below 
the hump a bladder, not inflated, and afterward introduced air into the 
bladder by means of a brass pipe connected with it. But the experiment 
did not succeed; for, when the man was fairly extended, the bladder 
yielded, and the air could not be forced into it; and, besides, the hump 
of the patient was apt to slip off the distended bladder when they were 
pressed together. But when I did not extend the man strongly, the 
bladder was swelled up by the air, and the man became more bent forward 
than proper. I have written this expressly; for it is a valuable piece of 
knowledge to learn what things have been tried and have proved in- 
effectual, and wherefore they did not succeed.1 
48. In curvatures forward of the vertebrae from a fall, or from some 
heavy body falling upon them, in general no one of them is displaced far 
beyond the others, but if one or more be so displaced, the case proves 
1 This is another example of our author's great candour in proclaiming his own 
mistakes for the benefit of posterity. It puts one in mind of our Sydenham's 
naive admission in his treatise on Dropsy, that he, on one occasion, fairly com- 
mitted himself by adhering too exclusively to the Rhamnus catharticus in the 
cure of that disease. ARTICULATIONS. 
123 
fatal; but, as formerly stated, the displacement is circular, and not 
angular. In such cases, then, the urine and feces are more apt to be 
retained than in displacement outward, the feet and the whole inferior 
extremities are colder, and the symptoms are more fata] than in the 
former case; and if they do survive, thev are more subject to retention of 
the urine, and to loss of strength, and to torpor in their legs. But if the 
displacement be in the upper part, they experience loss of strength and 
torpor of the whole body. I know no mechanical contrivance by which 
such a displacement could be reduced, unless that one might be benefited 
by succussion on a bladder, or any other similar plan of treatment, such 
as extension, as formerly described. I am not aware of any mode of 
pressure which might be applied along with the extension, like that of the 
board in displacement backward; for how could one apply pressure from 
before through the belly ? (internal cavity ?) The thing is impossible. 
But neither coughing nor sneezing has any power so as to co-operate with 
the extension, nor would the injection of air into the bowels have any 
effect. And to apply large cupping instruments with the view of drawing 
back the vertebrae which have protruded forward, shows a great error of 
judgment; for they rather propel than attract, and those who apply them 
are not aware even of this fact, for the greater will be tlie inclination 
forward the greater the instrument applied, the skin being forcibly drawn 
into the cupping-instrument. I could tell of other modes of succussion 
than those formerly described, which one might fancy would be more 
applicable in such an affection; but I have no great confidence in them, 
and therefore I do not describe them. On the main, it should be known, 
respecting the accidents which I have briefly described, that displacements 
forward are of a fatal and injurious nature; but that displacements back- 
ward, for the most part, do not prove fata], nor occasion retention of 
urine nor torpor of the limbs, for they do not stretch the ducts leading 
toward the intestines, nor occasion obstruction of the same; but displace- 
ments forward produce both these bad effects, and many others in addi- 
tion. And truly they are more apt to lose the power of their legs and 
arms, to have torpor of the body, and retention of urine, who experience 
no displacement either forward or backward, but merely a violent con- 
cussion along the spine, while those who have displacement backward are 
least subject to these symptoms.1 
49.2 And one might observe many other instances in medicine, of 
1 The subject of dislocations of the vetebrae is still obscure, notwithstanding 
the labors of recent authorities in illustration of it. See in particular the surgical 
works of Mr. Samuel Cooper, Sir Charles Bell, and Chelius. It will be remarked 
that our author still sticks to his favorite opinion, that fractures of bones in all 
parts of the body are less formidable than contusions. 
2 Oui' author now enters upon the treatment of injuries of the chest; and here 
again the professional reader will be struck with the similarity of his views re- 124 
GENUINE WORKS OF HIPPOCRATES. 
considerable injuries not proving serious, but producing a crisis in some 
affection, while less considerable injuries prove more serious, give rise to 
chronic diseases, and extend their effects to the whole system. Now some- 
thing similar may happen in fracture of the ribs; for in fracture of one 
or more ribs, in general, if the fractured bones are not driven inward, 
nor are kid bare, fever rarely supervenes, neither does it often happen 
that there is haemoptysis, empyema, any suppurating sores, which require 
treatment with pledgets, nor necrosis of the bones; and in these cases the 
ordinary regimen is sufficient. For, unless they be seized with continual 
fever, a strict diet does more harm than good, by inducing inanition, and 
increasing the pain, fever, and cough; for moderate fullness of the intes- 
tines has a tendency to replace the ribs, while evacuation leads to suspen- 
sion of the ribs, and suspension induces pain. Ordinary bandaging, ex- 
ternally, is sufficient in such cases; the bandages should be applied mod- 
erately tight, along with cerate and compresses, or a pad of wool may be 
applied. The rib is consolidated in twenty days, for callus soon forms 
in such bones. 
50. But when there is contusion of the flesh about the ribs, either 
from a blow, or a fall, or a bruise, or any like cause, there is often copious 
vomiting of blood, for there are canals stretched along the vacuity of each 
rib (intercostal space?), and nerves proceeding from the most important 
parts of the body have their origin there.1 Many of these, therefore, are 
troubled with coughs, tubercles, empyema, external suppurations, and 
sphacelus of the ribs. And even when no such symptoms supervene from 
contusion of the skin about the ribs, still in such cases there is, generally, 
more combined pain than in fractures of the ribs, and relapses of pain in 
the seat of the injury are more apt to occur. Wherefore some physicians 
pay much less attention to such injuries, than where the rib is fractured, 
whereas, if they were wise, they would treat such cases with far greater 
care than the other; for it is proper that the diet should be restricted, 
that the patients should, remain at rest as much as possible, and abstain 
from venery, from fat articles of food, from such as excite cough, and 
from everything strong; they should be bled in the arm, speak as little 
as possible, should have the contused part bound round with folded com- 
presses, plenty of bandages, broader than the contusion, and which should 
be smeared with cerate; in applying the bandages, broad and soft shawls 
should be used, and they should be put on moderately firm, so that the 
specting them to those laid down by him on the subject of injuries of the head. 
Thus severe contusions of the chest are held to be more dangerous than fractures 
attended with displacement of the fractured portions of bone. 
1 By canals (or passages), Galen says our author meant arteries and veins. 
These, he adds, have their origin from "a most important part," namely, the heart; 
while the nerves (rovot) are derived from the corresponding part of the spinal mar- 
row; and are further connected with anothei' class of nerves derived from the brain. ARTICULATIONS. 
125 
patient will say that they are neither too tight nor loose, and the band- 
aging should commence at the seat of the injury, and be made more 
particularly tight there, and the bandaging should be conducted as is 
done with a double-headed roller, so that the skin about the ribs may not 
be ruffled, but may lie smooth, and the bandaging should be renewed 
every day, or every alternate day. It is better also to open the bowels 
with some gentle medicine, so as just to produce an evacuation of the food, 
and the diet is to be restricted for ten days, and then the body is to be 
recruited and filled up; while you are upon the reducing system, the 
bandaging should be tighter, but when you are making him up again, it 
must be looser; and, if he spit blood from the commencement, the treat- 
ment and bandaging should be continued for forty days; but if there be 
no haemoptysis, treatment for twenty days will generally be sufficient; but 
the length of time must be regulated by the magnitude of the injury. 
When such contusions are neglected, if no greater mischief result there- 
from, at all events the bruised part has its flesh more pulpy than it had 
formerly.1 When, therefore, any such thing is left behind, and is not 
properly dissipated by the treatment, it will be worse if the mucosity be 
lodged near the bone, for the flesh no longer adheres to the bone as for- 
merly, the bone becomes diseased, and chronic sloughings of the bone in 
many cases arise from such causes. But if the mischief be not upon the 
bone, but it is the flesh itself which is pulpy, relapses and pains will re- 
turn from time to time, if there happen to be any disorder in the body; 
wherefore proper bandaging, and for a considerable time, must be had re- 
course to, until the extravasated blood forming in the bruise be dried up 
and absorbed, and the part be made up with sound flesh, and the flesh 
adhere to the bone. The best cure is the cautery in those cases which, 
from neglect, have become chronic, and the place turns painful, and the 
flesh is pulpy. And when the flesh itself is pulpy, the burning should 
be carried as far as the bone, but the bone itself should not be heated; 
but if it be in the intercostal space, you need not make the burning so 
superficial, only you must take care not to burn quite through. But if 
the contusion appear to be at the bone, if it be still recent, and the bone 
has not yet become necrosed, if it be very small, it is to be burned as has 
been described; but if the rising along the bone be oblong, several eschars 
are to be burned over it. Necrosis of the rib will be described along with 
the treatment of suppurating sores. 
51. There are four modes of dislocation at the hip-joint: of which 
modes, dislocation inward takes place most frequently, outward, the most 
1 The description here given of the swellings, both in the fleshy and solid parts 
of the chest, which are the usual consequences of a neglected injury, is so clear as 
not to require any elucidation. The treatment, I need scarcely add, is founded on 
most rational principles. 126 
GENUINE WORKS OF HIPPOCRATES. 
frequently of all the other modes;1 and it sometimes takes place back- 
ward and forward, but seldom. When, therefore, dislocation takes 
place inward, the leg appears longer than natural, when compared with 
the other leg, for two reasons truly; for the bone which articulates with 
the hip-joint is carried from above down to the ischium where it rises up 
to the pubes, upon it, then, the head of the femur rests, and the neck of 
the femur is lodged in the cotyloid foramen ( foramen thyroideum .^).2 
The buttock appears hollow externally, from the head of the thigh-bone 
having shifted inward, and the extremity of the femur at the knee is 
turned outward, and the leg and foot in like manner. The foot then 
being turned outward, physicians, from ignorance, bring the sound leg to 
it and not it to the sound leg; on this account, the injured limb appears 
to be much longer than the sound one, and in many other cases similar 
circumstances lead to error in judgment. Neither does the limb at the 
groin admit of flexion as in the sound limb, and the head of the bone is 
felt at the perineum too prominent. These, then, are the symptoms at- 
tending dislocation of the thigh inward. 
52. When, then, a dislocation has not been reduced, but has been 
misunderstood or neglected, the leg, in walking, is rolled about as is the 
case with oxen, and the weight of the body is mostly supported on the 
1 It will be remarked that our author states that dislocation inward is more 
frequent than any of the other modes of displacement, in which statement he is 
supported by Celsus, Paulus and most of the ancient authorities. This 
is at variance with the experience of Sir Astley Cooper, who found dislocation up- 
ward, that is to say, upon the dorsum of the ilium, the most frequent of all. 
And here I must take an opportunity of correcting a mistake into which I perceive 
that I have fallen, in my Commentary on Paulus ACguneta, B. VI., 118, where, 
through an oversight, I represent Hippocrates as holding that dislocation outward 
is the most common of all. His language is so laconic, that I might be excused 
for having committed this mistake: but if I had read the commentaries of Galen 
and Apollonius carefully at the time, I should have seen my error. Veram opere 
in longo fas est obrepere somnum ! 
2 Galen admits that, at first sight, there is a slight obscurity in this description; 
but he maintains that if any one will read the passage two or three times, he will 
not fail to apprehend the meaning. The two reasons for the lengthening of the 
limb resolve themselves very much into one, namely, that the head of the femur 
decends from a higher situation, and is lodged below on a bone. Perhaps, how- 
ever, it may be held rather arbitrary to apply the term kotvXt/ to the thyroid fora- 
men. I know not, however, how to make sense of the passage otherwise, unless 
by a conjectural emendation. If instead of ettZ rf/q Korv/.r/q we were permitted to 
read avrd, the meaning would obviously be, that " the neck of the femur is carried 
downward from the acetabulum." The interpretation which M. LittiA gives does 
not at all satisfy me. It is as follows: " 6 bri rf/q Korvfyq oxeetu, c'est-a-dire, 
que le col est appuye sur le rebord de la cavity cotyloide, est retenu par ce rebord, 
et de la sorte maintient la tete dans la nouvelle position etl'empeche de remon- 
te r." But this interpretation does not appear to me consistent with the facts of 
the case; for the head of the femur is not fixed at the border of the acetabulum, 
nor, if it were, could the lengthening of the limb be thereby accounted for. ARTICULATIONS. 
127 
sound leg,1 and the limb at the flank, and the joint where the dislocation 
has occurred is necessarily hollow and bent, while on the sound side the 
buttock is necessarily rounded.2 For if one should walk with the foot of 
the sound leg turned outward, the weight of the body would be thrown 
upon the injured limb, but the injured limb could not carry it, for how 
could it ? One, then, is forced in walking to turn the leg inward, and not 
outward, for thus the sound leg best supports its own half of the body, 
and also that of the injured side. But being hollow at the flank and the 
hip-joint, they appear small in stature, and are forced to rest on a staff at 
the side of the sound leg. For they require the support of a staff there, 
since the nates inclines to this side, and the weight of the body is carried 
to it. They are forced also to stoop, for they are obliged to rest the hand 
on the side of the thigh against the affected limb; for the limb which is 
injured cannot support the body in changing the legs, unless it be held 
when it is applied to the ground. 'They who have got an unreduced dis- 
location inward are forced to put themselves into these attitudes, and this 
from no premeditation on their part how they should assume the easiest 
position, but the impediment itself teaches them to choose that which is 
most conformable to their present circumstances. For persons who have 
a sore on the foot or leg, and cannot rest upon the limb, all, even children, 
walk in this way; for they turn the injured limb outward in walking, and 
they derive two advantages therefrom, to supply two wants; the weight 
of the body is not equally thrown upon the limb turned outward, as upon 
the one turned inward, for neither is the weight in a line with it, but is 
much more thrown upon the one under the body; for the weight is in a 
straight line with it, both in walking and in the shifting of the legs. In 
this position one can most quickly turn the sound limb under the body, 
by walking with the unsound limb outward, and the sound inward. In 
the case we are now treating of, it is well that the body finds out the atti- 
tudes which are the easiest for itself. Those persons, then, who have not 
attained their growth at the time when they met with a dislocation which 
is not reduced, become maimed in the thigh, the leg, and the foot, for 
neither do the bones grow properly, but become shortened, and especially 
the bone of the thigh; and the whole limb is emaciated, loses its muscu- 
11 can state, from familiar acquaintance with a case of unreduced dislocation 
on the thyroid foramen, that this is a most correct description of the appearances 
which it presents. The increased length of the limb and the inflexibility of the 
limb at the groin are the strongly marked symptoms. 
2 The meaning here is somewhat obscure, but I take it to be this: that in the 
lumbar region, and the region of the hip-joint, the parts are atrophied from want 
of the usual exercise (agreeably to a law which Hippocrates has frequently incul- 
cated); whereas the same parts on the opposite side are unusually plump, as be- 
ing subjected to extra work. Hippocrates frequently states this as a law in the 
animal economy. 128 
GENUINE WORKS OF HIPPOCRATES. 
larity, and becomes enervated and thinner, both from the impediment at 
the joint, and because the patient cannot use the limb, as it does not lie 
in its natural position, for a certain amount of exercise will relieve exces- 
sive enervation, and it will remedy in so far the deficiency of growth in 
length. Those persons, then, are most maimed who have experienced 
the dislocation in utero, next those who have met with it in infancy, and 
least of all, those who are full grown.1 The mode of walking adopted by 
adults has been already described; but those who are children when this 
accident befalls them, generally lose the erect position of the body, and 
crawl about miserably on the sound leg, supporting themselves with the 
hand of the sound side resting on the ground. Some, also, who had 
attained manhood before they met with this accident, have also lost the 
faculty of walking erect. Those who were children when they met with 
the accident, and have been properly instructed, stand erect upon the 
sound leg, but carry about a staff, which they apply under the armpit of 
the sound side, and some use a staff in both arms; the unsound limb they 
bear up, and the smaller the unsound limb, the greater facility have they 
in walking, and their sound leg is no less strong than when both are 
sound. The fleshy parts of the limb are enervated in all such cases, but 
those who have dislocation inward are more subject to this loss of strength 
than, for the most part, those who have it outward. 
53. Some tell a story how the Amazonian women dislocate the joints 
of their male children while mere infants, some at the knee, and others 
at the hip-joint, that they may be maimed, and that the male sex may 
not conspire against the female, and that they use them as artisans to 
perform any sedentary work, such as that of a shoemaker or brazier.2 
11 cannot refrain from calling the attention of the reader co me fullness and 
completeness of our author's description in this place. Where else shall we find 
so much interesting and important information on this subject? Sir Astley 
Cooper was fond of exalting his discoveries in practical surgery by representing 
the profession as having been totally ignorant of dislocations at the hip-joint be- 
fore his time; but it may be much doubted if even he was so well acquainted with 
the subject in all its bearings as Hippocrates in this place shows himself to have 
been. A g-ood deal of interesting information on the subject of congenital dislo- 
cation at the hip-joint has been collected, however, since the death of Sir Astley 
Cooper, more especially by Dupuytren, R. Smith, and Chelius. The first of these 
has given a very circumstantial description of the appearances which the limbs 
present in a case of congenital dislocation. See his work, On Injuries of the 
Bones, lately reprinted by the Sydenham Society. 
2 The myth of the Amazons is fully treated of in the Argument to the treatise 
On Airs, etc. In this place it will be remarked that our author declines giving an 
opinion whether he regarded the vulgar belief as being well founded or not. 
There seems no good reason, then, for holding, with Gruner, that the views main- 
tained regarding this myth in these two treatises are totally different, and indicate 
a distinct authorship. ARTICULATIONS. 
129 
Whether these things be true or not I do not know, but this I know, that 
matters would be such as is represented, provided their children, while 
infants, were to have their joints dislocated. The consequences of dislo- 
cation inward at the hip-joint are much greater than of dislocation out- 
ward at the hip-joint, but at the knee, although there be some difference, 
it is less; but the mode of either impediment is peculiar, their legs are 
more bandied when the dislocation is outward, but those who have dislo- 
cation inward stand erect on their feet with less freedom. In like manner, 
when the dislocation is at the ankle-joint, if outward they become vari 
(their toes are turned inward?), but they can stand; but if the dislocation 
be inward they become valgi (their toes are turned outward?), but they 
have less freedom of standing. The proportional growth of their bones 
is as follows: in those cases in which the bone of the leg is dislocated, the 
bones of the feet grow very little, as being very near the injury, but the 
bones of the leg increase in size, and«with very little defect, but the fleshy 
parts (muscles ?) are wasted. But when the ankle-joint is in its natural 
state, but the knee is dislocated, in these cases the bones of the leg do not 
grow in like mannor, but become shortened, as being nearest the seat of 
the injury, and the bones of the feet also are atrophied, but not in the 
same proportion; because, as was said a little while ago, the ankle-joint is 
safe, and if they could use it, as in the case of club-foot, the bones of the 
foot would be still less atrophied. When the dislocation takes place at 
the hip-joint, the bone of the thigh, in this case, does not generally grow 
in like manner, as being the one nearest the seat of the injury, but be- 
comes shorter than the sound one; but the growth of the bones of the 
leg is not arrested in like manner; nor of those of the feet, for this rea- 
son, that there is no displacement between the bones of the thigh and 
leg, nor between those of the leg and foot; in those cases, however, the 
fleshy parts of the whole limb are atrophied; but if they could make use 
of the limb, the growth of the bones would be still more developed, as 
formerly stated, only the thigh, although its flesh would be much less 
wasted, would still be by no means so fleshy as the sound limb. The fol- 
lowing observations are a proof of this: those persons who are weasel- 
armed (galiancones) from birth, owing to dislocation of the humerus, or 
when the accident has happened to them before they have attained their 
full growth, such persons have the bone of the arm shortened, but those 
of the fore-arm and hand are little inferior in size to the sound, for the 
reasons which have been stated, because the humerus is the bone 
nearest to the joint affected, and, on that account, it is shorter than 
natural; but the fore-arm is not equally affected by the accident, because 
the joint at which the bones of the arm and fore-arm are articulated re- 
mains in its natural condition, and the hand is still further distant than 
the fore-arm from the seat of the injury. Such are the reasons why cer- 
tain of the bones in this case increase in growth, and certain do not. The 
Vol. IL-9. 130 
GENUINE WORKS OF HIPPOCRATES. 
laborious office of the hand contributes much to the development of the 
flesh in the fore-arm and hand, for whatever work is done by the hand, 
these weasel-armed persons strive to do no less effectually with the other 
hand than with the sound; for the arms do not support the weight of the 
body like the legs, and the work performed by them is light. From ex- 
ercise, then, the fleshy parts on the hand and fore-arm are not atrophied 
in weasel-armed persons, and by these means the arm, too, gains flesh. 
But in dislocation inward at the hip-joint, whether from birth or from 
childhood, the fleshy parts, on that account, are much more atrophied 
than those of the hand, because the patients cannot exercise the leg. An- 
other proof will be given in the observations which will be presently stated, 
that these things are such as I have represented.1 
54. When the head of the femur is dislocated outward, the limb in 
these cases, when compared with the other, appears shortened, and this 
is natural, for the head of the femur no longer rests on a bone as in dis- 
location inward, but along the side of a bone which naturally inclines to 
the side, and it is lodged in flesh of a pulpy and yielding nature, and on 
that account it appears more shortened. Inwardly, the thigh about the 
perineum appears more hollow and flabby, but externally the buttock is 
more rounded, from the head of the thigh having slipped outward, but 
the nates appear to be raised up, owing to the flesh there having yielded 
to the head of the thigh-bone; but the extremity of the thigh-bone, at the 
knee, appears to be turned inward, and the leg and foot in like manner, 
neither does it admit of flexion like the sound limb. These, then, are the 
symptoms of dislocation outward.2 
55. When such a dislocation is not reduced in adults, the whole limb 
appears to be shortened, and in walking they cannot reach the ground 
with the heel, but they walk with the ball of the foot on the ground, and 
the points of their toes incline a little inward. But the injured limb, in 
this case, can support the body much better than in dislocation inward, 
both because the head of the femur and the neck of its articular extrem- 
ity, being naturally oblique, have formed a bed under a considerable portion 
of the hip, and because the extremity of the foot is not forcibly turned 
outward, but is nearly in a line with the body, and is even inclined more 
inwardly. When, then, the articular extremity of the femur has worn 
out a socket for itself in the flesh where it was lodged, and the flesh is 
lubricated, it ceases to be painful in the course of time, and when it be- 
comes free from pain, they can walk without a staff, if so inclined, and 
1 See § 55. 
2 The symptoms in this case are reported with a remarkable degree of accuracy. 
Celsus gives a very elegant version of this passage: "Si in exteriorem, brevius, 
varumque fit, et pes intus inclinatur; calx ingressu terram non contingit, sed 
planta ima; meliusque id crus superius corpus, quam in priore casu, fert, minusque 
baculo eget." (viii., 20.) ARTICULATIONS. 
131 
they can support the body on the injured limb. From usage then, in 
such cases, the fleshy parts are less enervated than in those which have 
been mentioned a little before, still, however, they lose their strength 
more or less; but in general there is more enervation when the disloca- 
tion is inward than when it is outward. Some of them, then, cannot 
wear their shoes, owing to the unbending state of their leg, and some of 
them can. But when this dislocation takes place in utero, and when the 
dislocation having occurred at any time before manhood, from violence, 
has not been replaced, or when from disease the articular extremity has 
started from Its socket, and is displaced (for many such cases occur, and 
from some of them, if the femur become necrosed, obstinate suppurations 
requiring the use of tents are formed, and in certain of them the bone is 
laid bare), whether the bone become necrosed or not, the bone of the 
thigh is much shortened, and does not usually grow like the sound one, 
the bones, too, of the leg, become shorter than those of the other, but in 
a small degree, for the same reasons that were formerly stated; such per- 
sons can walk, some of them in the same fashion as adults having an un- 
reduced dislocation, and some of them walk with the whole foot on the 
ground, but limp in walking, being obliged to do so by the shortness of 
the limb. Such is the result, even though they be carefully and properly 
trained in the attitudes before they have strength for walking, and in like 
manner also, after they have acquired the necessary strength; but those 
persons require the most care who were very young when they met with 
the accident, for, if neglected while children, the limb becomes entirely 
useless and atrophied. The fleshy parts of the entire limb are more 
wasted than those of the sound limb, but this is much less apt to happen 
in their case than in dislocation inward, owing to usage and exercise, as 
they are speedily able to make use of the limb, as was stated a little before 
with regard to the weasel-armed (galiancones').' 
56. There are persons who, from birth or from disease, have disloca- 
tions outward of both the thighs; in them, then, the bones are affected 
in like manner, but the fleshy parts in their case lose their strength less; 
the legs, too, are plump and fleshy, except that there is some little defi- 
ciency at the inside, and they are plump because they have the equal use 
11 would merely call the attention of the reader to this admirable account of 
the consequences resulting from an unreduced dislocation of the thigh backward. 
Congenital dislocation, dislocation from disease, and dislocation from violence, 
all these modes are described, and their after-consequences most faithfully re- 
corded. I may add, that none of the ancient commentators or authorities supply 
any additional information on this interesting subject. Indeed, after the lapse of 
twenty-four centuries, there is little to add to the observations of the Coan sage. 
The labours of Heine and Guerin have supplied, it is true, some new facts respect- 
ing the nature of congenital dislocation at the hip-joint; but, upon the whole, no 
one author of the present day, as far as I am aware, has given so complete a 
history of the displacements at the hip-joint as Hippocrates. 132 
GENUINE WORKS OF HIPPOCRATES. 
of both their legs, for in walking they totter equally to this side and that.1 
Their nates appear very prominent, from the displacement of the bones 
of the joint. But if in their case the bones do not sphacelate {become ca- 
rious 2 and if they do not become bent above the hip-joint, if nothing 
of this kind happen to them, they become otherwise sufficiently healthy, 
but the growth of all the rest of the body, with the exception of the head, 
is arrested.3 
57. In dislocations of the head of the femur backward, which rarely 
occur, the patient cannot extend the leg, either at the dislocated joint, 
or at the ham, to any extent, and of all the dislocations, this is the vari- 
ety in which the patients have the least power of making extension at the 
groin and the ham. But, moreover, this also should be known (for it is 
a valuable piece of knowledge, and of much importance, and yet most 
people are ignorant of it), that persons in health cannot extend the joint 
at the ham, if they do not extend the joint at the groin at the same time, 
unless they raise the foot very high, for in this way they could do it; 
neither also could they bend the joint at the ham, but with much greater 
difficulty, if they do not bend the joint at the groin at the same time. 
There are many other things in the body which have similar connections, 
both with regard to the contractions of nerves {ligaments ?), and the posi- 
tions of muscles, and many of them more worthy of being known than is 
generally supposed, and with regard to the nature of the intestine and 
that of the whole internal cavity, and with regard to the displacements 
and contractions of the uterus; but all these things will be treated of 
elsewhere, in a work akin to the present one. But with regard to the 
matter on hand, they cannot make extension, as has been already stated; 
and the limb appears shortened, for two reasons-first, because it cannot 
be extended, and also because the bone has slipped into the flesh of the 
nates; for the head and neck of the femur, in this dislocation, are carried 
downward from their natural situation, to the outside of the nates.4 But 
yet they can bend the limb, unless prevented by pain, and the leg and 
1 It is now well ascertained, that in a case of dislocation on both sides, the 
walking in the course of time improves very much. See Chelius, vol. i., p. 804. 
2 It will of course be readily understood, that our author here alludes to morbus 
coxarius in infancy and early life. Galen, in his Commentary, refers the disease 
to inflammation of the ligaments of the joint, and mentions that the disease oc- 
curs also at other joints, such as the elbow, knee, and fingers, and is followed by 
ankylosis in these parts. 
3 The atrophy of all the rest of the body, with the exception of the head, is as- 
cribed by Galen to sympathy of the spinal column with the inflammation at the 
hip-joint. He strongly calls attention to the remark, that when the spine is in 
anywise affected, the whole of the body, with the exception of the head, is less de- 
veloped than it naturally is. 
4 Notwithstanding the elaborate Commentary of Galen, there is some obscurity 
in this description. The natural meaning I take to be as expressed in the text. 
See the following note. ARTICULATIONS. 
133 
foot appear pretty straight, and not much inclined toward either side, but 
at the groin the flesh, when felt, appears looser, from the bone of the joint 
having slipped to the other side, but at the nates the head of the femur 
may be felt to be more prominent than natural. Such are the symptoms 
accompanying dislocation of the thigh backward.1 
58. When this dislocation occurs in an adult, and is not reduced, he 
can walk, indeed, after a time, and when the pain has abated, and when 
he has been accustomed to rotate the articular bone in the flesh; he finds 
it necessary, however, to make strong flexion at the groin in walking, for 
two reasons, both because the limb, for the causes already stated, be- 
1 This mode of dislocation is so rarely met with, that I am happy to have it in 
my power to give a satisfactory description of it, upon the authority of an emi- 
ment anatomist in London. See History of a Case of Dislocation of the Head of 
the Femur backwards; with some Observations on that Form of Dislocation. By 
Richard Quain. Medical Gazette, No. 1077. 
" The subject of the injury, a man aged 60, was killed by a fall from a ladder, 
the cause of death being extensive fracture through the base of the skull. Con- 
siderable deformity being observed in the right lower limb, the author was in- 
duced to make a careful examination of the extremity, with a view to detect the 
nature of the injury it had sustained. It was apparently, but not really, much 
shortened; it was also inverted, and separated from the sound leg. The tro- 
chanter major was altered in its relation to the iliac spine, and the depression be- 
hind it was wanting; the head of the femur could be felt toward the back of the 
pelvis. The limb could be flexed, but not rotated outward. On removing' the 
gluteeus maximus, the head of the dislocated bone was exposed below the pyriform 
muscle, and immediately behind the acetabulum. . . . The practical infer- 
ences drawn by the author from the foregoing observations may be summed up as 
follows:-1st. In the ordinary form of dislocation backward, the femur does not 
reach the sciatic notch. 2d. The head of the bone is lodged immediately behind 
the acetabulum, over the base of the ischiatic spine, and opposite to a small part 
of the sciatic foramina. 3d. The injury would be correctly named the dislocation 
of the head of the femur backward. 4th. During the extension made to reduce 
this dislocation, the thigh is most advantageously directed across the pelvis, so 
that it shall form a right angle with the abdomen. At the same time the limb is 
to be in a state of abduction; the femur will thus be drawn away from the pelvis, 
forward and outward. The knee is to be bent, the extending force being fixed 
above the joint." From the above description it will be remarked, that the fol- 
lowing account of this form of dislocation given by Sir Astley Cooper, is not cor- 
rect on all points; indeed, it is less accurate than the description given by Hippoc- 
rates:-"In this accident there is scarcely any difference in length between the 
one leg and the other; if any, about half an inch shorter. The knee and foot are 
turned inward, but different in appearance to that of the dislocated upward; 
the foot is turned over the other, the toe resting against the upper part of the 
other foot. When any attempt is made to move it, there is scarcely any motion. 
The situation of the bone is thus:-the head of the os femoris is thrown into the 
ischiatic notch, the trochanter resting upon the side, or a little behind the aceta- 
bulum." (Surgical Lectures, 27.) It appears from Mr. Quain's dissection, that 
modern authorities have been mistaken in supposing that, in this dislocation, the 
head of the femur is lodged in the ischiatic notch. The fact is, that, as represen- 
ted by Hippocrates, the head of the femur is displaced backward. 134 
GENUINE WORKS OF HIPPOCRATES. 
comes much shorter, and he is far from touching the ground with his 
heel, and he can barely reach it with the ball of his foot, and not even 
thus, unless he bend himself at the groins, and also bend with the other 
leg at the ham. And in this case, he is under the necessity of supporting 
the upper part of the thigh with his hand at each step: this also contrib- 
utes, in a certain degree, to make him bend the body at the groins; for, 
during the shifting of the feet in walking, the body cannot be supported 
on the unsound limb, unless it be pressed to the ground by the hand,- 
the end of the femur not being placed properly under the body, but hav- 
ing slipped backward to the nates; and if he should try to rest the weight 
of his body for a little, upon the foot, without any other support, he 
would fall backward, for there would be a great inclination in this direc- 
tion, from the hips having protruded backward far beyond the line of the 
foot, and the spine inclining toward the hips. Such persons can walk, 
indeed, without a staff, if so accustomed, for because the sole of the foot 
is in its old line, and is not inclined outward, they do not require anything 
to balance them. Such, however, as, instead of grasping the thigh, pre- 
fer resting their weight upon a staff introduced into the armpit of the 
affected side, these, if they use a longer staff, will walk, indeed, more 
erect, but will not be able to reach the ground with the foot, or if they wish 
to rest upon the foot, they must take a shorter staff, and will require to 
bend the body at the groins. The wasting of the fleshy parts is analo- 
gous to what happens in the cases formerly described, for the wasting is 
greatest in those cases in which the patients keep the limb up, and do 
not exercise it, whilst those who practice walking, have the least atrophy. 
The sound leg, however, is not benefited, but is rather rendered more de- 
formed, if the injured limb be applied to the ground, for it is forced to 
co-operate with the other, being protruded at the hip, and bent at the 
ham. But if the patient does not use the injured limb by applying it to 
the ground, but carries it up, and rests upon a staff, the sound leg there- 
by gains strength, for it is employed in its natural position, and further, 
the exercise gives it strength. But it may be said, these things are for- 
eign to medicine; for what is the use of enlarging upon cases which are 
already past remedy ? This is far from being the case, for it belongs to 
the knowledge of medicine to be acquainted also with these, and they 
cannot possibly be separated from one another; for to such as are curable, 
means are to be used to prevent them from becoming incurable, studying 
how they may best be prevented from getting into an incurable state. 
And incurable cases should be known, that they may not be aggravated 
by useless applications, and splendid and creditable prognostics are made 
by knowing where, how, and when every case will terminate, and whether 
it will be converted into a curable or an incurable disease.1 When then, 
11 need scarcely remark, that nowadays it will not be questioned that a minute 
acquaintance with incurable diseases constitutes a most important part of the ARTICULATIONS. 
135 
from birth, or during one's youth, this dislocation backward occurs, and 
is not reduced, whether it be connected with violence or disease (for many 
such dislocations occur in diseases, but the nature of the diseases in which 
dislocations take place, will be described afterward); if, then, the dislo- 
cated limb be not reduced, the bone of the thigh becomes shortened, the 
whole limb is impaired, is arrested in its growth, and loses its flesh from 
want of use; the articulation at the ham is also impaired, for the nerves 
(ligaments F) become stretched, from the causes formerly stated, wherefore 
those who have this dislocation, cannot make extension at the knee-joint. 
In a word, all parts of the body which were made for active use, if mod- 
erately used and exercised at the labor to which they are habituated, be- 
come healthy, increase in bulk, and bear their age well, but when not 
used, and when left without exercise, they become diseased, their growth 
is arrested, and they soon become old. Among these parts the joints and 
nerves (ligaments if not used, are not the least liable to be so affected; 
they are impaired, then, for the reasons we have stated, more in this variety 
of dislocation than in the others, for the whole limb is wasted, both in its 
bones and in its fleshy parts. Such persons, then, when they attain their 
full growth, keep the limb raised and flexed, rest the weight of the body 
on the other leg, and support themselves with a staff, some with one, 
and others with two. 
59. In dislocations of the head of the thigh-bone forward (they are of 
rare occurrence), the patients cannot extend the leg completely, but 
least of all can they bend it at the groin; they are pained, also, if forced 
to bend the limb at the ham. The length of the leg, if compared at the 
heel, is the same as that of the other; but the extremity of the foot in- 
clines less to project forward. But the whole limb has its natural direc- 
tion, and inclines neither to this side nor to that. These cases are par- 
ticularly attended with severe pain, and they are more apt to be accom- 
panied with retention of urine at first than any of the other dislocations; 
for the head of the thigh-bone is lodged very near to important nerves. 
And the region of the groin appears swelled out and stretched, while that 
of the nates is more wrinkled and flabby. The symptoms now stated are 
those which attend this dislocation of the thigh-bone.1 
physician's knowledge, without which he can neither form an accurate diagnosis 
nor prognosis. Our author's remarkable partiality for the latter is very apparent 
in this passage. 
1 Upon reference to Sir Astler Cooper's work, On Dislocations, p. 95, it will be 
found that there is but little disagreement between his description of this form of 
dislocation and that here given by our author. To be sure, Sir Astley says, the 
limb is shortened by an inch; but probably, as stated in Mr. Quain's description 
of the state of the limb in dislocation backward, this shortening is more apparent 
than real; for, considering the situation in which the head of the femur is lodged, 
it is difficult to see how there can be any real shortening. The turning outward 
which Sir Astley remarks, must also be very slight, seeing it is altogether denied 136 
GENUINE WORKS OF HIPPOCRATES. 
60. When persons have attained their full growth before meeting 
with this dislocation, and when it has not been reduced, upon the subsi- 
dence of the pain, and when the bone of the joint has been accustomed to 
be rotated in the place where it is lodged, these persons can walk almost 
erect without a staff, and with the injured leg almost quite straight, as it 
does not admit of easy flexion at the groin and the ham; owing, then, to 
this want of flexion at the groin, they keep the limb more straight in 
walking than they do the sound one. And sometimes they drag the foot 
along the ground, as not being able to bend the upper part of the limb, 
and they walk with the whole foot on the ground; for in walking they 
rest no less on the heel than on the fore part of the foot; and if they 
could take great steps, they would rest entirely on the heel in walking; 
for persons whose limbs are sound, the greater the steps they take in 
walking, rest so much the more on the heel, while they are putting down 
the one foot and raising the opposite. In this form of dislocation, per- 
sons rest their weight more on the heel than on the anterior part of the 
foot, for the fore part of the foot cannot be bent forward equally well 
when the rest of the limb is extended as when it is in a state of flexion; 
neither, again, can the foot be arched to the same degree when the limb 
is bent as when it is extended.1 The natural state of matters is such as 
has been now described; and in an unreduced dislocation, persons walk 
in the manner described, for the reasons which have been stated. The 
limb, moreover, is less fleshy than the other, at the nates, the calf of the 
leg, and the whole of its posterior part. When this dislocation occurs in 
infancy, and is not reduced, or when it is congenital, in these cases the 
bone of the thigh is more atrophied than those of the leg and foot; but 
the atrophy of the thigh-bone is least of all in this form of dislocation. 
The fleshy parts, however, are everywhere attenuated, more especially be- 
hind, as has been stated above. If properly trained, such persons, when 
they grow up, can use the limb, which is only a little shorter than the 
other, and yet they support themselves on a staff at the affected side. 
For, not being able to use properly the ball of the foot without the heel, 
nor to put it down as some can in the other varieties of dislocation (the 
cause of which has been just now stated), on this account they require a 
staff. But those who are neglected, and are not in the practice of put- 
ting their foot to the ground, but keep the limb up, have the bones more 
by Boyer. All the modern authorities agree with Hippocrates as to the effects 
produced by the pressure of the head of the bone upon the anterior crural nerve. 
See, in particular, Chelius, vol. i., p. 797. Galen's Commentary is merely explan- 
atory of the text, which, however, is sufficiently clear for all practical purposes. 
1 The meaning of this passage would appear to be as given in the text; but it 
jnust be admitted to be somewhat obscure, owing to the use of certain unusual 
terms in it (such as KayTrvZeEcrftzt as acfj-ovaOai), the exact meaning of which is not 
very clearly explained either by Erotian or Galen. ARTICULATIONS. 
137 
atrophied than those who use the limb; and, at the articulations, the 
limb is more maimed in the direct line than in the other forms of dislo- 
cation. 1 
61. In a word, luxations and subluxations take place in different 
degrees, being sometimes greater and sometimes less; and those cases in 
which the bone has slipped or been displaced to a much greatei' extent, 
are in general more difficult to rectify than otherwise; and if not reduced, 
such cases have greater and more striking impairment and lesion of the 
bones, fleshy parts, and attitudes; but when the bone has slipped, or 
been displaced to a less extent, it is easier to reduce such cases than the 
other; and if the attempts at reduction have failed, or have been neg- 
lected, the impairment in such cases is less, and proves less injurious than 
in the cases just mentioned. The other joints present great differences 
as to the extent of the displacements which they are subject to. But the 
heads of the femur and humerus are very similar to one another as to 
their dislocations. For the heads of the bones are rounded and smooth, 
and the sockets which receive the heads are also circular, and adapted to 
the heads; they do not admit then of being dislocated in any intermedi- 
ate degree, but, from tljeir rounded shape, the bones slip either outward 
or inward. In the case we are now treating of, then, there is either a 
complete dislocation or none at ah, and yet these bones admit of being 
displaced to a greater or less extent; and the thigh is more subject to 
these differences than the arm.2 
62. Wherefore, then, some of these congenital displacements, if to a 
small extent, may be reduced to their natural condition,and especially those 
at the ankle-joint. Most cases of congenital club-foot are remediable, unless 
the declination be very great, or when the affection occurs at an advanced 
period of youth.3 The best plan, then, is to treat such cases at as early 
1 The last sentence is obscure to vie, but neither Foes nor Littre states any 
difficulty which they find about it. The latter translates it thus: "Mais chez 
ceux qui, ayant 6te negliges, n'appuient pas la jambe sur le sol et la tiennent en 
Pair, les os croissent beaucoup moins que chez ceux qui se servent de leur jambe ; 
de la meme fagon, les chairs s'atrophient bien davantage ; dans cette luxation les 
articulations de la jambe out subi une lesion qui les tientplus droites que dans les 
autres luxations de la cuisse." The sense here would agree with the context, but 
seems scarcely warranted by the original. Foes, on the other hand, gives a 
literal translation, but it is as unintelligible as the original. "Circa articulos 
autem, quod ad directionem spectat, crure ii aliquanto magis capti sunt, quam 
quibus aliter luxatio contigerit. 
21 believe all our modern authorities are agreed that there is no incomplete 
luxation of the femur. Sir Astley Cooper speaks of a partial dislocation of the 
humerus, but the nature of it does not seem to be accurately defined. 
8 Galen remarks, in his Commentary on this passage, that it is clear our 
author treats of the cure both of congenital club-foot, and of the club-foot which 
occurs in early infancy. He further adds, that his account of this affection ap- 
plies principally to the species in which the leg is distorted outward, and the 
foot turned inward, that is to say, to varus. 138 
GENUINE WORKS OF HIPPOCRATES. 
a period as possible, before the deficiency of the bones of the foot is very 
great, and before there is any great wasting of the flesh of the leg. There 
is more than one variety of club-foot, the most of them being not com- 
plete dislocations,1 but impairments connected with the habitual mainte- 
nance of the limb in a certain position. In conducting the treatment, 
attention must be paid to the following points: to push back and rectify 
the bone of the leg at the ankle from without inward, and to make coun- 
ter-pressure on the bone of the heel in an outward direction, so as to bring 
it into line, in order that the displaced bones may meet at the middle 
and side of the foot; and the mass of the toes, with the great toe, are to 
be inclined inward, and retained so;2 and the parts are to be secured, 
with cerate containing a full proportion of resin,3 with compresses, and 
soft bandages in sufficient quantity, but not applied too tight; and the 
turns of the bandages should be in the same direction as the rectifying of 
the foot with the hand, so that the foot may appear to incline a little out- 
ward.4 And a sole made of leather not very hard, or of lead, is to be 
bound on, and it is not to be applied to the skin but when you are about 
11 need scarcely remark now that our author has here exactly hit the true 
character of this impediment, which, as he says, is not a dislocation, but, origi- 
nally, a mere declination of the foot. 
2 Having lately gone through the process of curing congenital varus in both 
feet of a child a year old, I can attest to the general accuracy of the directions 
here given. From the nature of the case, it will readily be understood that the 
foot is to be pushed outward, and the leg inward, so as to bring the foot into a 
line with the leg. The only difficulty which one encounters in the description, is 
the direction that " the mass of the toes, with the great toe, should be inclined 
inward, and retained so." M. J. Guerin, so well known for his skill in ortho- 
pedy, gave M. Littre the following explanation of this manoeuvre: "Quant a 
sfw kyKliveiv, il faut le traduire par abaisser, incliner tous les orteils en dedans 
(par un mouvement d'arc de cercle sur 1'axe ant6ro-posterieur du pied). C'est la 
]e sens litteral et il exprime parfaitement ce qu'il faut faire pour la reduction du 
varus. Dans cette variete du pied-bot, le pied etant renverse sur la face externe; 
la rang6e des orteils est, comme le pied, situee verticalement et regarde en dehors; 
il convient done d'inclineur on d'abaisser les orteils en dedans et les fixer dans 
cette position." By the way, there is some mistake in this quotation,, for the 
reading in the text is not eyickiveiv (although I humbly think sfw ekkMvelv would 
be the most suitable reading), but sf to etau pipoQ eyiMvetv. The only way in 
which I can attach any proper meaning to the common reading, is by supposing 
that it refers to a very aggravated case of talipes varus, in which the foot is 
fairly turned round on its axis. In such a case, no doubt the toes would have to 
be pushed inward and downward, in the first place. But, however we may 
understand this clause, there can be no doubt that Hippocrates understood 
properly the principles upon which the treatment ought to be conducted. 
3 No doubt, as is remarked by Galen in his Commentary, the addition of resin 
to the cerate would give the bandages a greater degree of firmness and stability. 
4 That is to say-agreeably to the Hippocratic rule, cont raria contrariis 
curantur-the abnormal inclination inward is to be cured by producing for a 
time an inclination outward. ARTICULATIONS. 
139 
to make the last turns of the bandages.1 And when it is all bandaged, 
you must attach the end of one of the bandages that are used to the band- 
ages applied to the inferior part of the foot on the line of the little toe; 
and then this bandage is to be rolled upward m what is considered to be a 
sufficient degree, to above the calf of the leg, so that it may remain firm 
when thus arranged. In a word, as if moulding a wax model, you must 
bring to their natural position the parts which were abnormally displaced 
and contracted together, so rectifying them with your hands, and with 
the bandaging in like manner, as to bring them into their position, not by 
force, but gently; and the bandages are to be stitched so as to suit the 
position in which the limb is to be placed, for different modes of the de- 
formity require different positions. And a small shoe made of lead is to 
be bound on externally to the bandaging, having the same shape as the 
Chian slippers had.2 But there is no necessity for it if the parts be prop- 
erly adjusted with the hands, properly secured with the bandages, and 
properly disposed of afterward. This, then, is the mode of cure, and it 
neither requires cutting, burning, nor any other complex means, for such 
cases yield sooner to treatment than one would believe. However, they 
are to be fairly mastered only by time, and not until the body has grown 
up in the natural shape; when recourse is had to a shoe, the most suita- 
ble are the buskins, which derive their name from being used in traveling 
through mud; for this sort of shoe doesnot yield to the foot, but the foot 
yields to it. A shoe shaped like the Cretan is also suitable. 
63. In cases of complete dislocation at the ankle-joint, complicated 
with an external wound, whether the displacement be inward or outward, 
you are not to reduce the parts, but let any other physician reduce them 
if he choose. For this you should know for certain, that the patient will 
die if the parts are allowed to remain reduced, and that he will not sur- 
vive more than a few days, for few of them pass the seventh day, being 
cut off by convulsions, and sometimes the leg and foot are seized with 
gangrene.5 It should be well known that such will be the results; and 
1 The benefit of this leather sole is in reality very marked in the treatment of 
infantile club-foot. This I can attest from personal experience. 
2 Of the Chian slippers or sandals, and the buskins for traveling through mud 
or clay, Galen can give no account. See further the editors of Erotian. They 
were, no doubt, composed of stout and unyielding- materials. It is well known 
that such a boot is very useful to keep the foot in position after it has been 
rectified. 
3 Galen, in his Commentary, states that the danger of reduction consists partly 
in the additional violence inflicted on the muscles, and partly in their being then 
put into a stretched state, whereby spasms or convulsions are brought on, and 
gangrene as the result of the intense inflammation which ensues. Galen explains 
the term gangrene to mean the intermediate state between intense inflammation 
and sphacelus, the latter term being applied to the complete corruption, that is 
to say, death of apart. Celsus uses "cancer" as being synonymous with the 
term "gangrene." (viii., 25.) 140 
GENUINE WORKS OF HIPPOCRATES. 
it does not appear to me that hellebore will do any good, though admin- 
istered the same day, and the draught repeated, and yet it is the most 
likely means, if any such there be; but I am of opinion that not even it 
will be of service. But if not reduced, nor any attempts at first made to 
reduce them, most of such cases recover. The leg and foot are to be ar- 
ranged as the patient wishes, only they must not be put in a dependent 
position, nor moved about;1 and they are to be treated with pitched cerate, 
a few compresses dipped in wine, and not very cold, for cold in such cases 
induces convulsions;2 the leaves also of beet, or of colt's foot, of any such, 
when boiled in dark-colored austere wine, form a suitable application to 
the wound and the surrounding parts; and the wound may further be 
anointed with cerate in a tepid state. But if it be the winter season, the 
part is to be covered with unscoured wool, which is to be sprinkled from 
above with tepid wine and oil, but on no account is either bandage or 
compress to be applied; for this should be known most especially, that 
whatever compresses, or is heavy, does mischief in such cases. And cer- 
tain of the dressings used to recent wounds are suitable in such cases; 
and wool may be laid upon the sore, and sprinkled with wine, and allowed 
to remain for a considerable time; but those dressings for recent wounds 
which only last for a few days, and into which resin enters as an ingredi- 
ent, do not agree with them; for the cleansing of the sores is a slow pro- 
cess, and the sore has a copious discharge for a long time. Certain of 
these cases it may be advantageous to bandage. It ought also to be well 
understood, that the patient must necessarily be much maimed and de- 
formed, for the foot is retracted outward, and the bones which have 
been displaced outward protrude: these bones, in fact, not being 
generally laid bare, unless to a small extent; neither do they exfoliate, 
but they heal by thin and feeble cicatrices, provided the patient 
keeps quiet for a length of time; but otherwise there is danger that a 
small ulcer may remain incurable. And yet in the case we are treating 
of, those who are thus treated are saved; whereas, when the parts are re- 
duced and allowed to remain in place, the patients die.3 
1 Celsus translates this clause of the sentence as follows : " tantum (membrum) 
ne moveatur, neve depencleat." (viii., 25.) 
2 It will be remarked that our author only forbids the use of "very cold" ap- 
plications, from which Galen justly infers that he did not disapprove of mode- 
rately cold thing's. Galen here gives some interesting- observations on the dis- 
tinction between things which are cold to the senses, and those which are pos- 
sessed of cold or congealing qualities, such as cicuta, mandragora, and the like. 
The ancient authorities all held that narcotics are of a cold or refrigerant 
nature. 
3 Our author, it will be remarked in this and the succeeding paragraphs, lays 
down his own views respecting the treatment of compound dislocations. That he 
must have been familiar with the treatment of them there can be no doubt, from 
the precise and well-defined manner in which he describes all the phenomena re- ARTICULATIONS. 
141 
64. The same rule applies to dislocations at the wrist, attended with 
a wound and projection of the bone, whether the bones of the arm be dis- 
placed inward or outward.1 For this should be well understood, that the 
patient will die in the course of a few days, by the same mode of death 
as formerly described, if the bone be reduced, and allowed to remain so. 
But in those cases in which they are not reduced, nor any attempt made 
to reduce them, the patients, for the most part, recover; and the same 
mode of treatment as has been described will be applicable; but the defor- 
mity and impediment of the limb must necessarily be great, and the fin- 
gers of the hand will be weak and useless; for if the bones have slipped 
inward, they cannot bend the fingers, or if outward, they cannot extend 
them.2 
65. When the os tibiae, having made a wound at the knee, has pro- 
truded through the skin, whether the dislocation be outward or inward, 
in such a case, if the bone be reduced, death will be even more speedy 
than in the other cases, although speedy also in them. But the only 
hope of recovery is if you treat them without reduction. These cases are 
more dangerous than the others, as being so much higher up, as being 
so much stronger joints, and displaced from bones which are so much 
stronger. But if the os femoris form a wound at the knee, and slip 
through it, provided it be reduced and left so, it will occasion a still more 
violent and speedy death than in the cases formerly described; but if not 
reduced, it will be much more dangerous than those cases mentioned be- 
fore, and yet this is the only hope of recovery.3 
garding them. The danger of such accidents he has fairly stated, but probably 
not exaggerated. I need scarcely say that, with the modern surgeon in these un- 
fortunate cases, the first consideration is, whether or not the limb is to be taken 
off at once ; and that, even with this frightful alternative, the results have been 
by no means satisfactory. We have discussed this subject, however, in the 
Argument, where we have given an abstract of the other views of practice en- 
tertained by subsequent authorities. 
1 That is to say, whether the bones of the fore-arm protrude before or behind. 
It is obvious from the text, and is made still more clear from Galen's Commentary, 
that, in this case, Hippocrates understands the bones of the fore-arm to be the 
parts displaced, and not those of the hand, as is usually understood in modern 
works on surgery. Sir Astley Cooper, however, like Hippocrates, considers the 
hand as the part in position, and the bones of the fore-arm as those which are 
displaced. But whether our author is always consistent with himself in regard 
to this, and the dislocations of the other joints, may be doubted. It is well 
known, that early writers, however remarkable they may be for originality of 
thought and vigor of expression, are seldom so distinguished for precision in the 
use of terms as succeeding' authors are. That Hippocrates is not exempt from 
this defect must be admitted, nor is this to be wondered at, since he lived before 
the age of Aristotle, who first brought logic and criticism to perfection. 
21 need scarcely say that recent authorities give the symptoms very differ- 
ently. See the Argument. 
3 As remarked by Galen, our author in this paragraph makes a distinction in 142 
GENUINE WORKS OF HIPPOCRATES. 
66. The same rule applies to the elbow-joint, and with regard to the 
bones of the fore-arm and arm. For when these bones protrude through 
a wound which they have made in the skin, all cases in which they are 
reduced prove fatal; but if not reduced, there is a chance of recovery; 
but to those that survive there is certain impediment. And if in any 
instance the bones of the upper articulations {shoulder-joint ?), should be 
dislocated, and project through a wound which they have made in the 
skin, these, if reduced, are followed by more speedy death; and if not 
reduced, they are more dangerous than the others. But the mode of 
treatment which appears to me most suitable has been already described. 
67. When the joints of the toes or hands are dislocated, and the bones 
protrude through a wound which they have made, and when there is no 
fracture of the bone, but merely displacement of the joint, in these cases, 
if the reduction be made and allowed to remain, there is some danger of 
spasms (tetanus?) if not properly treated, and yet it may be worth while 
to reduce them, having warned the patient beforehand that much caution 
and care will be required. The easiest, the most efficient method, and 
the one most conformable to art, is that by the lever, as formerly described 
when treating of bones which have been fractured and protruded; then 
the patient must be as quiet as possible, lie in a recumbent position, and 
observe a restricted regimen. And it will be better also that he should 
get some gentle emetics. The sore is to be treated with dressings for 
fresh wounds, which permit of affusions, or with the leaves of camomile,1 
or with the applications for fractured bones of the head, but nothing very 
cold must be applied. The first (most distant ?) joints are least dangerous, 
but those still higher, are more so. Reduction should be made the same 
day, or the next, but by no means on the third or fourth, for it is on the 
fourth day that exacerbations especially attack. In those cases, then, 
where immediate reduction cannot be accomplished, we must wait until 
after the aforesaid days; for whatever you reduce within ten days, may 
be expected to induce spasm. But if the spasm supervene on its being 
reduced, the joint should be quickly displaced, and bathed frequently with 
warm water, and the whole body should be kept in a warm, soft, and easy 
condition, and more especially about the joints, for the whole body should 
rather be in a bent than in an extended state. Moreover, it is to be 
expected, that the articular extremities of the bones of the fingers will 
exfoliate, for this generally happens, if even the least degree of inflamma- 
tion take place, so that if it were not that the physician would be exposed 
dislocations at the knee-joint, according as it is the end of the tibia or of the 
femur which protrudes through the skin. Galen adds, that at the ankle it is 
only the bones of the leg, and at the wrist only those of the fore-arm, which are 
protruded. 
1 Probably the Anthemis valentina. See the Appendix to Dunbar's Greek 
Lexicon, under no7.v6(i)0ar/wv. ARTICULATIONS. 
143 
to censure, owing to the ignorance of the common people, no reduction 
should be made at all. The reduction of the bones of joints which have 
protruded through the skin, is attended with the dangers which have 
been described. 
68. When the articular bones of the fingers are fairly chopped off, 
these cases are mostly unattended with danger, unless deliquium come on 
in consequence of the injury, and ordinary treatment will be sufficient to 
such sores. But when resection is made, not at the articulations, but at 
some other point in the bones, these cases also are free from danger, and 
are still more easily cured than the others; and the fractured bones of the 
fingers which protrude otherwise than at the joint admit of reduction 
without danger. Complete resections of bones at the joints, whether the 
foot, the hand, the leg, the ankle, the fore-arm, the wrist, for the most 
part, are not unattended with danger, unless one be cut off at once by 
deliquium animi, or if continual fever supervene on the fourth day.1 
69. With regard to the sphacelus of fleshy parts, it takes place in 
wounds where there are large blood-vessels, which have been strongly 
compressed, and in fractures of bones which have been bound too tight, 
and in other cases of immoderate constriction, when the parts which have 
been strangulated generally drop off; and the most of such patients 
recover, even when a portion of the thigh comes away, or of the arm, both 
bones and flesh, but less so in this case; and when the fore-arm and leg 
drop off, the patients readily recover.2 In cases then, of fracture of the 
1 This paragraph on resection of the bones in compound dislocations and 
fractures contains almost all the information on the subject which is to be found 
in the works on ancient medicine. Galen finds our author's meaning in this para- 
graph so obvious, that he does not think it necessary to give anything more than 
an apology for a commentary. Celsus notices the practice of resection in com- 
pound dislocations very briefly, as follows: " Si nudum os eminet, impedimentuni 
semper futurum est; ideo quod excedit, abscindendum est." (viii., 25.) 
In modern times this practice has been partially advocated by several eminent 
authorities in surgery, especially Mr. Hey, of Leeds, and Sir Astley Cooper, in 
this country, and by M. Leveille, in France, the last of whom professes to have 
been guided by the authority of Hippocrates. (Nouvelle Doctrine Chirurgicale, 
tom. ii., p. 44.) The case in which this practice has been most generally followed 
is compound dislocation of the astragalus. In dislocations of the bones of the 
larger joints, such as the end of the humerus, the lower end of the tibia and 
fibula, and the like, resection has seldom been practiced, and only when reduc- 
tion was otherwise found to be impracticable. Mr. Fergusson suggests the propriety 
of resection at the elbow under these circumstances. Mr. Syme, upon the whole, 
approves of resection in the case of the elbow, the wrist, and the ankle, when the 
bones cannot be otherwise reduced; but, in the case of of the knee-joint, he holds 
that amputation must be immediately had recourse to. 
2 This paragraph contains a very interesting account of the ancient mode of 
treating severe injuries of the extremities which terminate in g'angrene. It will 
be seen that our author's practice was altogether of the expectant mode; when a 
limb mortified, as much of it as was become quite dead was separated at a joint, 144 
GENUINE WORKS OF HIPPOCRATES. 
bones, when strangulation and blackening of the parts take place at first, 
the separation of the dead and living parts quickly occurs, and the parts 
speedily drop off, as the bones have already given way; but when the 
blackening {mortification) takes place while the bones are entire, the fleshy 
parts, in this case, also quickly die; but the bones are slow in separating 
at the boundary of the blackening, and where the bones are laid bare. 
Those parts of the body which are below the boundaries of the blacken- 
ing are to be removed at the joint, as soon as they are fairly dead and 
have lost their sensibility; care being taken not to wound any living part; 
for if the part which is cut off give pain, and if it should prove not to be 
quite dead, there is great danger lest the patient may swoon away from 
the pain, and such swoonings often are immediately fatal. I have known 
the thigh-bones, when denuded in this manner, drop off on the eightieth 
day; but in the case of this patient, the parts below were separated at the 
knee on the twentieth day, and, as 1 thought, too early, for it appeared 
to me that this should be done more guardedly. In a case which I had 
of such blackening in the leg, the bones of the leg, as far as they were 
denuded, separated at its middle on the sixtieth day. But the separation 
of denuded bones is quicker or slower, according to the mode of treat- 
ment; something, too, depends upon whether the compression be stronger 
or weaker, and whether the nerves, flesh, arteries, and veins are quicker 
or slower in becoming blackened and in dying; since, when the parts are 
not strongly compressed, the separation is more superficial, and does not 
go the length of laying the bones bare, and in some cases it is still more 
superficial, so as not even to expose the nerves. For the reasons now 
stated, it is impossible to define accurately the time at which each of these 
cases will terminate.1 The treatment of such cases, however, is to be 
readily undertaken, for they are more formidable to look at than to treat;2 
and the whole mortified part was not removed until there was a complete line of 
separation between the dead and living part. The constitutional treatment was 
altogether of a mild character. The advocates for the mild system of treatment 
in gangrene of the foot, it would thus appear, have the authority of Hippocrates 
to quote on their side. I need scarcely add that, until within the last few years, 
the opposite system of treatment is what was adopted in modern practice. 
1 Galen mades the following remarks on this passage: Hippocrates having pre- 
viously stated that in those cases in which the flesh connected with the bones has 
become blackened and corrupted, the same thing, in the course of time, should 
happen to the bones; and, on that account, having given directions to cut them 
off, he now advises the removal to be made without touching the sound parts, 
lest, owing to the pain, the patient should fall into a severe swoon, from which it 
would be difficult to recover him. He recommends, therefore, that this should be 
done at a joint, as the removal there can be speedily accomplished, whereas, in 
the middle of a limb, time is taken up in cutting off the bone. 
2 Galen remarks on this passage that here our author shows that he had a 
proper regard for the safety of the physician as well as for that of the patient; 
for, as he states, these cases, although they put on a formidable appearance, are ARTICULATIONS. 
145 
and a mild treatment is sufficient in all such cases, for they come to a 
crisis of themselves; only the diet must be attended to, so that it may 
be as little calculated to create fever as possible, and the body is to be 
placed in the proper positions: these are, neither raised very high up, nor 
inclined much downward, but rather upward, until the separation be 
completed; for at that time there is most danger of hemorrhage; on this 
account, wounds should not be laid in a declining position, but the con- 
trary.1 But after a while, and when the sores have become clean, the 
same positions will no longer be appropriate; but a straight position, and 
one inclining downward, may be proper; and in the course of time, in 
some of these cases, abscesses form, and require bandages. One may also 
expect that such patients will be attacked with dysentery; for dysentery 
usually supervenes in cases of mortification and of hemorrhage from 
wounds; it comes on generally when the blackening and hemorrhage have 
arrived at a crisis, and is profuse and intense, but does not last many 
days; neither is it of a fatal nature, for such patients do not usually lose 
their appetite, nor is it proper to put them on a restricted diet.2 
70.3 Dislocation inward at the hip-joint is to be reduced in the follow- 
not so dangerous in reality, but that a physician may undertake the management 
of them without endangering his own character. Those cases, on the other hand, 
which at first sight do not appear formidable, but are dangerous in reality, he ad- 
vises the physician to have nothing to do with it. Many passages in the works 
of our author, and in those of the other ancient writers on medicine, have led me 
to the conclusion, that in ancient times a greater degree of responsibility attached 
to the physician in undertaking the management of the sick than there does in 
our days. It would appear to have been a very serious matter for the physician 
when his patient died without his death having been previously prognosticated. 
Necessity, then, and the regard for personal safety, would compel the ancient 
physician to cultivate prognosis, so that he might not decline to undertake the 
management of cases by which any credit could be gained, nor, on the other 
hand, undertake a formidable one without announcing, beforehand, its probable 
issue. I fear it must be admitted that professional virtue in ancient times never 
rose to that pitch of disinterestedness enjoyed by our Sydenham, when he says 
that ' the physician ought to be always ready to serve his patient even at the 
risk of his own reputation." 
11 need scarcely point out to the professional reader how very sensible and 
judicious these directions are as regards the position of the limb in such cases. 
Galen, in a Commentary written in his elegant but diffuse style, gives our author's 
meaning in a more expanded form, but without supplying any additional infor- 
mation of the least practical importance. 
2 Galen, in his Commentary, enters into a lengthy discussion on the nature of 
the symptomatic dysentery here briefly described, but there is not much in it of 
any great interest, or that is not quite obvious. 
3 Our author, in this and the six following paragraphs, resumes the considera- 
tion of dislocations of the hip-joint, and describes, very clearly and ciicumstantially, 
various modes of reducing the head of the bone. Galen, in his Commentary, in- 
forms us that Ctesias, being a kinsman of Hippocrates, and one of the Asclepiadae, 
and certain others after him, had found fault with Hippocrates for giving direc- 
Vol. II.-10. 146 
GENUINE WORKS OF HIPPOCRATES. 
ing manner: (it is a good, proper, and natural mode of reduction, and 
lias something of display in it, if any one takes delight in such ostentatious 
modes of procedure.) The patient is to be suspended by the feet from a 
cross-beam with a strong, soft, and broad cord; the feet are to be about 
four inches or less from one another; and a broad and soft leather col- 
lar connected with the cross-beam is to be put on above the knees; and 
the affected leg should be so extended as to be two inches longer than 
the other; the head should be about two cubits from the ground, or a 
little more or less; and the arms should be stretched along the sides, and 
bound with something soft; all these preparations should be made while 
he is lying on his back, so that he may be suspended for as short a time 
as possible. But when the patient is suspended, a person properly 
instructed and not weak, having introduced his arm between his thighs, 
is to place his fore-arm between the perineum and the dislocated head of 
the os femoris; and then, having joined the other hand to the one thus 
tions respecting the reduction, seeing that, as they alleged, the bone, when so re- 
duced, in all cases immediately slips out of its socket. This opinion they pretended 
to have founded partly on experience and partly on the construction of the hip- 
joint; for they maintained that, as dislocation cannot take place unless the liga- 
mentum teres be torn, and as, when torn, its parts cannot unite, it follows that a 
complete cure in this case is physically impossible. Galen enters into a lengthy 
and elaborate discussion of this question, in the course of which he states, that in 
laxity of the joint, the ligamentum teres may be so elongated as to allow the bone 
to slip out of the acetabulum without being ruptured. And, coming to the point, 
he cites the authority of Heraclides Tarentinus in support of the opinion, that a 
reduced femur may remain in its place. Heraclides further appeals to Hippo- 
crates, Diodes, Philotimus, Euenor Beleus (Nileus?), Molphis, and Nymphodorus 
on the same side. Galen concludes this portion of his Commentary with further 
stating that many recent authorities had reported cases in which they had effected 
the reduction without its being followed by another escape of the bone.-Apollon- 
ius Citiensis, in his Commentary on this passage, replies to the same objection as 
made by Hegetor, and others of the followers of Herophilus. This discussion of 
the question is interesting as a piece of ancient polemic, but does not elicit any 
additional facts in illustration of the subject. See Scholia in Hippocratem et 
Galenum, tom. i., pp. 34-41; ed. Dietz.-Celsus alludes to this controversy in the 
following terms: "Magnum autem fermori periculum est, ne vel difficulter re- 
ponatur, vel repositum rursus excidat. Quidam semper iterum excedere conten- 
dunt; sed Hippocrates, et Diodes, et Philotimus, et Nileus, et Heraclides Taren- 
tinus, clari admodum auctores, ex toto se restituisse memoriae prodiderunt. 
Neque tot genera machinamentorum quoque, ad extendendum in hoc casu femur, 
Hippocrates, Andreas, Nileus, Nymphodorus, Protarchus, Heraclides, faber 
quoque quidam reperissent, si id rustra esset." (viii., 20.) With regard to the 
methods of reducing this dislocation, recommended by our author, I may men- 
tion, in general terms, that they will be readily understood by any person who 
will read his descriptions carefully, and compare them with the figures as given 
by Vidus Vidius, and copied from him by M. Littr A There is not much, if any- 
thing, of practical importance in the Commentaries either of Appollonius or of 
Galen, so that I shall make but few extracts from them. ARTICULATIONS. 
147 
passed through the thighs, he is to stand by the side of the suspended 
patient, and suddenly suspend and swing himself in the air as perpen- 
dicularly as possible. This method comprises all the conditions which 
are natural; for the body being suspended by its weight, produces exten- 
sion, and the person suspended from him, along with the extension, forces 
the head of the thigh-bone to rise up above the acetabulum; and at the 
same time he uses the bone of the fore-arm as a lever, and forces the os 
femoris to slip into its old seat. The cords should be properly prepared, 
and care should be taken that the person suspended along with the patient 
have a sufficiently strong hold. 
71. Wherefore, as formerly stated, men's constitutions differ much 
from one another as to the facility or difficulty with which dislocations 
are reduced; and the cause of this was also stated formerly in treating of 
the shoulder. In some the thigh is reduced with no preparation, with 
slight extension, directed by the hands, and with slight movement; and 
in some the reduction is effected by bending the limb at the joint, and 
making rotation. But much more frequently it does not yield to any 
ordinary apparatus, and therefore one should be acquainted with the 
most powerful means which can be applied in each case, and use whatever 
may be judged most proper under all circumstances. The modes of 
extension have been described in the former parts of the work, so that 
one may make use of whatever may happen to be at hand. For, exten- 
sion and counter-extension are to be made in the direction of the limb and 
the body; and if this be properly effected, the head of the thigh-bone will 
be raised above its ancient seat; and if thus raised, it will not be easy to 
prevent it from settling in its place, so that any ordinary impulse with the 
lever and adjustment will be quite sufficient; but some apply insufficient 
extension, and hence tjie reduction gives much trouble. The bands then 
should be fastened, not only at the foot, but also above the knee, so that 
the force of the extension may not be expended on the knee-joint more 
than upon the hip-joint. The extension in the direction of the foot is to 
be thus contrived. But the counter-extension is not only to be managed 
by means of something carried round the chest and armpits, but also by 
a long, double, strong, and supple thong applied to the perineum, and 
carried behind along the spine, and in front along the collar-bone, and 
fixed to the point from which counter-extension is made; and then force 
is to be so applied, by means of this extension and counter-extension, 
that the thong at the perineum may not pass over the head of the thigh- 
bone, but between it and the perineum; and during the extension one 
should strike the head of the femur with the fist, so as to drive it outward. 
And when the patient is raised up by the stretching, you should pass a 
hand through (between the legs ?) and grasp it with the other hand, so as 
at the same time to make extension, and force the dislocated limb out- 
ward; while some other person sitting by the knee quietly directs it 
inward. 148 
GENUINE WORKS OF HIPPOCRATES. 
72. It lias been formerly stated by us that it will be of importance for 
any person who practices medicine in a populous city to get prepared a 
quadrangular board, about six cubits or a little more in length, and about 
two cubits in breadth;1 a fathom will be sufficient thickness for it; and 
then along it from the one end to the other, an excavation must be made, 
so that the working of the levers may not be higher than is proper; then 
at both sides we are to raise short, strong, and strongly-fixed posts, having 
axles; and in the middle of the bench five or six long grooves are to be 
scooped out about four inches distant from one another, three inches will 
be a sufficient breadth for them, and the depth in like manner; and 
although the number of grooves I have mentioned will be sufficient, there 
is nothing to prevent their being made all over the bench. And the 
bench should have in its middle a pretty deep hole, of a square shape, and 
of about three inches in size; and into this hole, when judged necessary, 
is to be adjusted a corresponding piece of wood, rounded above, which, at 
the proper time, is to be adjusted between the perineum and the head of 
the thigh-bone. This upright piece of wood prevents the body from 
yielding to the force dragging downward by the feet; for sometimes this 
piece of wood serves' the purpose of counter-extension upward; and some- 
times, too, when extension and counter-extension are made, this piece of 
wood, if susceptible of some motion to this side or that, will serve the 
purpose of a lever for pushing the head of the thigh-bone outward. It 
is on this account that several grooves are scooped out on the bench, so 
that this piece of wood, being erected at the one which answers, may act 
as a lever, either on the sides of the articular heads of bones, or may make 
pressure direct on the heads along with the extension, according as it may 
suit to push inward or outward with the lever; and the lever may be either of 
a round or broad form, as may be judged proper; for sometimes the one form 
and sometimes the other suits with the articulation. This mode of apply- 
ing the lever along with extension is applicable in the reduction of all 
dislocations of the thigh. In the case now on hand, a round lever is 
proper; but in dislocations outward a flat lever will be the suitable one. 
By means of such machines and of such powers, it appears to me that we 
need never fail in reducing any dislocation at a joint. 
73. And one might find out other modes of reduction for this joint. 
If the large bench were to have raised on it two posts about a foot (m 
diameter?}, and of a suitable height, on each side near its middle, and if 
a transverse piece of wood like the step of a ladder, were inserted in the 
1 The drawings of the scamnum Hippocratis, as given by us from Vidus Vidius 
and Littr6, will render this description quite intelligble. It is thus described by 
Celsus: " Etiamnum valentius intenditur membram super scamnum, cui ab utra- 
que parte axes sunt, ad quos habente illae deligantur: qui, ut in torcularibus, con- 
versi, rumpere quoque, si perseveraverit, non solum extendere, nervos et musculos 
possunt." (viii., 20.) See the Plates. ARTICULATIONS. 
149 
posts, then if the sound leg were carried through between the posts, and 
the injured limb were brought over the transverse piece of wood, which 
should be exactly adapted in height to the joint which is dislocated, 
(and it is an easy matter so to adjust it, for the step of the ladder should 
be made a little higher than required, and a convenient robe, folded 
several times, is to be laid below the patient's body), then a piece of wood, 
of suitable breadth and length, is to be laid below the limb, and it should 
reach from the ankle to beyond the head of the thigh-bone, and should 
be bound moderately tight to the limb. Then the limb being extended, 
either by means of the pestle-like piece of wood (formerly described), or 
by any of the other methods of extension, the limb which is carried over 
the step with the piece of wood attached to it, is to be forced downward, 
while somebody grasps the patient above the hip-joint. In this manner 
the extension will carry the head of the thigh-bone above the acetabulum, 
while the lever power that is exercised will push the head of the thigh- 
bone into its natural seat. All the above-mentioned powers are strong, 
and more than sufficient to rectify the accident, if properly and skillfully 
applied. For, as formerly stated, in most cases reduction may be effected 
by much weaker extension, and an inferior apparatus. 
74. If the head of the bone slip outward, extension and counter- 
extension must be made as described, or in a similar manner. But along 
with the extension a broad lever is to be used to force the bone from without 
inward, the lever being placed at the nates or a little farther up, and some 
person is to steady the patient's body, so that it may not yield, either by 
grasping him at the buttock with his hands, or this may be effected by 
means of another similar lever, adjusted to one of the grooves, while the 
patient has something laid below him, and he is secured, and the dislocated 
thigh is to be turned gently from within outward at the knee. Suspen- 
sion will not answer in this form of dislocation, for, in this instance, the 
arm of the person suspended from him, would push the head of the thigh- 
bone from the acetabulum. But one might use the piece of wood placed 
below him as a lever, in such a manner as might suit with this mode of 
dislocation; it must work from without. But what use is there for more 
words? For if the extension be well and properly done, and if the lever 
be properly used, what dislocation of the joint could occur, that might 
not be thus reduced ?1 
75. In dislocation of the thigh, backward, extension and counter- 
extension should be made as has been described; and having laid on the 
bench a cloth which has been folded several times, so that the patient 
may lie soft, he is to be laid on his face, and extension thus made, and, 
along with the extension, pressure is to be made with a board, as in the 
case of humpback, the board being placed on the region of the nates, and 
1 See the Plate at the end of the volume. 150 
GENUINE WORKS OF HIPPOCRATES. 
rather below than above the hip-joint; and the hole made in the wall for 
the board should not be direct over, but should be inclined a little down- 
ward, toward the feet. This mode of reduction is particularly appropriate 
to this variety of dislocation, and at the same time is very strong. But 
perhaps, instead of the board, it might be sufficient to have a person sit- 
ting (on the seat of luxation?), or pressing with his hands, or with his foot, 
and suddenly raising himself up, along with the extension. None of the 
other afore-mentioned modes of reduction are natural in this form of 
dislocation. 
76. In dislocation forward, the same mode of extension should be 
made; but a person who has very strong hands, and is well trained, should 
place the palm of the one hand on the groin, and taking hold of this 
hand with the other, is at the same time to push the dislocated part 
downward, and at the same time to the fore part of the knee. This 
method of reduction is most especially conformable to this mode of dis- 
location. And the mode of suspension is also not far removed from being 
natural, but the person suspended should be well trained, so that his arm 
may not act as a lever upon the joint, but that the force of the suspension 
may act about the middle of the perineum, and at the os sacrum. 
77. Reduction by the bladder is also celebrated in dislocations at this 
joint, and I have seen certain persons who, from ignorance, attempted to 
reduce both dislocations outward and backward therewith, not knowing 
that they were rather displacing than replacing the parts; it is clear, 
however, that he who first invented this method intended it for disloca- 
tion inward. It is proper, then, to know how the bladder should be used, 
if it is to be used, and it should be understood that many other methods 
are more powerful than it. The bladder should be placed between the 
thighs uninflated, so that it may be carried as far up the perineum as 
possible, and the thighs beginning at the patella are to be bound together 
with a swathe, as far up as the middle of the thigh, and then a brass pipe 
is to be introduced into one of the loose feet of the bladder,1 and air forced 
into it, the patient is to lie on his side with the injured limb uppermost. 
This, then, is the preparation; some, however, do the thing worse than 
as I have described, for they do . not bind the thighs together to any 
extent, but only at the knees, neither do they make extension, whereas 
extension should be made, and yet some people by having the good fortune 
to meet with a favorable case, have succeeded in making reduction. But 
1 By " feet" is meant corners, I suppose. Dietz gives the following note on this 
passage: " Pedes utris quatuor anguli dicuntur, caprse pedum reliquiae. Saepius 
in Hispania vinum hujusmodi utribus inclusum, qui pleni tumidique caprae for- 
mam referunt, a mulionibus transvehi cognovi iisque mulis impositis loco clitel- 
larum usus sum viator." (Ed. Dietz, tom. i., p. 30,) In like manner, " pes veli" 
means " the lower corner of a sail." See Catullus, iv., 19; and Facciolati's Lexi- 
con, under Pes. ARTICULATIONS. 
151 
it is not a convenient method of applying force, for the bladder, when 
inflated, does not present its most prominent part to the articular extremity 
of the femur, which is the place that ought to be more especially pressed 
outward, but its middle, which probably corresponds with the middle of 
the thigh, or still lower down, for the thighs are naturally curved, being 
fleshy, and in contact above, and becoming smaller downward, so that 
the natural configuration of the parts forces the bladder from the most 
proper place. And if a small bladder be introduced, its power will be 
small, and unable to overcome the resistance of the articular bone. But 
if the bladder must be used, the thighs are to be bound together to a con- 
siderable extent, and the bladder is to be inflated along with the extension 
of the body, and in this method of reduction both legs are to be bound 
together at their extremity. 
78. The prime object of the physician in the whole art of medicine 
should be to cure that which is diseased; and if this can be accomplished 
in various ways, the least troublesome should be selected; for this is 
more becoming a good man, and one well skilled in the art, who does 
not covet popular coin of base alloy. With regard to the subject now on 
hand, the following are domestic means of making extension of the body, 
so that it is easy to choose from among the things at hand:-In the first 
place, when soft and supple thongs are not at hand for ligatures, either 
iron chains, or cords, or cables of ships, are to be wrapped round with 
scarfs or pieces of woolen rags, especially at the parts of them which are 
to be applied, and in this state they are to be used as bands. In the 
second place, the patient is to be comfortably laid on the strongest and 
largest couch that is at hand, and the feet of the couch, either those at 
the (patient's ?) head, or those at the feet, are to be fastened to the thres- 
hold, either within or without, as is most suitable; and a square piece of 
wood is to be laid across, and extending from the one foot to the other; 
and if this piece of wood be slender, it should be bound to the feet of the 
couch, but, if it be thick, there will be no necessity for this; then the 
heads of the ligatures, both of those at the head and those at the feet, are 
to be fastened to a pestle, or some such piece of wood, at either end; the 
ligatures should run along the line of the body, or be a little elevated 
above it, and it should be stretched proportionally to the pestles, so that, 
standing erect, the one may be fastened to the threshold, and the other 
to the transverse piece of wood. Extension is then to be made by bending 
back the ends of the pestles.1 A ladder, having strong steps, if laid below 
the bed, will serve the purpose of the threshold and the piece of wood 
laid along (the foot of the conch?}, as the pestles can be fastened to the 
steps at either end, and when drawn back they thus make extension of 
1 By "pestles," as explained above, was meant poles, or strong staffs. Celsus 
uses the expression " valida bacula" as applied to them, (viii., 20.) 152 
GENUINE WORKS OF HIPPOCRATES. 
the ligatures. Dislocation, inward or forward, may be reduced in the 
following manner: a ladder is to be fastened in the ground, and tlie man 
is to be seated upon it, and then the sound leg is to be gently stretched 
along and bound to it, wherever it is found convenient; and water is to 
be poured into an earthen vessel, or stones put into a hamper and slung 
from the injured leg, so as to effect the reduction. Another mode of 
reduction: a cross-beam is to be fastened between two pillars of moderate 
height; and at one part of the cross-beam there should be a protuberance 
proportionate to the size of the nates;1 and having bound a coverlet 
round the patient's breast, he is to be seated on the protuberant part of 
the cross-beam, and afterward the breast is to be fastened to the pillar by 
some broad ligature; then some one is to hold the sound leg so that he 
may not fall olt, and from the injured limb is to be suspended some con- 
venient weight, as formerly described.2 
79. It should be particularly known that the union of all bones is, for 
the most part, by a head and socket (cotyle)', in some of these the place 
(socket?) is cotyloid and oblong, and in some the socket is glenoid 
(shallow ?)? In all dislocations reduction is to be effected, if possible, 
immediately, while still warm, but otherwise, as quickly as it can be done; 
for reduction will be a much easier and quicker process to the operator, 
and a much less painful one to the patient, if effected before swelling 
comes on. But all the joints when about to be reduced should be first 
softened, and gently moved about; for, thus they are more easily reduced. 
And, in all cases of reduction at joints, the patient must be put on a spare 
diet, but more especially in the case of the greatest joints, and those most 
difficult to reduce, and less so in those which are very small and easily 
reduced. 
80. If any joint of the fingers is dislocated, whether the first, second, 
or the third, the same method of reduction is to be applied, but the 
largest joints are the most difficult to reduce. There are four modes of 
displacement-either upward, downward, or to either side; most com- 
monly upward, and most rarely laterally, and in consequence of violent 
■■The reading- here seems very doubtful; Vidus Vidius appears to have read 
which M. Little approves of, though he does not adopt it. 
2 We have got no commentary of Galen on this paragraph, and there is noth- 
ing in the Scholia of Apollonius of much interest bearing upon it. The modes of 
reduction adverted to in it are easily understood, when the description is compared 
with the drawings given by Vidus Vidius and Littre. 
3 Our author evidently alludes especially to the hip- and shoulder-joints, but he 
applies the terms in a general way to all the articulations. The application of 
the term to the articular cavity of the hip-joint is very ancient, being met 
with in the Homeric poems, as- 
svda pppb<; 
loxi<p evarptyerat, kotvXt/v avrr/v naXtovai. 
(Iliad, v., 305, 306.) AKTICULATIONS. 
153 
motion.1 On both sides of its articular cavity there is a sort of raised 
border. When the dislocation is upward or downward, owing to the 
articular cavity having smoother edges there than at the sides, if the joint 
of it be dislocated, it is more easily reduced. This is the mode of reduc- 
tion:-The end of the finger is to be wrapped round with a fillet, or 
something such, that, when you lay hold of it and make extension, it will 
not slip; and when this is done, some person is to grasp the arm at the 
wrist, and another is to take hold of the finger which is wrapped in the 
fillet, and then each is to make considerable extension toward himself, 
and at the same time the projecting bone is to be pushed into its place. 
But, if the dislocation be lateral, the same mode of reduction is to be 
used; but when you think that the extremity of the bone has cleared the 
rim, at the same time that extension is made, the bone is to be pushed 
direct into its place, while another person on the other side of the finger 
is to take care and make counter-pressure, so that it may not again slip 
out there. The twisted nooses formed from palm-shoots are convenient 
for effecting reduction, if you will make extension and counter-extension 
by holding the twisted string in the one hand and the wrist in the other.2 
When reduced, you must bind the part as quickly as possible with band- 
ages; these are to be very slendei' and waxed with cerate, neither very soft 
nor very hard, but of middle consistence; for that which is hard drops off 
from the finger, while that which is soft and liquid is melted and lost by 
the increased heat of the finger. The bandage is to be loosed on the 
third or fourth day; but on the whole, if inflamed, it is to be the more 
frequently loosed, and if otherwise, more rarely; this I say respecting all 
the joints. The articulation of a finger is restored in fourteen days. The 
treatment of the fingers and of the toes is the same. 
81. After all reductions of joints the patient should be confined to a 
restricted diet and abstinence until the seventh day; and if there be 
inflammation, the bandages are to be the more frequently loosed, but 
otherwise, less frequently, and the pained joint is to be kept constantly 
in a state of rest, and is to be laid in the most convenient position possible. 
82. Accidents at the knee are more mild than at the elbow, from its 
being more compact, regular, and elegant in its construction; and,therefore, 
1 Our author evidently understands the hand to be placed in a state of prona- 
tion; by upward, then, is meant forward, and by downward is meant back- 
ward, as the terms are now generally applied. See Cooper's Surgical Dictionary. 
Celsus also uses the terms forward and backward; " qui vel in priorem vel in pos- 
teriorem partem exciderunt." (viii., 19.) 
1 These strings or nooses, formed from palm-shoots, are mentioned in allusion 
to this surgical use of them by Aristotle (De Partibus Animal., iv., 9); and by 
Diodes, in a fragment preserved by Apollonius Citiensis (ed. Dietz, p. 19). See 
further Littre, tom. iv., p. 61. They would appear to have been formed from the 
inner rind of the palm-tree; these, if of a glutinous nature, would, no doubt, an- 
swer excellently in the case to which they are applied by our author. 154 
GENUINE WORKS OF HIPPOCRATES. 
it is more readily dislocated and reduced. It is most frequently dislocated 
inward, but also outward and backward. The modes of reduction are 
these: by flexion at the knee, or by sudden calcitration,1 or having rolled 
a swathe into a ball, and fixed it in the ham, the patient's body is to be 
suddenly dropped on its bended knees. Dislocation backward, also, as 
in the case of the elbow, may be reduced by moderate extension, and to 
either side, either by flexion or calcitration, but also by moderate exten- 
sion. The adjustment is the same in all cases. In dislocations backward 
which are not reduced, the patient cannot bend the joint, but neither can 
he, to any great extent, in the other varieties: the thigh and leg are 
wasted in front; but if inward the patients become bow-legged, and the 
external parts are wasted; but if outward they become more bandy-legged, 
but the impediment is less, for the body is supported on the larger of the 
bones, and the inner parts are wasted. When these accidents happen at 
birth or during adolescence, they follow the rule formerly stated.2 
83. Dislocations at the ankle-joints require strong extension, either 
with the hands or some such means; and adjustment, which at the same 
time effects both purposes, as is common in all cases.3 
84. Injuries of the foot are to be remedied like those of the hand.' 
85. The bones connected with the leg, and which are dislocated, either 
at birth or during adolescence, follow the same course as those in the 
hand.5 
86. When persons jumping from a height pitch on the heel, so as to 
occasion separation (diastasis') of the bones, ecchymosis of the veins, and 
contusion of the nerves; when these symptoms are very violent there is 
danger of sphacelus, and that the case may give trouble during life, for 
the bones are so constructed as to slip from one another, and the nerves 
communicate together.6 And, indeed, in cases of fracture, either from 
1 This term has not been explained by any ancient author, and therefore there 
is some difficulty in understanding properly the process to which it is applied. M. 
Littre gives a very elaborate and ingenious disquisition on this subject. The fol- 
lowing is his own explanation: " Cela etabli, voici comment je congois de Teclac- 
tisme: le patient 6tait place debout sur la jambe saine, et des aides le maintenaient 
dans cette position; la jambe hixee etait en 1'air; le mSdecin la saississait par le 
pied et la brusquement en la portant vers les fesses. Ce procede, 
dans 1'hypothese que je propose, ne diffgrerait de la flexion simple que parce qu'il 
se pratiquerait le malade etant debout." (CEuv. Hip., tom. iv., p. 68, Arg.) Foes, 
in his note on this passage, explains the term thus: " Excalcitratio, per calces 
elapsi ossis impulsio, aut ea quae fit repente calcibus in sublime jactatis et per 
subitum flexum articuli repositio." I do not exactly see how the process, as rep- 
resented by Foes, could have effected the purpose; I am inclined therefore to 
think that M. Littre's explanation is the true one. 
3 On dislocations at the knee-joint, see the Argument, and § 37 of the work, On 
Fractures. 
3 See, On Fractures, § 13. 4Ibid., § 9. 5 Ibid., § 10. 
6 The accident here briefly touched upon would appear to be dislocation of the ARTICULATIONS. 
155 
an injury in the leg or thigh, or in paralysis of the nerves (tendons ?) 
connected with these parts, or from neglect during confinement to bed, 
when the heel gets blackened the most serious consequences result there- 
from. Sometimes, in addition to the sphacelus, there come on acute 
fevers accompanied with hiccup, aberration of intellect, and speedy death, 
with lividities of the large blood-vessels. With regard to the symptoms 
attending exacerbations, if the ecchymosed and blackened parts and those 
around be somewhat hard and red, and if along with the hardness there 
be lividity, mortification is to be apprehended; but if the parts be slightly 
livid, or even very livid, and the swelling diffused, or if greenish and soft, 
these appearances, in such cases, are all favorable. The treatment, if no 
fever be present, consists in the administration of hellebore, but otherwise 
it is not to be given, but oxyglyky (decoction of honeycombs and vinegar} 
is to be given for drink, if required. Bandaging as in the other articula- 
tions: above all, more especially in contusions, the bandages should be 
numerous and softer than usual, but the compression should be less; 
most turns should be made around the heel. Position, like the bandaging, 
os calcis from the astragalus. A very distinct case of it was reported lately by 
Mr. Bransby Cooper. "John Ryley, aged 49, was admitted into Guy's Hospital 
with a dislocation of foot. He stated that in swinging himself out of a cart, he 
lost his hold, and slipped down from the curb-stone, his right foot being turned 
completely inwards, in which position it remained until he was brought into the 
Hospital. The diagnostic marks of the injury were as follows: The chief defor- 
mity arose from the complete inversion of the whole foot, the sole of which faced 
directly inwards. The astragalus formed also a very evident deformity; for, al- 
though it remained in its natural position with respect to the tibia and fibula, its 
anterior articulatory surface pressed so tightly against the skin, that, had the dis- 
location remained unreduced, the integuments must very soon have undergone 
ulceration. The superior edge of the anterior articulatory surface of the' astrag- 
alus could be easily felt, and its form was distinctly visible; a deep hollow was 
also observed below the external malleolus, where there was evidently extensive 
contusion of the soft parts. The external malleolus formed a considerable pro- 
jection in its natural situation; but neither it nor any of the other bones of the 
foot was fractured. From these appearances it was judged to be a dislocation of 
the os calcis and navicular bone, with the rest of the foot outwards from the as- 
tragalus. The reduction was effected in the following manner: The surgeon 
knelt at the foot of the patient's bed, and, grasping the heel with his right hand, 
made extension from the instep with his left, an assistant at the same time press- 
ing the tibia inwards towards its natural position. The reduction was very easily 
effected." Severe symptoms supervened at first, but afterwards a perfect recov- 
ery took place. (Med. Gaz., No. 1069.) Though in this case the result was favor- 
able, there can be little doubt that if the dislocation had been compound, or if the 
parts had not been promptly replaced, the consequences might have been such as 
Hippocrates describes, namely, great swelling and gangrene. These symptoms, 
it will be seen, he also represents as the consequences of injuries, and of the 
pressure produced by position in cases of paralysis. His observations on the latter 
case are most appropriate and deserving of attention. 156 
GENUINE WORKS OF HIPPOCRATES. 
should be so regulated as not to determine to the heel. Splints are not 
to be used. 
87. When the foot is dislocated, either alone or along with its epiphy- 
sis, the displacement is, for the most part, to the inside. If not reduced, 
in the course of time, the hip, the thigh, and the side of the leg opposite 
the dislocation, become atrophied. Reduction is the same as in the wrist, 
but the extension requires to be very powerful. Treatment, agreeably to 
the general rule for joints. Exacerbations do occur, but less frequently 
than in dislocations at the wrist, provided the parts get rest. While they 
remain at rest the diet should be restricted. Those which occur at birth, 
or during adolescence, follow the rule formerly stated.1 
1 See, On Fractures, § 13. Dislocation of the foot, that is to say, of the astrag- 
alus, is here correctly described. Compare Mr. Bransby Cooper's description of 
the accident in the Medical Gazette, No. 1069. As stated by our author, disloca- 
tion inward is far more common than any of the other varieties, and is generally 
accompanied with fracture of the malleolus. Whether by epiphysis, in this par- 
agraph, is meant the external malleolus or conjoined malleoli, has been much 
disputed. If the latter, the case was evidently fracture of bones of the leg im- 
mediately above the ankle-joint. See the Argument. MOCHLICUS. MOCHLICUS. 
THE ARGUMENT. 
The work commences with a very brief description of the bones of the 
human body; that is to say, with a compendious system of Osteology (§1). 
In § 2, fractures of the nose are treated of. 
In § 3, those of the ears are treated of. 
In § 4, there is given a summary view of dislocations of the lower jaw. 
In § 5, the dislocations of the shoulder are minutely described, along 
with all the known methods of reduction. 
In § 6, is given an account of the nature and treatment of abruption 
of the acromion. 
In § 7, two forms of displacement of the bones of the fore-arm, at the 
elbow-joint, are described: the same as " Articulations," § 17. 
In § 8, two complete luxations of the same are given in the same terms 
as § 18, of " Articulations." 
In § 9, is given a brief notice of dislocation forward and backward: 
is the same as " Articulations," § 19. 
In § 10, there is a brief notice of diastasis of the bones at the elbow, 
by which is evidently meant separation of the radius from the ulna: the 
same as " Articulations," § 20. 
In § 11, the effects of these luxations when not reduced, are briefly 
described: the same as " Articulations," § 21. 
In § 12, complete lateral dislocations of the bones of the fore-arm, are 
treated of: the same as " Articulations," § 22. 
In § 13, complete dislocations forward and backward, are noticed: the 
same as " Articulations," § 23. 
In § 14, another form of dislocations is described: the same as § 7, 
and " Articulations," § 24. 
In § 15, the general rules by which reduction is to be accomplished, 
are briefly given. 
In § 16, a description is given of luxation, or subluxation inward and 
outward, of the bones at the wrist. 
In § 17, complete luxations of the bones at the wrist, in all direc- 
tions, along with separate displacement of either bone are described very 
succinctly. 
In § 18, the consequences of unreduced dislocations are very briefly 
noticed. 160 
GENUINE WORKS OF HIPPOCRATES. 
In § 19, luxations of the fingers are described. 
Luxations at the hip-joint are correctly and distinctly described in 
§§ 20, 21, 22, 23, 24. 
The modes of reduction are briefly enumerated in § 25. 
In § 26, the symptoms and treatment of dislocation at the knee are 
correctly given. 
In § 27, the modes of reducing dislocations at the ankle-joint are briefly 
described. 
In § 28, the analogy between the accidents which befall the bones of 
the foot, and those of the hand, is adverted to. 
In § 29, the consequences of unreduced luxations in the bones of the 
foot are compared with the same in the hand. 
In § 30, the treatment of gangrene, following upon dislocation of the 
os calcis, and the consequence of other causes, is laid down in the same 
terms as at " Articulations," § 86. 
In § 31, the luxations at the ankle-joint are briefly given as in § 87 of 
the work " On the Articulations." 
In § 32 a brief summary is given of the important chapter on club- 
foot, in the work "On the Articulations," § 62. 
In § 33, the treatment of compound luxations is given with much 
precision 
In § 34, a summary is given of the rules of practice respecting complete 
section of the extremities. 
In § 35, gangrene of the members resulting from dislocation or any 
other cause, is distinctly treated of. 
In § 36, curvatures of the spine from accident, and otherwise, are 
treated of. The doctrine is enforced that, as in injuries of the chest, 
there is more danger from a severe contusion than from a fracture. 
In § 37, the displacement of the spinal vertebrae from injury is briefly 
treated of. 
In § 38, all the usual modes of reducing dislocation of the spine are 
treated of at considerable length. 
In § 39, necrosis of the palate with subsidence of the nasal bones is 
briefly described. 
In § 40, some general observations of considerable importance, on 
displacement of bones are given, with other remarks. 
In § 41, the treatment of fractures complicated with a wound, is dis- 
tinctly laid down. 
In § 42, are given a few general observations on complete and partial 
luxations. 
We can have no difficulty in deciding that the author of this work, 
whether Hippocrates himself, or one of his immediate successors, must 
have intended it as a remembrancer to the reader on all the various 
subject-matters treated of in the preceding works " On Fractures," and MOCHLICUS. 
161 
" On the Articulations." In fact, many of the paragraphs in it, and the 
work " On the Articulations," are given in exactly the same words. That 
the object of the work is to fix in the mind the important facts more 
fully given in these two works, can admit of no doubt, and as such its 
importance cannot be questioned. Taking together the four treatises, 
namely, "On the Surgery," " On Fractures," "On the Articulations," 
and " The Mochlicus," the subject of dislocations and fractures is treated 
of most scientifically and completely. In the first place, the work " On 
the Surgery," supplies us with a coup d'ceil, as it were, of the whole 
subject, and prepares us for what we are to meet with in the course of 
our investigation; then we have all the parts of the subject examined 
separately and minutely, in the works "On Fractures," and "On the 
Articulations; " and to conclude, we have here a brief recapitulation of 
all the heads of the preceding inquiry. When we reflect on the admirable 
manner in which the whole subject is handled, and the many important 
truths which are evolved in the course of it, we cannot surely but regard 
with veneration the labors of our forefathers, nor can we miss to be 
impressed with the feeling that they have more cause look down with 
contempt upon us their posterity for not having prosecuted with more 
success the path of discovery which they had pointed out, than their 
posterity have to look with scorn upon them, because we have now macle 
some little advances beyond their limits. In conclusion, I do not hesitate 
to declare it as my decided opinion, that no other author has treated the 
same subject in so complete a manner as Hippocrates has done in these 
treatises. 
MOCHLICUS. 
I.1 With regard to the construction of bones, the bones and joints of 
the fingers are simple, the bones of the hand and foot are numerous, and 
articulated in various ways; the uppermost are the largest; the heel 
consists of one bone which is seen to project outward, and the back 
tendons are attached to it. The leg consists of two bones, united together 
above and below, but slightly separated in the middle; the external bone 
(fibula), where it comes into proximity with the little toe, is but slightly 
smaller than the other, more so where they are separated, and at the knee, 
the outer hamstring arises from it;2 these bones have a common epiphysis 
1 The brief description of the bones given in this paragraph is evidently con- 
densed from a larger work on the subject. A considerable portion of the matter 
which is found here in an abridged form, is taken from the preceding treatises, 
On Fractures and On the Articulations, but not the whole of it. 
2 The tendon of the biceps. 
Vol. IL-11. 162 
GENUINE WORKS OF HIPPOCRATES. 
below, with which the foot is moved, and another epiphysis above,1 in 
which is moved the articular extremity of the femur, which is simple and 
light in proportion to its length, in the form of a condyle, and having the 
patella (connected with it?), the femur itself bends outward and forward; 
its head is a round epiphysis which gives origin to the ligament inserted 
in the acetabulum of the hip-joint.2 This bone is articulated somewhat 
obliquely, but less so than the humerus. The ischium is united to the 
greatvertebra contiguous to the os sacrum by a cartilaginous ligament.3 
The spine, from the os sacrum to the great vertebra, is curved backward; 
in this quarter are situated the bladder, the organs of generation, and the 
inclined portion of the rectum; from this to the diaphragm it proceeds in 
a straight line inclining forward, and the psote are situated there; from 
this point, to the great vertebra above the tops of the shoulders, it rises 
in a line that is curved backward, and the curvature appears greater than 
it is in reality, for the posterior processes of the spine are there highest; 
the articulation of the neck inclines forward. The vertebrae on the 
inside4 are regularly placed upon one another, but behind they are con- 
nected by a cartilaginous ligament; they are articulated in the form of 
synarthrosis at the back part of the spinal marrow; behind they have a 
sharp process having a cartilaginous epiphysis, whence proceeds the roots 
of nerves running downward, as also muscles extending from the neck to 
the loins, and filling the space between the ribs and the spine. The ribs 
are connected to all the intervertebral spaces on the inside, from the neck 
to the lumbar region, by a small ligament, and before to the sternum, 
their extremities being spongy and soft; their form is the most arched 
in man of all animals; for in. this part, man is, of all animals, the 
narrowest in proportion to his bulk. The ribs are united to each vertebra 
by a small ligament at the place from which the short and broad lateral proc- 
esses (transverse processes f) arise. The sternum is one continuous bone, 
having lateral pits for the insertion of the ribs; it is of a spongy and 
cartilaginous structure. The clavicles are rounded in front, having some 
slight movements at the sternum, but more free at the acromion. The 
acromion, in man, arises from the scapulae differently from most other 
1 It will be here perceived that by epiphysis is merely meant a close union of 
the two bones by means of a ligament. The term in this paragraph is not always 
used in this sense. Strictly speaking, its signification would appear to be a pro- 
tuberance of a bone. It is applied to the malleoli, to the head of the tibia, to the 
head and neck of the femur, to the spinous processes of the vertebrae, to the upper 
and lower extremities of the humerus and to the lower extremity of the radius. 
2 Allusion is evidently made to the ligamentum teres. 
3 It will be readily perceived that the term ischium is not used here exactly as 
applied by modern anatomists. It is applied in this place to the ilium where it is 
articulated with the os sacrum. By the great vertebra, as stated in the preced- 
ing work, is meant the last vertebra of the loins. 
4 Meaning before, that is to say, at their anterior part. MOCHLICUS. 
163 
animals. The scapula is cartilaginous toward the spine, and spongy else- 
where, having an irregular figure externally; its neck and articular cavity 
cartilaginous; it does not interfere with the movements of the ribs, and 
is free of all connection with the other bones, except the humerus. The 
head of the humerus is articulated with its {glenoid ?) cavity, by means of 
a small ligament, and it consists of a rounded epiphysis composed of 
spongy cartilage, the humerus itself is bent outward and forward, and it 
is articulated with its {glenoid cavity by its side, and not in a straight 
line. At the elbow it is broad, and has condyles and cavities, and is of a 
solid consistence; behind it is a cavity in which the coronoid process 
{olecranon P) of the ulna is lodged, when the arm is extended;1 here, too, 
is inserted the benumbing nerve,2 which arises from between the two 
bones of the fore-arm at their junction, and terminates there. 
2. When the nose is fractured, the parts should be modeled instantly, 
if possible. If the fracture be in its cartilaginous part, introduce into the 
nostrils a tent formed of caddis, inclosed in the outer skin of a Cartha- 
ginian hide, or anything else which does not irritate; the skin is to be 
glued to the parts displaced, which are to be thus rectified. Bandaging 
in this case does mischief. The treatment is to consist of flour with 
manna, or of sulphur with cerate. You will immediately adjust the 
fragments, and afterward retain them in place with your fingers intro- 
duced into the nostrils, and turning the parts into place; then the 
Carthaginian skin is to be used. Call/us forms even when there is a 
1 Here I would call the attention of the reader to the application of this term, 
"the coronoid process of the ulna " (7 nopuvri p in rov mixeos), which creates a g-ood 
deal of ambiguity in several of our author's descriptions of the accidents at the 
elbow-joint. There can be no doubt, in this place, that it is applied to the 
olecranon, as I think it is on all occasions, but M. Littre interprets differently 
several of the passages in which it occurs. In the present instance, M. Littre, 
however, understands it as I always do. By Galen, the term (nopuvp') is always 
decidedly applied to the whole of the posterior process of the ulna, that is to say, 
to the olecranon. See Chirurgici Veteres, ed. Cocchi, p. 141. 
"Foes explains this as meaning the ligament: he says, " vapnutkg vevpov liga- 
mentum intelligere videtur quod ligamentorum natura sensu careat. Innuit 
autem ligamentum illud densum, crassum et validum ac membranosum, quod ex 
brachii fine inferiore exertum, cubitum cum radio connectit, totamque dearticula- 
tionem circumvestiens, majore tamen parte cubitum annectit, ut scribit Hippo- 
crates libro de Fract." But, if our author meant the ligament in this place, it is 
clear that he ascribes to it the well-known sensation occasioned by pressure on 
the ulnar nerve. The following description of it will explain clearly what I 
allude to: "At the elbow the ulnar nerve is superficial, and supported by the 
inner condyle, against which it is easily compressed, giving rise to the thrilling 
sensation along the inner side of the fore-arm and little finger, ascribed to strik- 
ing the 'funny-bone.'" (Wilson's Anatomy, p. 392.) Whether or not Hippocrates 
may not fall into the mistake of confounding nerves with ligaments I cannot 
venture to state positively. 164 
GENUINE WORKS OF HIPPOCRATES. 
wound; and the same things are to be done, even when there is to be 
exfoliation of the bones, for this is not of a serious nature.1 
3. In fractures of the ears, neither bandages nor cataplasms should be 
used; or, if any bandage be used, it should be put on very tight; the 
cerate and sulphur, should be applied to agglutinate the bandages. When 
matter forms in the ears, it is found to be more deeply seated than might 
be supposed, for all parts that are pulpy, and consist of juicy flesh, prove 
deceptions in such a case. But no harm will result from making an 
opening, for the parts are lean, watery, and full of mucus. No mention 
is here made of the places and circumstances which render it fatal to 
make an opening.2 The cure is soonest effected by transfixing the ear 
with a cautery; but the ear is maimed and diminished in size, if burned 
across. If opened, one of the gentle medicines for flesh wounds should 
be used as a dressing.3 
4. The jaw-bone is often slightly displaced {subluxated?'), and is 
restored again; it is dislocated but rarely, especially in gaping; in fact, 
the bone is never dislocated unless it slips while the mouth is opened 
wide. It slips, however, the more readily from its ligaments being 
oblique, supple, and of a yielding nature. The symptoms are: the lower 
jaw protrudes, it is distorted to the side opposite the dislocation, and the 
patient cannot shut his mouth; when both sides are dislocated, the jaw 
projects more, the mouth can be less shut, but there is no distortion; this 
is shown by the rows of the teeth in the upper and lower jaw corresponding 
with one another. If, then, both sides be dislocated, and not imme- 
diately reduced, the patient for the most part dies on the tenth day, with 
symptoms of continued fever, stupor, and coma, for the muscles there 
induce such effects; there is disorder of the bowels attended with scanty 
and unmixed dejections; and the vomitings, if any, are of the same 
character. The other variety is less troublesome. The method of reduc- 
tion is the same in both:-The patient being laid down or seated, the 
physician is to take hold of his head, and grasping both sides of the jaw- 
bone with both hands, within and without, he must perform three 
manoeuvres at once,-rectify the position of the jaw, push it backward, 
and shut the mouth. The treatment should consist of soothing applica- 
tions, position, and applying a suitable bandage to support the jaw-bone, 
so as to co-operate with the reduction.4 
5. The bone of the shoulder is dislocated downward I have never 
heard of any other mode. The parts put on the appearance of disloca- 
1 This paragraph is abridged from §§ 35, 36, 37, 38, 39 of the work, On the 
Articulations. On the caddis mentioned in this paragraph, see the editors of 
Erotian, Eustachius, and Frantzius, under a%vr/ bdoviov. 
2 Compare On the Articulations, § 15. 
3 The contents of this paragraph are abridged from § 40 of the work, On the 
Articulations. 
4 This is an abridgment of §§ 30 and 31 of the work, On the Articulations. MOCHLICUS. 
165 
tion forward, when the flesh about the joint is wasted during consumption, 
as also seems to be the case with cattle when in a state of leanness after 
winter.1 Those persons are most liable to dislocations who are thin, 
slender, and have humidities about their joints without inflammation, for 
it knits the joints. Those who attempt to reduce and rectify dislocations 
in oxen, commit a blunder, as forgetting that the symptoms arise from 
the manner in which the ox uses the limb, and that the appearance is the 
same in a man who is in a similar condition, and forgetting also that 
Homer has said, that oxen are most lean at that season. In this disloca- 
tion, then, when not reduced, the patient cannot perform any of those 
acts which others do, by raising the arm from the side. I have thus 
stated who are the persons most subject to this dislocation, and how they 
are affected. In congenital dislocations the nearest bones are most 
shortened, as is the case with persons who are weasel-armed; the fore-arm 
less so, and the hand still less; the bones above are not affected. And 
the parts (near the seat of the injury) are most wasted in flesh; and this 
happens more especially on the side of the arm opposite the dislocation, 
and that during adolescence, yet in a somewhat less degree than in con- 
genital cases. The deep-seated suppurations occur most frequently to 
new-born infants about the joint of the shoulder, and these produce the 
same consequences as dislocations.2 In adults, the bones are not so 
diminished in size, and justly, seeing that the others will not increase as 
in the former case; but wasting of the flesh takes place, for it is increased, 
and is diminished every day, and at all ages. And attention should be 
paid to the force of habit, and to the symptom produced by the tearing 
away of the acromion, whereby a void is left, which makes people suppose 
that the humerus is dislocated. The head of the humerus is felt in the 
armpit, and the patient cannot raise his arm, nor swing it to this side and 
that, as formerly. The other shoulder shows the difference. Modes of 
reduction:-The patient himself having placed his fist in the armpit, 
pushes up the head of the humerus with it, and brings the hand forward 
to the breast. Another:-Force it backward, so that you may turn it 
round. Another:-Apply your head to the acromion, and your hands to 
the armpit, separate the head of the humerus {from the side?}, and push 
the elbow in the opposite direction; or, instead of your knees, another 
person may turn aside the elbow, as formerly directed. Or, place the 
patient on your shoulder, with the shoulder in his armpit. Or, with the 
heel, something being introduced to fill up the hollow of the armpit, and 
using the| right foot to the right shoulder. Or, with a pestle. Or, with 
1 The language here would seem to imply that the dislocation in cattle is not 
real, but merely apparent. See § 8 of the Articulations, and the Annotations on 
it. 
- Every experienced physician must have met with cases in which abscess 
about a joint has occasioned impairment of it. 166 
GENUINE WORKS OF HIPPOCRATES. 
the step of a ladder. Or, by rotation made with piece of wood stretched 
below the arm. Treatment:-As to attitude, the arm placed by the side, 
the hand and shoulder raised; the bandaging and adjustment of the parts 
while in this attitude. If not reduced, the top of the shoulder becomes 
attenuated.1 
6. When the acromion is torn away, the appearance is the same as in 
dislocation of the shoulder; but there is no impediment, except that the 
bone does not return to its position. The figure should be the same as in 
dislocation, both as regards bandaging and suspending the limb. The 
bandaging according to rule.2 
7. When partial displacement /*) takes place at the elbow, 
either inside or outside, but the sharp point (olecranon ?) remains in the 
cavity of the humerus, make extension in a straight line, and push the 
projecting parts backward and to the sides.3 
8. In complete dislocations to either side, make extension while the 
arm is in the position it is put in to be bandaged for a fracture, for thus 
the rounded part of the elbow will not form an obstacle to it. Disloca- 
tion most commonly takes place inward. The parts are to be adjusted by 
separating the bones as much as possible, so that the end of the humerus 
may not come in contact with the olecranon, but it is to be carried up and 
turned round, and not forced in a straight line; at the same time the 
opposite sides are to be pushed together, and the bones reduced to their 
place? In these cases rotation of the elbow co-operates; that is to say, 
turning the arm into a state of supination and pronation; so much for 
the reduction. With regard to the attitude in which it is to be put,-the 
hand is to be placed somewhat higher than the elbow, and the arm by 
the side; this position suits with it when slung from the neck, is easily 
borne, is its natural position, and one adapted for ordinary purposes, 
unless callus form improperly: the callus soon forms. Treatment:-By 
bandages according to the common rule for articulations, and the point 
of the elbow is to be included in the bandage.5 
9. The elbow, when luxated, induces the most serious consequences, 
fevers, pain, nausea, vomiting of pure bile; and this especially in disloca- 
tions backward, from pressure on the nerve which occasions numbness; 
next to it is dislocation forward. The treatment is the same. The 
reduction of dislocation backward is by extension and adaptation: the 
symptom of this variety, loss of the power of extension; of dislocation 
1 This description of the symptoms and treatment of dislocation at the 
shoulder-joint is abridged from § 1-13 of the work, On the Articulations. 
2 This is an abridgment of § 14 of the work, On the Articulations. 
3 This is a repetition of § 17 of the work, On the Articulations. 
4 The meaning in this passage seems very equivocal. See Littrd, and our 
Argument to the work, On the Articulations. 
5 This is a repetition of § 18 of the work. On the Articulations. MOCIILICUS. 
167 
forward, loss of the power of flexion. In it a hard ball is to be placed 
in the bend of the elbow, and the fore-arm is to be bent over this while 
sudden extension is made.1 
10. Diastasis of the bones may be recognized by examining the part 
where the vein which runs along the arm divides.2 
11. In these cases callus is speedily formed. In congenital dislocations, 
the bones below the seat of the injury are shorter than natural; in this 
case, the greatest shortening is in the nearest, namely, those of the fore- 
arm; second, those of the hand; third, those of the fingers. The arm 
and shoulders are stronger, owing to the nourishment which they receive, 
and the other arm, from the additional work it has to perform, is still 
more strong. The wasting of the flesh, if the dislocation was outward, 
is on the inside; or if otherwise, on the side opposite the dislocation.3 
12. In dislocation at the elbow, whether outward or inward, exten- 
sion is to be made with the fore-arm at right angles to the arm; the arm 
is to be suspended by a shawl passed through the armpit, and a weight is 
to be attached to the extremity of the elbow; or force is to be applied 
with the hands. The articular extremity being properly raised, the parts 
are to be adjusted with the palms of the hands, as in dislocations of the 
hands. It is to be bandaged, suspended in a sling, and placed, while in 
this attitude.4 
13. Dislocations backward are to be rectified with the palms of the 
hands along with sudden extension. These two acts are to be performed 
together, as in other cases of the kind. In dislocation forward, the arm 
is to bend around a ball of cloth, of proper size, and at the same time 
replaced.6 
14. If the displacement be on the other side both these operations are 
to be performed in effecting the adjustment of the arm. With regard to 
the treatment,-the position and the bandaging are the same as in the 
other cases. For all these cases may be reduced by ordinary distention.6 
15. With regard to the modes of reduction, some act upon the princi- 
ple of carrying the one piece of bone over the other, some by extension, 
and some by rotation: these last consist in rapidly turning the arm to this 
side and that.7 
16. The joint of the hand is dislocated inward or outward, but most 
frequently inward. The symptoms are easily recognized; if inward, the 
patient cannot at all bend his fingers, but if outward, he cannot extend 
1 This is copied from § 19 of the work, On the Articulations. 
2 This is literally copied from § 20 of the work, On the Articulations. 
3 This is taken from § 21 of the work, On the Articulations. 
4 This is taken from § 22 of the work, On the Articulations. 
5 This is copied from § 23 of the work, On the Articulations. 
6 This is taken from § 24 of the work, On the Articulations. 
1 This is the same as § 25 of the work, On the Articulations. 168 
GENUINE WORKS OF HIPPOCRATES. 
them. Reduction:-By placing the fingers above a table, extension and 
counter-extension are to be made by assistance, while, with the palm of 
the hand or the heel on the projecting bone, one presses forward, and 
from behind, upon the other bone, and lays some soft substance on it; 
and, if the dislocation be above, the hand is to be turned into a state of 
pronation; or, if backward, into a state of supination. The treatment 
is to be conducted with bandages.1 
17. The whole hand is dislocated either inward, or outward, but 
especially inward, or to this side or that. Sometimes the epiphysis is 
displaced, and sometimes there is displacement (diastasis') of the one 
bone from the other. Powerful extension is to be made in this case; and 
the projecting part is to be pressed upon, and counter-pressure made on 
the opposite side: both modes being performed at the same time, both 
backward and laterally, either with the hands on a table, or with the 
heel. These accidents give rise to serious consequences and deformities; 
but in time the parts get so strong as to admit of being used. The treat- 
ment consists of bandages comprehending the hand and fore-arm, and 
splints are to be applied as far as the fingers; when put in splints, they 
are to be more frequently loosed than in fractures, and more copious 
affusions of water are to be used.2 
18. In congenital dislocations the hand becomes shortened, and the 
atrophy of the flesh is generally on the side opposite the dislocation. In 
the adult the bones remain of their proper size.3 
19. The symptoms of dislocation of the finger are obvious, and need 
not be described. This is the mode of reduction:-By stretching in a 
straight line, and making pressure on the projecting part, and counter- 
pressure, at the opposite side, on the other. The proper treatment 
consists in the application of bandages. When not reduced, the parts 
unite by callus outside of the joints. In congenital dislocations, and in 
those which occur during adolescence, the bones below the dislocation are 
shortened, and the flesh is wasted principally on the side opposite to the 
dislocation; in the adult the bones remain of their proper size.4 
20. Dislocation at the hip-joint occurs in four modes, inward most 
frequently, outward next, the others of equal frequency. The symptoms: 
-The common, a comparison with the sound leg. The peculiar symp- 
toms of dislocations inward; the head of the bone is felt at the perineum; 
the patient cannot bend his leg as formerly; the limb appears elongated, 
and to a great extent, unless you bring both limbs into the middle space 
between them in making a comparison of them; and the foot and the 
knee are inclined outward. If the dislocation has taken place from birth, 
1 This is the same as § 26 of the work, On the Articulations. 
2 This is taken from § 27 of the work, On the Articulations. 
3 This is the same as § 28 of the work, On the Articulations. 
4 This is taken from § 29 of the work, On the Articulations. MOCHLICUS. 
169 
or during one's growth, the thigh is shortened, the leg less so, and the 
others according to the same rule; the fleshy parts are atrophied, especi- 
ally on the outside. Such persons are afraid to stand erect, and crawl 
along on the sound limb; or, if compelled, they walk with one or two 
staves, and bear up the affected limb; and the smaller the limb so much 
the more easily do they walk. If the accident happens to adults the bones 
remain of their proper size, but the flesh is wasted, as formerly described; 
the patients walk in a wriggling manner, like oxen ; they are bent 
toward the flank, and the buttock on the uninjured side is prominent; 
for the uninjured limb must necessarily come below that it may support 
the body, whilst the other must be carried out of the way, as it cannot 
support the body, like those who have an ulcer in the foot. They poise 
the body by means of a staff on the sound side, and grasp the affected 
limb with the hand above the knee so as to carry the body in shifting 
from one place to another. If the parts below the hip-joint be used, the 
bones below are less atrophied, but the flesh more.1 
21. The symptoms and attitudes in dislocation outward are the oppo- 
site, and the knee and foot incline a little inward. When it is congenital, 
or occurs during adolescence, the bones do not grow properly; according 
to the same rule, the bone of the hip-joint is somewhat higher than 
natural, and does not grow proportionally. In those who have frequent 
dislocations outward, without inflammation, the limb is of a more humid 
(flabby?) temperament than natural, like the thumb, for it is the part 
most frequently dislocated, owing to its configuration; in what persons 
the dislocation is to a greater or less extent; and in what persons it is 
more difficultly or easily produced; in what there is reason to hope that 
it can be speedily reduced, and in what not; and the remedy for this; 
and in what cases the dislocation frequently happens, and treatment of 
this. In dislocation outward from birth, or during adolescence, or from 
disease, (and it happens most frequently from disease, in which case there 
is sometimes exfoliation of the bone, but even where there is no exfolia- 
tion,) the patients experience the same symptoms, but to an inferior de- 
gree to those in dislocations inward, if properly managed so that in walk- 
ing they can put the whole foot to the ground and lean to either side. 
The younger the patient is, the greater care should be bestowed on him; 
when neglected, the case gets worse; when attended to, it improves; and, 
although there be atrophy in all parts of the limb, it is to a less extent. 
22. When there is a dislocation on both sides, the affections of the 
bones are the same; the flesh is well developed, except within, the nates 
protrude, the thighs are arched, unless there be sphacelus.2 If there be 
1 This is mostly condensed from §§ 51 and 52 of the work, On the Articula- 
tions. 
2 That is to say, unless the case proceed from disease of the bone. 170 
GENUINE WORKS OF HIPPOCRATES. 
curvature of the spine above the hip-joint, the patients enjoy good health, 
but the body does not grow, with the exception of the head.1 
23. The symptoms of dislocation backward are:-The parts before 
more empty, behind they protrude, the foot straight, flexion impossible, 
except with pain, extension least of all: in these the limb is shortened. 
They can neither extend the limb at the ham, nor at the groin, unless it 
be much raised, nor can they bend it. The uppermost joint, in most 
cases, takes the lead: this is common in joints, nerves, muscles, intestines, 
uteri, and other parts. There the bone of the hip-joint is carried back- 
ward to the nates, and on that account it is shortened, and because the 
patient cannot extend it. The flesh of the whole leg is wasted in all cases, 
in which most, and to what extent, has been already stated. Every part 
of the body which performs its functional work is strong, but, if inactive, 
it gets into a bad condition, unless its inactivity arise from fatigue, fever, 
or inflammation. And in dislocations outward, the limb is shortened, 
because the bone is lodged in flesh which yields; but, in dislocations in- 
ward, it is longer, because the bone is lodged on a projecting bone. 
Adults, then, who have this dislocation unreduced, are bent at the groins 
in walking, and the other ham is flexed; they scarcely reach the ground 
with the ball of the foot; they grasp the limb with the hand, and walk 
without a staff if they choose; if the staff be too long, their foot cannot 
reach the ground,-if they wish to reach the ground, they must use a 
short staff. There is wasting of the flesh in cases attended with pain; 
and the inclination of the leg is forward, and the sound leg in proportion. 
In congenital cases, or when in adolescence, or from disease, the bone is 
dislocated (under what circumstances will be explained afterward), the 
limb is particularly impaired, owing to the nerves and joints not being 
exercised, and the knee is impaired for the reasons stated. These per- 
sons, keeping the limb bent, walk with one staff or two. But the sound 
limb is in good flesh from usage.2 
24. In dislocations forward the symptoms are the opposite: a vacuity 
behind, a protuberance before; of all motions they can least perform flex- 
ion, and extension best; the foot is straight, the limb is of the proper 
length at the heel; at its extremity the foot a little turned up; they are 
especially pained at'first: of all these dislocations retention of urine oc- 
curs most frequently in this variety, because the bone is lodged among 
important nerves. The fore parts are stretched, do not grow, are diseased, 
and are obnoxious to premature decay; the back parts are wrinkled. In 
the case of adults, they walk erect, resting merely on the heel, and this 
they do decidedly if they can take great steps; but they drag it along; the 
1 The contents of this and the preceding paragraph are mostly condensed from 
§§ 54, 55, 56 of the work, On the Articulations. 
2 The contents of these two paragraphs on dislocation backward are con- 
densed from §§ 57, 58 of the work, On the Articulations. MOCHLICUS. 
171 
wasting is least of all in this variety of dislocation, owing to their being 
able to use the limb, but the wasting is most behind. The whole limb 
being straighter than natural they stand in need of a staff on the affected 
side. When the dislocation is congenital, or has occurred during ado- 
lescence, if properly managed, the patient has the use of the limb as well 
as adults (otherwise ?) have of it. But, if neglected, it is shortened and 
extended, for in such cases the joint is generally ankylosed in a straight 
position. The diminution of the bones, and wasting of the fleshy parts, 
are analogous.1 
25. In reduction-the extension of the thigh is to be powerful, and 
the adjustment what is common in all such cases, with the hands, or a 
board, or a lever, which, in dislocations inward, should be round, and in 
dislocations outward, flat; but it is mostly applicable in dislocations out- 
ward. Dislocations inward are to be remedied by means of bladders, ex- 
tending to the bare part of the thigh, along with extension and binding 
together of the limbs. The patient may be suspended, with his feet a lit- 
tle separated from one another, and then a person inserting his arm with- 
in the affected limb, is to suspend himself from it, and perform extension 
and readjustment at the same time; and this method is sufficient in dis- 
locations forward and the others, but least of all in dislocations backward. 
A board fastened under the limb, like the board fastened below the arm 
in dislocations at the shoulder, answers in dislocations inward, but less 
so in the other varieties. Along with extension you will use pressure 
either with the foot, the hand, or a board, especially in dislocations for- 
ward and backward.2 
26. Dislocations at the knee are of a milder character than those of 
the elbow, owing to the compactness and regularity of the joint; and 
hence it is more readily dislocated and reduced. Dislocation generally 
takes place inward, but also outward and backward. The methods of re- 
duction are-by circumflexion, or by rapid excalcitration, or by rolling a 
fillet into a ball, placing it in the ham, and then letting the patient's body 
suddenly drop down on his knees: this mode applies best in dislocations 
backward. Dislocations backward, like those of the elbows, may also be 
reduced by moderate extension. Lateral dislocations may be reduced by 
circumflexion or excalcitration, or by extension (but this is most applica- 
ble in dislocation backward), but also by moderate extension. The adjust- 
ment is what is common in all. If not reduced, in dislocations backward, 
they cannot bend the leg and thigh upon one another, but neither can 
they do this in the others except to a small extent; and the fore parts of 
the thigh and leg are wasted. In dislocations inward they are bandy- 
1 The contents of this paragraph are condensed from §§ 59, 60 of the work, On 
the Articulations. 
2 This paragraph is made up from § 70 and other paragraphs of the work, On 
the Articulations. 172 
GENUINE WORKS OF HIPPOCRATES. 
legged, and the external parts are atrophied. But, in dislocations out- 
ward, they incline more outward, but are less lame, for the body is sup- 
ported on the thickei* bone, and the inner parts are wasted. The conse- 
quences of a congenital dislocation, or one occurring during adolescence, 
are analogous to the rule formerly laid down.1 
27. Dislocations at the ankle-joint require strong extension, either 
with the hands or some such means, and adjustment, which at the same 
time effects both acts; this is common in all cases.2 
28. Dislocations of the bones of the foot are to be treated like those 
of the hand.3 
29. Dislocations of the bones connected with the leg, if not reduced, 
whether occurring at birth or during adolescence, are of the same char- 
acter as those in the hand.4 
30. Persons who, in jumping from a height, have pitched on the 
heel, so as to occasion diastasis (separation) of the bones, ecchymosis of 
the veins, and contusion of the nerves,-when these symptoms are very 
violent, there is danger that the parts may sphacelate, and give trouble 
to the patient during the remainder of his life; for these bones are so con- 
structed as to slip past one another, and the nerves communicate together. 
And, likewise, in cases of fracture, either from an injury in the leg or 
thigh, or in paralysis of the nerves connected with these parts, or, when 
in any other case of confinement to bed the heel, from neglect, becomes 
blackened, in all these cases serious effects result therefrom. Sometimes, 
in addition to the sphacelus, very acute fevers supervene, attended with 
hiccup, tumors, aberration of intellect, and speedy death, along with 
lividity of the large blood-vessels, and gangrene. The symptoms of the 
exacerbations are these: if the ecchymosis, the blackened parts, and those 
around them, be somewhat hard and red, and if lividity be combined with 
the hardness, there is danger of mortification; but, if the parts are sub- 
livid, or even very livid and diffused, or greenish and soft, these symp- 
toms, in all such cases, are favorable. The treatment consists in the ad- 
ministration of hellebore, if they be free from fever, but otherwise, they 
are to have oxyglyky for drink, if required. Bandaging,-agreeably to 
the rule in other joints; but this is to be attended to also,-the bandages 
should be numerous, and softer than usual; compression less; more water 
tham usual to be used in the affusions; to be applied especially to the heel. 
The same object should be sought after in the position as in the bandag- 
ing, namely, that the humors may not be determined to the heel; the limb 
1 The substance of what is here said on dislocations at the knee, is taken from 
§ 82 of the work, On the Articulations, and § 37 of the work, on Fractures. 
2 See On the Articulations, § 83; and on Fractures, § 13. 
3 See on the Articulations, § 84. 
4 Ibid, § 85. MOCHLICUS. 
173 
to be well laid should have the heel higher than the knee. Splints not 
to be used.1 
31. When the foot is dislocated, either alone, or with the epiphysis, 
the displacement is more apt to be inward. If not reduced, in the course 
of time the parts of the hips, thigh, and leg, opposite the dislocation, 
become attenuated. Reduction:-As in dislocation at the wrist; but the 
extension requires to be very powerful. Treatment:-Agreeably to the 
rule laid down for the other joints. Less apt to be followed by serious 
consequences than the wrist, if kept quiet. Diet restricted, as being in 
an inactive state. Those occurring at birth, or during adolescence, ob- 
serve the rule formerly stated.2 
32. With regard to slight congenital dislocations, some of them can 
be rectified, especially club-foot. There is more than one variety of club- 
foot. The treatment consists in modeling the foot like a piece of wax; 
applying resinous cerate, and numerous bandages; or a sole, or a piece of 
lead is to be bound on, but not upon the bare skin; the adjustment and 
attitudes to correspond.3 
33. If the dislocated bones cause a wound in the skin, and protrude, 
it is better to let them alone, provided only they are not allowed to hang, 
nor are compressed. The treatment consists in applying pitched cerate, 
or compresses dipped in hot wine (for cold is bad in all such cases), and 
certain leaves; but in winter unwashed wool may be applied as a cover to 
the part; neither cataplasms nor bandaging; restricted diet. Cold, great 
weight, compression, violence, restricted position, all such are to be ac- 
counted as fatal measures. When treated moderately (they escape), 
maimed and deformed; for, if the dislocation be at the ankle, the foot is 
drawn upward, and, if elsewhere, according to the same rule. The bones 
do not readily exfoliate; for only small portions of them are denuded, and 
they heal by narrow cicatrices. The danger is greatest in the greatest 
joints, and those highest up. The only chance of recovery is, if they are 
not reduced, except at the fingers and hand, and in these cases the dan- 
ger should be announced beforehand. Attempts at reduction to be made 
on the first or second day; or, if not accomplished then, on the tenth, by 
no means on the fourth. Reduction by levers. Treatment:-As in in- 
juries of the bones of the head, and the part is to be kept hot; and it 
is better to give hellebore immediately after the parts have been reducwl. 
With regard to the other bones, it should be well known, that, if replaced, 
death will be the consequence; the more surely and expeditiously, the 
greater the articulation, and the more high its situation. Dislocation of 
1 The contents of this paragraph are copied almost word for word from § 86 of 
the work, On the Articulations. 
2 This is literally taken from § 87 of the work, On the Articulations. 
3 This is a very brief abstract of the contents of § 62 of the work, On the Arti- 
culations. 174 
GENUINE WORKS OF HIPPOCRATES. 
the foot is attended with spasm (tetanus) and gangrene; and if, upon its 
being replaced, any of these symptoms come on, the chance of recovery, 
if there be any chance, is in displacing it anew; for spasms do not arise 
from relaxation, but from tension of the parts.1 
34. Excision, either of articular bones or of pieces of bones, when not 
high up in the body, but about the foot or the hand, is generally followed 
by recovery, unless the patient die at once from deliquium animi. Treat- 
ment:-As in injuries of the head; warmth.2 
35. Sphacelus of the fleshy parts is produced by the tight compression 
of bleeding wounds, and by pressure in the fractures of bones, and by 
blackening, arising from bandages. And in those cases in which a 
portion of the thigh or arm, both the bones and the flesh drop off, many 
recover, the case being less dangerous than many others. In cases, then, 
connected with fracture of the bones, the separation of the flesh quickly 
takes place, but the separation of the bone, at the boundary of its denuded 
part, is slower in taking place. But the parts below the seat of the 
injury, and the sound portion of the body, are to be previously taken 
away (for they die previously), taking care to avoid producing pain, for 
deliquium animi may occasion death. The bone of the thigh in such a 
case came away on the eightieth day, but the leg was removed on the 
twentieth day. The bones of the leg, in a certain case, came away at the 
middle of the sixtieth day. In these cases the separation is quick or slow, 
according to the compression applied by the physician. When the com- 
pression is gently applied the bones do not drop off at all, neither are 
they denuded of flesh, but the gangrene is confined in the more superfi- 
cial parts. The treatment of such cases must be undertaken; for most 
of them are more formidable in appearance than in reality. The treat- 
ment should be mild, but, with a restricted diet; hemorrhages and cold 
are to be dreaded; the position, so as that the limb may be inclined 
upward, and afterward, on account of the purulent abscess, horizontally, 
or such as may suit with it. In such cases, and in mortifications, there 
are, usually, about the crisis, hemorrhages and violent diarrhoeas, which, 
however, only last for a few days; the patients do not lose their appetite, 
neither are they feverish, nor should they be put upon a reduced diet.a 
36. Displacement of the spine, if inward, threatens immediate death, 
with retention of urine and loss of sensibility. Outward, the 
accident is free from most of these bad effects, much more so than where 
there is merely concussion without displacement; the effects in the former 
case being confined to the spot affected, whereas in the latter they are 
further communicated to the whole body, and are of a mortal character. 
In like manner, when the ribs are fractured, whether one or more, pro- 
1 This is condensed from §§ 63-7 of the work, On the Articulations. 
2 See § 68 of the work, On the Articulations. 
3 This is condensed from § 69 of the work, On the Articulations. MOCHLICUS. 
175 
vided there be no splinters, there is rarely fever, spitting of blood, and 
sphacelus, and ordinary treatment without evacuation will suffice, pro- 
vided there be no fever;-bandaging, according to rule; and the callus 
forms in twenty days, the bone being of a porous nature. But in cases 
of contusion, tubercles form, along with cough, suppurating sores, and 
sphacelus- of the ribs, for nerves from all the parts run along each rib. 
In many of these cases haemoptysis and empyema also take place. The 
management of this case consists in careful treatment, bandaging accord- 
ing to rule, diet at first restricted, but afterward more liberal, quiet, 
silence, position, bowels, and venereal matters regulated. Even when 
there is no spitting of blood, these contusions are more painful than fract- 
ures, and are more subject in time to relapses;. and when any mucous 
collection is left in the part, it makes itself be felt in disorders of the 
body. Treament:-burning, when the bone is affected, down to the 
bone, but not touching the bone itself; if in the intercostal space, the 
burning must not extend through it, nor be too superficial. In sphacelus 
of the ribs, tents are to be tried, all other particulars will be stated after- 
ward: but they should be learned by sight rather than by words, namely, 
food, drink, heat, cold, attitude; medicines, dry, liquid, red, dark, white, 
sour, for the ulcers, and so with regard to the diet.1 
37. Displacements (of the vertebra) from a fall rarely admit of being 
rectified, and those above the diaphragm are most difficult to rectify. 
When the accident happens to children, the body does not grow, with the 
exception of the legs, the arms, and head. Excurvation, in adults, 
speedily relieves the individual from the disease he is laboring under, but 
in time it renews its attack, with the same symptoms as in children, but 
of a less serious nature. Some individuals have borne this affection well, 
and have turned out to be brawny and fat. But few of them have lived 
to the age of sixty. Lateral curvatures also occur, the proximate cause of 
which is the attitudes in which these persons lie. These caseshave their 
prognostics accordingly. 
38. The rule for the reduction and adjustment:-The axle, the lever, 
the wedge, pressure above;2 the axle to separate, the lever to push aside. 
Reduction and adjustment are to be accomplished by forcible extension, 
the parts being placed in such a position as will facilitate the conveying of 
the displaced bone over the extremity of the bone from which it was 
displaced: this is to be accomplished either with the hands, or by sus- 
•pension, or axles, or turned round something. With the hands this is to 
be effected properly, according to the structure of the parts. In the case 
of the wrist and elbow, the parts are to be forced asunder, at the wrist in 
the line of the elbow, and the elbow with the fore-arm at a right angle 
1 This and the next paragraph are taken partly from § 41 of the work, On the 
Articulations, and partly from the three following paragraphs of the same book. 
• See On Fractures, § 31. 176 
GENUINE WORKS OF HIPPOCRATES. 
with the arm, as when it is suspended in a sling. When we want to 
separate the protruding bones, and force them into place, in the case of 
the fingers, the toes, or the wrist, the proper separation may be made by 
hands, while the projecting part is forced into its place by pressing down 
with the heel or the palm of the hand upon some resisting object, while 
something moderately soft is laid under the projecting part, but nothing 
such under the other, and then pressure is to be made backward and 
downward, whether the dislocation be inward or outward. In lateral dis- 
placement, pressure and counter-pressure must be made on the opposite 
sides. Displacements forward can be reduced neither by sneezing, nor 
coughing, nor by the injection of air, nor by the cupping-instrument; 
and if anything can do good in such a case, it is extension. People are 
deceived in fractures of the spinal processes, the pain of which causing 
the patient to stoop forward, the case is taken for dislocation inward; 
these fractures heal speedily and easily. Dislocation outward is to be 
remedied by succussion, when high up, toward the feet; and when 
situated low down, in the contrary direction; the part is to be pressed back 
into its place, either with the foot or a board. Dislocations to either 
side, if they admit of any remedy, are to be treated by extension, and 
suitable attitudes, with regimen. The whole apparatus should be broad, 
soft, and strong; or otherwise, they should be wrapped in rags; before 
being used, they should all be prepared proportionately to the length, 
height, and breadth. In applying extension to the thigh, for example, 
the bands should be fastened at the ankle and above the knee, these 
stretching in the same direction, another band to be passed by the loins, 
and around the armpits, and by the perineum and thigh, one end passing 
up the breast and the other along the back, these all stretching in the 
same direction and being fastened either to a piece of wood resembling a 
pestle or to an axle. When this is done on a couch, either of its feet is 
to be fastened to the threshold, and a strong block of wood is to be laid 
across the other, and the pieces of wood resembling a pestle are to be 
raised on these, to make extension and counter-extension; the naves of a 
wheel are to be fastened in the floor, or a ladder is to be adjusted, so that 
extension may be made in both directions. The thing commonly used is 
a bench six cubits long, two cubits broad, one fathom in thickness, having 
two low axles at this end and that, and having at its middle two moderate- 
sized pillars, to which is to be adjusted a transverse piece of wood like 
the step of a ladder, which is to receive the piece of wood tied below the 
limb, as is done in dislocation at the shoulder; and the bench is to have 
excavations like trays, smooth, foui' inches in breadth and depth, and at 
such an interval as to leave room for the lever used to reduce the limb. 
In the middle of the bench a square hole is to be scooped out to receive a 
small pillar, which, being adjusted to the perineum, will obviate the 
tendency of the body to slip downward, and being rather loose may act MOCHLICUS. 
177 
somewhat as a lever. In certain occasions a piece of wood is required, 
which is inserted into a hole scooped out of the wall; the other end of it 
is then to be pressed down, something moderately soft being placed under 
it.1 
39. In those cases where the bone of the palate has exfoliated, the 
nose sinks in its middle. In contusions of the head without a wound, 
either from a fall, a fracture, or pressure, in certain of these cases acrid 
humors descend from the head to the throat, and from the wound in the 
head to the liver and thigh.2 
40. The symptoms of sub-luxations and luxations, and where, and 
how, and how much these differ from one another. And the cases in 
which the articular cavity has been broken off, and in which the ligament 
has been torn, and in which the epiphysis has been broken off; and in 
which, and how, when the limb consists of two bones, one or both are 
broken: in consequence of these the dangers, chances in which bad, and 
when the injuries will result in death, and when in recovery. What cases 
are to be reduced or attempted, and when, and which, and when not; 
the hopes and dangers in these cases. Which and when congenital dis- 
locations are to be undertaken: the parts in a state of growth, the parts 
fully grown, and why sooner, or slower: and why a part becomes maimed, 
and how, and how not: and why a certain part is atrophied, and where, 
and how, and in what cases to a less extent. And why fractured parts 
unite sooner or slower, how distortions and callosities form, and the remedy 
for them. In what cases there are external wounds, either at first or 
afterwards: in what fractures the bones are shortened, and in what not: 
in what cases the fractured bones protrude, and when they protrude 
most: in what cases dislocated bones protrude. That physicians are 
deceived, and by what means, in what they see, and in what they devise, 
regarding affections, and regarding cures. Established rules with regard 
to bandaging: preparation, presentation of the part, extension, adjust- 
ment, friction, bandaging, suspension and placing of the limb, attitude, 
seasons, diet. The most porous parts heal fastest, and vice versa. Dis- 
tortions, where the bones are crooked. Flesh and tendons wasted on the 
side of the dislocation. The force used in reduction to be applied at as 
1 The contents of this paragraph are taken from various parts of the works, On 
Fractures, and On the Articulations, but more especially from § 47 of the latter. 
2 The greater part of this paragraph is founded on the work, On Injuries of the 
Head. See Epidem. iv., 19, and vi., 3, for the cases of exfoliation of the bones of 
the nose. These are evidently cases of malignant sloughing about the mouth and 
nose, connected no doubt with the pestilential constitution then prevalent The 
notice of this affection, given in the Sixth Book, is to this effect: "In those cases 
in which the bone of the palate exfoliates, the middle of the nose sinks down; but 
in those in which the sloughing is about the teeth, the ridge is flattened." At 
Epid. iv., the case is related more circumstantially. 
Vol. II.-12. 178 
GENUINE WORKS OF HIPPOCRATES. 
great a distance as possible from the seat of the displacement. Of nerves 
(ligaments ?), those which are in motion and in humidity ( flabby are of 
a yielding nature; those that are not, less so. In every dislocation the 
most speedy reduction is best. Reduction not to be made while the 
patient is in a febrile state, nor on the fourth or fifth day; and least of 
all, in those of the elbow, and all cases which induce torpor; the soonest 
the best, provided the inflammatory stage be avoided. Parts torn asunder, 
whether nerves, or cartilages, or epiphyses, or parts separated at sym- 
physes, cannot possibly be restored to their former state; but callus is 
quickly formed in most cases, yet the use of the limb is preserved. Of 
luxations, those nearest the extremities are least dangerous. Those joints 
which are most easily dislocated are the least subject to inflammation. 
Those which have been least inflamed, and have not been subjected to 
after-treatment, are most liable to be dislocated anew. Extension should 
be made in the position most calculated to enable the one bone to clear 
the extremity of the other, attention being paid to configuration and 
place. Adjustment to be made in the direction of the displacement; to 
push the displaced limb straight backward and sideways. Parts suddenly 
drawn aside are to be suddenly drawn back by a rotatory motion. Articu- 
lations which have been oftenest dislocated are the most easily reduced; 
the cause is the conformation of the nerves (ligaments?) or of the bones; 
of the ligaments that they are long and yielding; and of the bones, the 
shallowness of the articulai' cavity, and roundness of the head [of the 
bone that enters it]. Usage, by its friction, forms a new socket. The 
cause-the disposition, and habit, and age. A part somewhat mucous is 
not subject to inflammation.1 
41. In those cases where there are wounds, either at first, or from pro- 
trusion of the bones; or afterward, from pruritus, or irritation; in the 
lattei* case you are immediately to unloose the bandages, and having 
applied pitched cerate to the wound, bandage the limb, placing the head 
of the roller upon the wound, and proceeding otherwise as if there were 
no wound in the case; for thus will the swelling be reduced as much as 
possible, and the wound will suppurate most quickly, and the diseased 
parts will separate, and when it becomes clean the wound will most 
quickly heal. Splints are not to be applied to the place, nor is it to be 
bound tight. Proceed thus when no large bones exfoliate, but not in th 
latter case, for then there is great suppuration, and the same treatment 
is not applicable, but the parts require to be exposed to the ah' on account 
of the abscesses. In such cases where the bones protrude, and whether 
reduced or not, bandaging is not befitting, but distention is to be prac- 
ticed by means of rolls of cloth, made like those used upon shackles; one 
1 The contents of this paragraph are taken from various parts of the works, On 
Fractures, and On the Articulations. MOCHLICUS. 
179 
of these is to be placed at the ankle, and the other at the knee; they are 
to be flattened toward the leg, soft, strong, and having rings; and rods 
made of cornel, and of a proper length and thickness are to be adjusted to 
them, so as to keep the parts distended; and straps, attached to both extrem- 
ities, are to be inserted into the rings, so that the extremities being fixed 
into the rolls, may effect distention.1 Treatment:-Pitched cerate, 
in a hot state; the attitudes, position of the foot and hip; regulated diet. 
The bones which have protruded through the skin are to be replaced the 
same day, or next; not on the fourth or fifth, but when the swelling has 
subsided. Reduction is to be performed with levers; when the bone does 
not present any place upon which the lever can rest, a portion of the part 
which prevents this is to be sawed off. But the denuded parts will drop 
off, and the limb become shortened.2 
42. Dislocations at the joints are to a greater and less extent. Those 
that are to a less extent are the most easily reduced; those that are to a 
greater extent occasion lesions of the bones, of the ligaments, of the joints, 
of the fleshy parts, and of the attitudes. The thigh and arm resemble 
one another very much in their dislocations.3 
1 This method of treating fractures by continued distention is abridged from 
Fractures, § 30. See also the figures at the end of this volume. 
2 This is condensed from various parts of the work, On Fractures. 
3 The opinions here expressed occur both in the treatise on Fractures, and in 
the work On the Articulations. The analogy between the joints of the upper 
and lower extremities is adverted to in §§ 8, 9 of the work, On Fractures, and in 
other parts of that work and the treatise, On the Articulations. See the note on 
§ 18, On Fractures. APHORISMS. APHORISMS 
THE ARGUMENT. 
We now come to the examination of a work so celebrated, that Snidas, 
who lived more than seventeen centuries after the time of Hippocrates, 
and no doubt spoke the established opinion of his age, does not hesitate 
to pronounce it to be " a performance surpassing the genius of man." In 
short it is a work which, from his own time down to within a very recent 
period, when ancient authority in medicine came to be unjustly discarded, 
was always looked upon as being one of the most important productions 
which have come down to us from antiquity. It has been translated (I 
believe I may say) into all the learned languages on earth: into the Hebrew, 
Arabic, Latin, English, Dutch, Italian, German, and French languages; 
it has been commented upon from the earliest time down to the present 
day, by a whole host of commentators, some of whom are remarkable for 
their learning and practical acquaintance with their profession; and it has 
been published so frequently, and in so many different forms, that the 
titles alone of the various editions occupy ten pages in the edition of Lit- 
tre, and still more in that of Kuhn. I shall be readily believed, then, to 
be sincere, when I state that it is with much diffidence that I approach 
this part of my task, more especially as every previous attempt to confer 
upon this great work its proper position in the English literature of medi- 
cine has proved a complete failure. Of these insignificant translations into 
English I have already given some account in the Preliminary Discourse, 
and I shall now merely state in a few words the plan upon which I myself 
have proceeded. The work in question being remarkable for condensa- 
tion of thought and brevity of style, the necessity of some explanatory 
notes, in order to adapt the subject-matters to the tastes of modern read- 
ers, was felt by me to be so strong, that I resolved upon giving on each 
of the Aphorisms a brief commentary, founded on a careful study of all 
the commentaries and annotations which I myself have had an opportu- 
nity of consulting. It will be seen that my commentaries are remarkably 
brief, when their bulk is contrasted with that of many of my predecessors; 
but I may be permitted to say in this place, that I shall feel nmch disap- 
pointed if it be found that I have not given a sufficient amount of illus- 
tration to render the understanding of all parts of the work an easy task 
to a careful reader. Illustrated in this manner, it is hoped that my 184 
GENUINE WORKS OF HIPPOCRATES. 
readers will find no difficulty in comparing the views of our author with 
those entertained by the profession at the present time. 
I have now to give a general exposition of the nature of the work, and 
a brief analysis of its contents. First, then, with regard to the nature and 
scope of the present work: the three ancient commentators, Theophilus, 
Meletius, and Stephanus,1 have all virtually given the same definition of 
what is meant by an aphorism, namely (to give a literal translation of 
their quaint language), that " it is a succinct saying, comprehending a 
complete statement," or, in other words, that it is "a saying poor in ex- 
pression, but rich in sentiment." They say it is called an aphorism be- 
cause (agreeably to the derivation of the word in Greek) " the thought in 
every instance is defined and distinctly separated from what goes before 
and succeeds it." Galen, in like manner, pronounces an aphorism to be 
" a writing of great power, comprehended in few words," that is to say, 
in more modern language, that it is a writing remarkable for brevity and 
point.2 With regard to the scope and object of our author in this work, 
the same commentators do not hesitate to pronounce it to have been to 
embrace the heads of the whole Art and the operations of Nature, by 
which is probably meant, to give an exposition in brief terms of all the 
principles of medicine, physiology, and physical philosophy; for the two 
latter branches of science were generally held to be inseparably connected 
with the Art of medicine. Hence the work embraces many things relat- 
ing to the seasons, the risings of the stars, the nature of waters, the symp- 
toms of disease, and the modes of combating them. Stephanus, in par- 
ticular, passes a high eulogium on the work, as being useful to the perfect 
scholar, and to the uninitiated,-to those who have been late in beginning 
their studies, and to those who have been familiar with them from their 
youth,-to travelers, and to those who reside in cities,-to men of excel- 
lent parts, and to those of obtuse understanding,-to the enterprising and 
the indolent,-to persons whose knowledge is complete, as putting in 
mind summarily of those things which they formerly knew, and to those 
who are imperfect in knowledge, as giving them in a brief space what had 
been previously delivered to them in a diffuse style. 
From a careful examination of the work, it is not difficult to perceive 
that our author's object was to collect the conclusions to which his inves- 
tigations on various subjects had conducted him, or, in other words, to 
give in a'general view all the grand results of his preceding inquiries. 
That the work in question was the production of his advanced age, is fre- 
quently stated by Galen,3 and, indeed, from the nature of it, we might 
confidently affirm, that no one could have written it but a person who 
1 See the edition of their Scholia by Dietz, vol. ii. Regiment. Pruss., 1834. 
2 Comment. IV., in Ditet. Morb. Acut. 
3 See De Crisibus, i., 6. APHORISMS. 
185 
had been long familiarly acquainted with the phenomena of disease, and 
had maturely reflected on all the various subjects to which the several books 
of Aphorisms relate. A very considerable portion of the sentences which 
occur in it are evidently taken from the treatises with which we have 
been already occupied, especially " The Prognostics," " On the Articula- 
tions," and " On Airs, Waters, and Places." But here, on the outset, we 
are met with a puzzle, namely, how to account for the books of Aphor- 
isms containing many extracts from works we have set down as being of a 
spurious nature ? Are these interpolations ? or, have these sentences been 
taken from the books of Aphorisms, and transferred to the other works 
in which they appear ? These are questions, which it is much to be re- 
gretted that, in many instances, we have no means of answering in a sat- 
isfactory manner. Indeed, it must be admitted that, with the most posi- 
tive evidence in favor of the general authenticity of the Aphorisms, it is 
unfortunately but too well ascertained that a certain portion of them are 
unquestionably interpolations; and of a good many more it is often diffi- 
cult to pronounce whether they be genuine or not. With these draw- 
backs, from which it is to be lamented that few works which have de- 
scended to us from remote antiquity, are altogether exempt, we must pro- 
ceed to examine the book as we now possess it, and to give a succinct 
analysis of its subject-matters. 
I must mention, however, in the first place, that the Aphorisms were 
differently divided by the commentators in ancient times. Thus, Sora- 
nus divided them into three sections, Ruffus into four, and Galen into 
seven. In modern editions they are usually divided into eight sections, 
but those contained in the last of them are generally admitted to be apocry- 
phal, with the exception of a few which have been added to the seventh 
section by Foes and Littre. 
SECTION I. 
The work opens with a memorable Aphorism, in which the author 
strikingly contrasts the shortness of human life with the prolixity of Art; 
proclaims the necessity of prompt decision, while he states the difficulty 
of forming a correct judgment, owing to the fallaciousness of medical ex- 
perience; and evinces his practical acquaintance with the business of the 
profession, by announcing that it is not sufficient for the physician to be 
prepared to do his duties himself, unless he disposes those who sur- 
round the patient to co-operate with him in the performance of his 
task (§1). 
The following Aphorisms, down to the 20th, relate principally to die- 
tetics, or, at least, they bear more or less upon that subject. In the 2d, 
it is stated that, as in natural evacuations, if the discharges, whether up- 
ward or downward, be such as the system requires to get rid of, they do 
good, and are easily supported, but if otherwise, the contrary is the case; 186 
GENUINE WORKS OF HIPPOCRATES. 
so the same rule applies to evacuations produced by the administration 
of medicines. The next states the danger of too full and too spare a diet 
in the persons of the Athletes, and hence follows the natural conclusion, 
that a very full or very spare diet is equally dangerous in the case of con- 
valescents (§§ 3, 4, 5). The rules of diet in diseases are next given with 
great precision; the propriety of using the sparest diet when the disease 
is at its acme, is stated; and in particular it is laid down as a general rule, 
that the administration of food is to be avoided at the stage of the exacer- 
bations in intermittent fevers, attention, however, being paid to the 
strength of the patient, so that it may not be allowed to sink for want of 
proper support. See §§ 6, 7, 8, 9, 10, 11. The symptoms by which the 
exacerbations and remissions of fever may be judged of, are tersely but 
distinctly stated in § 12. The system of diet best suiting the different 
ages, founded on the grand principle of the differences of the innate or 
animal heat in youth and old age, are stated in §§ 13, 14, and the regi- 
men befitting the different seasons in § 15. In § 16 is announced the 
great principle upon which the regimen in acute diseases is to be regulated, 
namely, that a diluent diet, that is to say, a diet consisting principally of 
liquids, is the most suitable in all such cases. In the 17th, 18th, and 
19th are given some further directions with regard to the times of admin- 
istering food. One of the rules there laid down, deserves to be kept in 
constant remembrance: " something is to be conceded to habit, to sea- 
son, to country, and to age." 
The remaining Aphorisms in this section from the 20th to the 25th, 
relate entirely to purging, the rules of which are here accurately laid 
down. One of them is most important, namely, that when the strength 
permits, evacuation in certain cases should be carried the length of induc- 
ing deliquium animi. (See § 2.) 
SECTION II. 
The first eight Aphorisms of this section relate principally to the rules 
of prognosis, especially those regarding sleep, fasting, and repletion, §§ 
1-6: then there are two relating to the effect of food in convalescence, 
which leads to the remark that when food does not recruit the body, we 
know that evacuation is required (§ 8); and hence our author proceeds to 
give directions about purgings (§§ 9, 10), and then he remarks upon the 
mode of recruiting, which he recommends to be done with liquid food 
(§ 11); and the consequences of allowing the peccant humors to remain 
in the system are stated in § 12. Next follow two Aphorisms touching 
the crisis (§§ 13, 14); and afterward ingenious directions are given for de- 
termining whether an abscess in the throat or elsewhere, be of a local 
nature, or whether it affect the constitution (§ 15); then follow three 
Aphorisms regarding hunger and the administration of food in convales- 
cence (§§ 16, 17, 18); with an important advice as to the necessity of be- APHORISMS. 
187 
ing cautious in giving a prognosis in acute diseases (§ 19); in the next 
(S 20), is given a statement, not very intelligible, regarding the condition 
of the bowels in youth and old age; then, after a short aphorim, in which 
wine is declared to be the crire of hunger (§ 21), the author states the 
grand rule of all rational therapeutics, namely, that diseases are to be 
cured by their contraries (§22); three Aphorisms (§§ 23, 24, 25) then fol- 
low, relative to crises (the 26th, in which the combination of fever with 
spasms is stated, seems rather out of place); after this there are two 
Aphorisms, relative to prognostics in febrile diseases (§§ 27, 28); the next 
two Aphorisms are devoted to the exposition of the times at which reme- 
dial measures are to be used in fevers, these are the beginning and decline, 
avoiding the acme (§§ 29, 30); the two following (§§ 31, 32) relate to the 
regimen in convalescence; in the next, the importance of a sound intel- 
lect and good appetite in all diseases is stated (§ 33); the following one 
refers to prognostics, and states the comparative immunity from danger 
in diseases, when they are in accordance with ages, constitutions, and 
habits (§ 34); the next one relates to the state of the hypochondrium in 
diseases,-a point in semeiology to which our author paid great attention 
(§ 35); in §§ 36, 37, the deleterious effects of purgatives, when unseason- 
ably administered, are pointedly declared; in § 38, the propriety of con- 
sulting the palate in laying down the rules of regimen is distinctly stated; 
the comparative effects of diseases on the old and young are given in § 39; 
and the danger of pectoral complaints in the old are stated in § 40. The 
danger attending sudden swoonings is proclaimed in § 41, and hence, natu- 
rally apoplexy, and the danger with which it is accompanied, form the 
subject of § 42; probably from some fancied connection between the sub- 
jects, the author next states the appearances from which one may judge 
whether or not a person who has been strangled may be resuscitated (§■ 
43). The comparative degree of danger when disease attacks the fat and 
the lean is declared in § 44. The 45th relates to the influence which 
changes of age, place, and circumstances have on epileptics. The 46th 
contains the announcement of an important principle in the natural treat- 
ment of diseases, namely, that a milder attack of pain is obscured by a 
more severe. The 47th embraces the symptoms which accompany the 
formation of pus in an abscess; in the 48th is stated the well-known fact 
of the need of rest in all disorders of the body. The next four relate to 
changes, and the dangers attending them: the 49th proclaims the effect 
of habit in making the weak endure more than the strong; the 50th em- 
braces the same subject in a more comprehensive form; in the 51st the 
danger of sudden changes is depicted; and in the 52d, the medical prac- 
titioner is cautioned not to alter his plan of treatment without a suitable 
indication. The 53d is a repetition of the 20th, and the last proclaims 
the advantages of tallness in youth, and the disadvantages in old age. 
From the outline now given, it will be readily perceived that very im- 188 
GENUINE WORKS OF HIPPOCRATES. 
portant subjects in semeiology, therapeutics, and prognostics, are touched 
upon in this section, but that it is often difficult to trace any connection 
between the different parts of which it is composed. 
SECTION III. 
This section, as is stated by Theophilus, the Commentator, is princi- 
pally devoted to two subjects: the one being the temperature of the 
seasons and the diseases connected with them; and the other, the different 
ages and the diseases peculiar to them. The first sixteen relate almost 
entirely to the seasons, and the states of the weather, with the diseases to 
which they give rise, and the constitutions best and worst adapted to 
particular seasons. The changes of the seasons, and the changes of the 
weather in the different seasons, are declared to be the principal causes of 
disease. Autumn is held to be the most unhealthy of the seasons. The 
17th resumes the subject of the effects of the seasons in different states 
of the health, and in the 18th, 19th, 20th, 21st, 22d, and 23d, the diseases 
which prevail most in particular seasons are enumerated. The remaining 
Aphorisms in this section are devoted to the consideration of the diseases 
peculiarly incident to certain periods of life. 
A large portion of the Aphorisms in this section are taken from the 
works " On Airs, Water, and Places," and " On Humors," that is to say, 
provided the latter be genuine, which is not now generally admitted. If 
it is not recognized to be genuine, we must suppose that the parallel 
passages have been transferred from the Aphorisms to the other work. 
SECTION IV. 
A great portion of this section relates to semeiology, but the first twenty- 
one Aphorisms are restricted to the consideration of purgings, and the cir- 
cumstances under which they are to be performed. In purgings, it is 
directed (§ 2) to eject only those humors which it is advantageous for the 
system to get rid of. In summer the system is to be purged upward, and 
in autumn downward (§ 4); and during the great heat of the dog-days, 
purgings are to be entirely avoided (§ 5); and many directions are given 
respecting the administration of the hellebores (§§ 13-16). 
From §§ 21-28), the prognostics founded on the alvine discharges are 
given. The dangers attending the evacuations of black bile are strongly 
stated in §§ 22, 23, 24. 
The 29th and 30th relate principally to crises. The 31st, 32d, and 
33d contain a statement of the circumstances under which deposits or 
abscesses take place on particular parts, and the marks by which they are 
to be recognized. In the 34th and 35th, two acute affections of the neck 
are noticed in very striking, terms. The next three, namely, the 36th, 
37th, and 38th, are semeiotic, and relate to sweats. The 39th and 40th 
are allied to them, and the same subject is resumed in the 41st and 42d. APHORISMS. 
189 
The 43d 44th, 45th, 46th, and 47th relate to remittent fevers and the 
usual terminations and complications of fevers in general. The Aphor- 
isms from §§ 48-74 all relate to the prognostics in fever, and contain many 
important observations on this subject. A considerable proportion of 
them are taken from "The Prognostics," and "The Coan Praenotions." 
From the 84th to the end of the section, the Aphorisms relate principally 
to prognostics founded on the appearances of the urine. 
From what has now been stated, it will be readily perceived that this 
section relates mainly to semeiology and prognostics. 
SECTION V. 
Theophilus, the Commentator, states, in general terms, that our author 
delivers diagnostic and prognostic rules in this section. It contains a 
variety of matters, which may be thus arranged. From §§ 1-6, the danger 
of convulsions from purging by hellebore, from a wound, from loss of 
blood, from immoderate purgings, and from drinking, is clearly stated. 
A favorable prognosis is given in the case of persons before puberty who 
are seized with epilepsy, but an unfavorable, in the case of those who 
have passed their 25th year (§7). 
From §§ 8-15, various prognostics relating to empyema and phthisis 
are given. The danger of the case in which angina passes down to the 
lungs is strongly expressed (§ 10). 
The medicinal effects of heat and cold in a variety of diseases are 
delivered with much precision from §§ 16-29. The danger of applying 
snow and ice to the chest is strongly expressed (§ 24); and the benefit of 
the affusion of cold water in diseases of the joints is stated with much 
force (§ 25). 
Then follows an interesting series of Aphorisms relating to pregnant 
women, and the diseases of pregnancy, from §§ 28-62. The 63d relates 
to the causes of impotence in men. The good and bad effects of milk are 
given in § 64. The 65th relates to the translations of swelling from the 
external to the internal parts. To this the next two Aphorisms are 
nearly allied, that is to say, they relate to swellings consequent upon 
severe wounds. The 68th contains an important rule in therapeutics, 
namely, that when the back part of the head is pained, it is relieved by 
bleeding from the frontal vessels. The 69th relates to the rationale of 
rigors in women and in men. The 70th announces a most important 
principle in natural therapeutics, namely, that a quartan may prove a 
cure of convulsions. The 71st relates to the indications from the state 
of the skin; and the 72d to the nature of jaundice. 
SECTION VI. 
This section relates principally to a class of cases which, in the ancient 190 
GENUINE WORKS OF HIPPOCRATES. 
system of prognostics, were called superventions.1 By this term was 
meant a disease supervening or coming on another disease, as a fever upon 
pleurisy; or a symptom on a disease, as headache on fever; or a disease 
on a symptom, as dryness on headache; or a symptom on a symptom, as 
headache on insomnolency. These superventions are scattered over the 
section, in what would appear to be a disorderly manner, and are also 
mixed up with other important Aphorisms on totally different subjects. 
The Aphorisms in the present section, then, do not well admit of any 
distinct grouping; but M. Littre has attempted an arrangement of them, 
which I, in part, shall follow. 
The first class of superventions contains cases in which the symptom 
or disease which supervened proved favorable. These are §§ 1, 10, 11, 
13, 14, 15, 17, 21, 25, 26, 37, 40, 44, 48, and 51. Of these, some suggest 
valuable indications as to the proper method of cure, such as (§ 37) that 
an external swelling coming on in a case of quinsy relieves the latter; and 
(§17) that it is a good thing in ophthalmy when a diarrhoea comes on; 
and (§ 15) that spontaneous vomiting relieves diarrhoea; and (§ 14) that 
dropsy is carried off by a watery discharge from the bowels. 
The second class contains cases in which the new disease, or symptom, 
proves an aggravation of the disease. These are §§ 3, 19, 35, 42, 43, 54, 
56. Of these, some of the most interesting are-(§ 16) that in confirmed 
pleurisy and pneumonia a looseness of the bowels aggravates the disease; 
and (§ 43) that dysentery is a fatal disease when it supervenes on enlarge- 
ment of the spleen. 
Of the others it is difficult to give any arrangement; and I shall merely 
advert to a few which appear to me particularly deserving of notice, such 
as (§ 5) that one should consider the nature of pains in the side, and other 
parts of the body, whether they differ from one another; and (§ 7) that 
pains in the abdominal region are formidable in proportion as they are 
deep seated; and (§ 12) that in removing hemorrhoids, one should be left, 
as a safety valve, so to speak, to the system; that (§ 18) wounds in certain 
parts of the body, of which a list is given, are deadly; that (§ 19) bone 
and certain other structures of the body, when excised, are not restored; 
that (§ 20) extravasated blood, in certain cavities of the body, becomes 
purulent; that (§ 27) it is dangerous to evacuate the fluid rapidly in 
empyema and ascites. In §§ £9, 30, 55 are given some important state- 
ments respecting gout. In § 31 there is an important list of all the 
various remedies for ophthalmy. At §§ 36 and 48 venesection is pro- 
nounced to be a remedy in acute pains of the bladder and side. In § 48 
the danger of meddling with cancerous diseases is stated. In § 39 the 
1A modern writer, Leonard lacchinus, in his work entitled Methodus Praecog- 
noscendi, has an interesting chapter on the Supervenientia (c. viii). In a word, 
this formed a very important part of the ancient system of prognostics. APHORISMS. 
191 
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 haemoptysis; and (§ 16) purulent expec- 
toration 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 attend- 
ing to the excretions is pointedly stated. In § 72, the prognosis founded 
on coldness of the extremities while the internal parts are warm, in inter- 
mittent 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 Foes and Littre, 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 thor- 
oughly 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 192 
GENUINE WORKS OF HIPPOCRATES. 
feel that any formal eulogy on a work of so undisputed a reputation 
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 pre- 
pared to do what is right himself, but also to make the patient, the at- 
tendants, and externals co-operate. 
The exordium of this work bespeaks at once the reflective phi- 
losopher 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 diver- 
sified, 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 diffi- 
culties 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 phil- 
osophical 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 Log. in Hom. 1., 1; ib. liv., 1; II. Prsedict. 
xix., 13, xxix., 8; I. Morb. iv., 1-2; I. Morb. Mui. Ixvi., 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 
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 Lin- 
den, unless otherwise stated. APHORISMS. 
193 
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 divis- 
ions: 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 cor- 
rectness 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 fash- 
ion 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 chmate. 
They had not forgot the rule laid down by their ancient countryman: 
" differunt pro natura locorum genera medicinae." (Celsus, Praef.) 
Compare Aphor. i., 25; Humor, ii., 49; VI. Epid. iv., 30. 
3. In the athletae, embonpoint, if carried to its utmost limit, is dan- 
gerous, for they cannot remain in the same state nor be stationary; and 
since, then, they can neither remain stationary nor improve, it only re- 
mains 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 Vete- 
rum.) Hippocrates evidently points out what happens in the case 
of the athletae, 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, an- 
cient or modern, supply much interesting information under this 
head. Compare IV. Morb. xi., 15, 16; Aphor. ii., 51; Vet. Med. 
xviii., 1; Viet. 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. IL-13. 194 
GENUINE WORKS OF HIPPOCRATES. 
brought to the extreme point of attenuation is dangerous; and repletion, 
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 satis- 
factorily by Heurnius and Berends, in their very sensible Commen- 
taries on the Aphorisms of Hippocrates. Compare Viet. 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 gener- 
ous. On 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. 
There have been different interpretations of the first clause of 
this Aphorism, but I am satisfied that Galen and Theophilus are cor- 
rect 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 correct- 
ness of the opinions there stated, there can, to my mind, be no ques- 
tion. On the propriety of using a varied regimen, see Celsus, i., 1. 
Compare Vet. Med. xv., 9-14; Viet. 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, ex- 
tremely acute, as is explained by Galen, Theophilus, Damascius, and 
Stephanas. By extreme methods of cure these commentators all un- 
derstood 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 "diaeta quam tenuissima, pharmacia exquisita, et crudeli 
chirurgia." This mode of interpretation is ingenious, but it is un- 
supported 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 interpre- 
tation; for it would appear to be this passage which he alludes to (de APHORISMS. 
195 
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 explain- 
ing " 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 evi- 
dently a proper rule of practice, and consistent with reason. Com- 
pare Aph. ii., 28; Viet. 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 pre- 
viously, and become less acute. 
This Aphorism is evidently a corollary, as it were, to the preced- 
ing 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 pa- 
tient will not endure through all the stages of the disease, it is evi- 
dently 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 (ffurreupaipefftfai), the meaning of which 
rests on the distinction between a general symptom (ffppptov) and a 
special one (rexpapais). The physician, then, is supposed to form 
his judgment in this case from his knowledge of the peculiar consti- 
tution 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 Viet. 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 196 
GENUINE WORKS OF HIPPOCRATES. 
later, we must retrench at that period or a little before it; but previously 
we must allow a more generous diet to support the patient. 
The meaning here is so obvious, that even Galen is very brief un- 
der this head. Damascius states that it was considered to be an early 
acme when it happened during the first seven days. Compare Viet. 
Acut. xix., 8, 9; Affect, xlii., 3. 
11. We must retrench during paroxysms, for to exhibit food would be 
injurious. And in all diseases having periodical paroxysms, we must re- 
strict during the paroxysms. 
This rule follows, as a natural consequence, from Aphor. i., 7. 
I would beg here to refer the reader to the admirable chapter of Cel- 
sus, On Regimen in Fevers, iii., 4. See, further, Aph. i., 19; Nat. 
Hom. xviii., 30, 31; Humor., iii., 82; Loc. in Hom. xxxix., 1; 
Affect, xlii., 3, lii., 14. 
12. The exacerbations and remissions will be indicated by the diseases, 
the seasons of the year, the reciprocation of the periods, whether they 
occur every day, every alternate day, or after a longer period, and by the 
supervening symptoms; as, for example, in pleuritic cases, expectoration, 
if it occur at the commencement, shortens the attack, but if it appear 
later, it prolongs the same; and in the same manner the urine, and alvine 
discharges, and sweats, according as they appear along with favorable or 
unfavorable symptoms, indicate diseases of a short or long duration. 
The general meaning here is obvious, although there be differences 
of opinion respecting certain terms which are used in this Aphorism. 
On them see, in particular, Heurnius and Berends, by which I have 
been assisted in making my translation. That the changes in any 
disease are to be calculated from the nature of the disease, and from 
the symptoms which come on in its later stages (the epiphsenomena, 
the superventions of our author), seems quite clear. Galen's lengthy 
and elaborate Commentary on this head may be read with some ad- 
vantage, although one cannot see much necessity for it, seeing that 
the meaning is sufficiently transparent without such illustration. 
Compare II. Epid. i., 26-30; Aph. v., 8, 15; Pramot. xiii., 1, 12, 
xiv., 12; Coac. iii., 132, 143; HI. Morb. xxi., 33, 34. 
13. Old persons endure fasting most easily; next, adults; young per- 
sons not nearly so well; and most especially infants, and of them such as 
are of a particularly lively spirit. 
This Aphorism is beset with considerable difficulties. Celsus 
would appear, at first sight, to controvert decidedly the rule laid down 
by Hippocrates. He says, " quod ad setates vero pertinet, inediam 
facillime sustinent mediae aetates, minus juvenes, minime pueri et 
senectute confecti." (i., 3.) In fact, it stands to reason, and it is 
conformable to common experience, that persons in extreme old age 
could not long endure a total abstinence from food; for, as the poet 
Sophocles beautifully expresses it,a slight turn of the scale settles APHORISMS. 
197 
aged persons (ffpiMpa Ttakaia ffatpat' cvvaZzi poTtp," Gid. Tyr. 
961). Berends thinks the view which Galen takes of our author's 
meaning is the only one which solves the difficulties. Galen holds 
that Hippocrates did not mean "total abstinence from food," but 
merely " a spare diet," and by " aged persons," that he did not un- 
derstand "persons in extreme olcl age," but "persons of advanced 
years." I am inclined to adopt this interpretation. Sanctorius, how- 
ever, (Aph., i., 83) and Kaau Boerhaave (Persp. Diet. Hippocrat.) 
held that it is true that old men bear fasting better than men at any 
other age. 
14. Growing bodies have the most innate heat; they therefore require 
the most food, for otherwise their bodies are wasted. In old persons the 
heat is feeble, and therefore they require little fuel, as it were, to the 
flame, for it would be extinguished by much. On this account, also, fevers 
in old persons are not equally acute, because their bodies are cold. 
This Aphorism contains the physiological explanation of the facts 
assumed in the preceding one; namely, that the vital flame, so to 
speak, is strongest in growing bodies, and gradually becomes weaker 
as life advances, until in extreme old age it becomes quite feeble. 1 
refer the reader to what I have stated in the Third Section of the 
Preliminary Discourse, on the connection between heat and vitality. 
The ancient philosophers all held that every animal and vegetable 
substance is endued with a calidum innatum, which serves as the first 
instrument by which its vital operations are performed. On this phys- 
iological opinion Galen has written with great ingenuity and earnest- 
ness, more especially in his Commentary on this Aphorism, and in 
his work, Against Lyons. (Opera,-tom. v., 329; ed. Basil.) The term 
calidum innatum occurs frequently in the works of Harvey and his 
contemporaries. We now use " animal heat " in place of it, as applied 
to animals; but we seem to want a term to comprehend the corre- 
sponding tepidity of vegetables. It is to be regretted, in short, that 
physiologists should have dropped the use of the term " calidum in- 
natum." On this subject, one of the best works which the reader 
can consult is the one entitled Perspiratio dicta Hippocrati, of Kaau 
Boerhaave. Compare De Arte, xxii., 2; I. Diaet. xxviii., 5, 6, 7; Nat. 
Human, xxiv., 7, 8; Aph. iii., 7; I. Morb. xx., 15,16, xxi., 16. 
15. In winter and spring the bowels are naturally the hottest, and the 
sleep most prolonged; at these seasons, then, the most sustenance is to 
be administered; for as the belly has then most innate heat, it stands in 
need of most food. The well-known facts with regard to young persons 
and the athletae prove this. 
This Aphorism, in like manner, turns upon the ancient doctrine 
of calidum innatum, which, according to Hippocrates and the other 
authorities, is most abundant in winter and spring; and hence the 
greatest supply of food is required at these seasons. In confirmation 
of the opinions here stated, he appeals to the well-known facts in 
reference to infants and the athletae, who, being possessed of a large 
amount of the calidum innatum, require a corresponding supply of 198 
GENUINE WORKS OF HIPPOCRATES. 
food. Berends' Commentary on this Aphorism is very sensible and 
instructive. Compare Humor, v., 4; Aer., Aq., Loc. ii., 2; Aphor. 
i., 18; Salubr. Diaet. i., 2, 26; IV. Morb. xvii., 9. 
16. A humid regimen is befitting in all febrile diseases, and particularly 
in children, and others accustomed to live on such a diet. 
That a humid or diluent diet is the kind best adapted for febrile 
diseases, is an important conclusion derived by our author from his 
disquisition, On the Regimen in Acute Diseases. I need scarcely re- 
mark that it is one of the most important facts in the practice of 
medicine. It is well expressed by Celsus: "Cibus autem febricitan- 
tibus humidus est aptissimus, aut humori certe quam proximus," 
etc. (iii., 6.) The rationale of this practice, according to Galen, is, 
that a fever being an affection of a hot and dry nature, the propel- 
indication in the cure of it is to administer things of a cooling and 
humectating nature. Galen informs us that some of the adversaries 
of Hippocrates objected to this Aphorism as not containing a truth 
of general applicability, since, as they argued, such a regimen would 
be very improper in fevers of a dropsical nature; but, as Berends 
justly remarks, modern experience in the treatment of dropsy is quite 
in favor of the diluent treatment even in that case. Compare Insomn. 
xv., 12, 15, 16, 17; III. Morb. xxxi., 11; Salubr. Diaet. ii., 5, 11. 
17. We must consider, also, in which cases food is to be given once or 
twice a day, and in greater or smaller quantities, and at intervals. Some- 
thing must be conceded to habit, to season, to country, and to age. 
In the work, On Ancient Medicine, our author adverts to the dif- 
ferences which prevail in regal'd to the number of meals among per- 
sons in good health. He seems here to lay it down as a rule, that 
attention should be paid to the habit in administering food to per- 
sons in disease. Compare Viet. Acut. v., 19, 20, xix., 6; Vet. Med. 
xviii., 4; HI. Diaet. i., 10. 
18. Invalids bear food worst during summer and autumn, most easily 
in winter, and next in spring. 
There will be little doubt, I suppose, that the opinion here stated 
is well founded. This Aphorism is nearly allied to the fifteenth; in- 
deed Theophilus informs us that some had held it to be merely a repe- 
tition of that Aphorism. Compare also, Humor, viii., 24; and Cel- 
sus, i., 3. 
19. Neither give nor enjoin anything to persons during periodical 
paroxysms, but abstract from the accustomed allowance before the crisis. 
This Aphorism is so like the eleventh, that I am much disposed, 
with Lefebure and Berends, to set it down as an interpolation. Galen 
and Heurnius attempt to make out a distinction, "but it is not obvi- 
ous after all. See also, Humor, viii., 24. 
20. When things are at the crisis, or when they have just passed it, 
neither move the bowels, nor make any innovation in the treatment, APHORISMS. 
199 
either as regards purgatives or any other such stimulants, but let things 
alone. 
Our author, it will be seen, here recommends the expectant method, 
when things are at a crisis. It would be difficult to controvert this 
practice even at the present day. By other stimulants, he means 
clysters and suppositories. Compare Humor, iii.,' 83; Nat. Hum. 
xix., 8. 
21. Those things which require to be evacuated should be evacuated, 
wherever they most tend, by the proper outlets. 
That is to say, by the stomach, or bowels, or uterus. See the 
Commentaries of Galen and Theophilus; also Humor, i., 2, 24, iii., 
85; VII. Epid. xxxii., 4; Aph. vii., 61. 
22. We must purge and move such humors as are concocted, not such 
as are unconcocted, unless they are struggling to get out, which is mostly 
not the case. 
The only difficulty in this Aphorism is about the expression, which 
I have rendered " struggling to get out " (opyti). As Galen explains, 
its original meaning is " in a state of orgasm," that is to say, in a 
state of excitement and irritability, or in a turgid state. See 
Heurnius and Berends; also Humor, iii., 84; Aph. iv., 13, vii., 68. 
23. The evacuations are to be judged of not by their quantity, but 
whether they be such as they should be, and how they are borne. And 
when proper to carry the evacuation to deliquium animi, this also should 
be done, provided the patient can support it. 
I need scarcely remark that this is a very important rule of prac- 
tice, and one that deserves to be maturely weighed and comprehended. 
The commentators attempt to define the cases in which evacuation 
is to be carried the length of inducing deliquium animi. They in- 
stance strong inflammations, violent fevers, and very severe pains. 
See the Commentaries of Galen, Theophilus, and Damascius. It 
will be remarked that our author guards his recommendation of this 
practice by restricting it to those cases in which the powers of the 
patient are sufficient to support it. The commentators understood 
that the evacuation here meant is venesection, but I incline to think 
it is purging by drastic medicines. This Aphorism seems to be taken 
from the work, On Humors, iii., 86, 87. See also, A ph. i., 25; Loc. 
in Hom. xxxix., 9; Viet. Acut. Iii., 8, 9; II. Morb. Mulier. xxix., 9. 
24. Use purgative medicines sparingly in acute diseases, and at the 
commencement, and not without proper circumspection. 
This rule of practice here laid down is a natural inference from 
Aphor. xxii; indeed Berends arranges this Aphorism immediately 
after it. Galen admires our author's cautious spirit in forbidding 
purging altogether in acute diseases, unless when proper circumspec- 
tion has been used. He seems to lay it down as a rule that we are to 
purge only when we have reason to believe that more good will be 200 
GENUINE WORKS OF HIPPOCRATES. 
derived from the evacuation of the offending matters, than harm 
from the administration of the purgative medicines. This seems a 
very safe and sensible rule; but, I need scarcely remark, that we are 
much bolder in the use of purgative medicines; and accordingly Ber- 
ends seems at a loss to decide in this case between modern usage and 
the authority of Hippocrates. This Aphorism is in accordance with 
Humor, iii., 97. See Purg. iv., 1, v., 4; Aph. i., 22; I. Morb. Mui. 
xxiii., 9. 
25. If the matters which are purged be such as should be purged, the 
evacuation is beneficial, and easily borne; but, if otherwise, with difficulty. 
All the commentators point out the resemblance between this and 
the second Aphorism. Although certainly in so far a repetition, it 
is evidently, as stated by Galen, a timely remembrancer, in this place, 
of a truth formerly announced and applying to the present occasion. 
There can be no doubt that, in this place, it forms an excellent con- 
clusion to the four preceding Aphorisms on the use of purgative 
medicines. Compare further, Humor, ii., 49; VI. Epid. iv., 30. 
SECTION II. 
1. In whatever disease sleep is laborious, it is a deadly symptom; but if 
sleep does good, it is not deadly. 
The meaning of " laborious," as an epithet to sleep, Galen re- 
marks, is clearly indicated by the last clause of the sentence to which 
it is a contrast. As the meaning there is clearly stated to be " to do 
good," there can be no doubt that, in the former clause, it signifies 
" to do harm." The term " deadly," too, it deserves to be remarked, 
is only a strong expression for " dangerous." This is pointed out by 
Galen, Foes, and Berends. Galen acutely remarks further under this 
head, that sleep, being sometimes the commencement of coma in dis- 
ease, is, in such a case, the very reverse of a favorable symptom. He 
further explains the cause of sleep having these effects, upon physio- 
logical principles: the innate heat, he remarks, being more concen- 
trated inwardly during sleep, if it does not do good, it must necessa- 
rily do harm. I. Epid. iii; 2Eg. vii., 83; II. Epid. iii., 12; Aph. iv., 
67; I. Predict. xv., 5, 17; VI. Epid. viii., 5. 
2. When sleep puts an end to delirium, it is a good symptom. 
As remarked by Galen and the others, the truth embodied in this 
Aphorism follows naturally from the preceding one. Lefebure men- 
tions as an addition to this Aphorism, which is found in certain MSS. 
to this effect: " but when it increases (the delirium), it is deadly "- 
okov db naps)(Si, This reading does not appear to be 
recognized by any of the ancient commentators, and therefore it may 
be regarded as an interpolation. Compare I. Epid. iii.; 2Eg. vii., 13, 
16; II. Epid. iii., 11, 12; also Celsus, iii., 18. 
3. Both sleep and insomnolency, when immoderate, are bad. 
Few experienced physicians will be disposed to question the opin- 
ion here stated, and yet Galen informs us that some of the commen- APHORISMS. 
201 
tators had denied that sleep could ever be a symptom of bad omen. 
Galen and the other commentators hold that sleep is produced by the 
cooling of the first sensorium, that is to say, of the brain, and in- 
somnolency by a heated state of the same. This physiological dogma 
seems plausible, and our modern physiologists have neither confirmed 
nor controverted it. Compare Aph. vii., 71; Humor, iii., 78; I. 
Coac. ii., 35; VI. Epid. vi., 6. 
4. Neither repletion, nor fasting, nor anything else, is good when more 
than natural. 
The propriety of the rule " ne quid nimis" will, of course, not be 
questioned. I need scarcely remark that it is a truth which the poets 
have frequently proclaimed to mankind. Compare VI. Epid. viii., 
16; II. Morb. xvi., 13; Aph. ii., 21, 61; Vet. Med. xv., 13, 15. 
5. Spontaneous lassitude indicates disease. 
This Aphorism announces an important and now generally ad- 
mitted facet. On the kinds of lassitude described by the ancient au- 
thorities, see Paulus tEgineta, Book I., 22, Syd. Soc. edit. 
6. Persons who have a painful affection in any part of the body, and 
are in a great measure insensible of the pain, are disordered in intellect. 
This also is the announcement of an important and unquestion- 
able fact. Galen instances erysipelas, inflammation, a wound, a bruise, 
a rupture, and a sprain, as cases in which it is an unfavorable symp- 
tom when the patient does not feel pain, and when delirium may 
accordingly be apprehended. Compare Celsus, ii., 2, 7. 
7. Those bodies which have been slowly emaciated should be slowly re- 
cruited; and those which have been quickly emaciated should be quickly 
recruited. 
This appears a very judicious rule of practice, the rationale of 
which, as pointed out by Berends, seems to be, that, in emaciation 
resulting from acute disease, the digestive functions are only impaired 
for a time; whereas in chronic, the depravation of them is of a more 
inveterate character. The ancient commentators have nothing inter- 
esting under this head. Compare Aliment, xi., 6, 7; Aph. ii., 11, 18. 
8. When a person after a disease takes food, but does not improve in 
strength, it indicates that the body uses more food than is proper; but 
if this happen when he does not take food, it is to be understood that 
evacuation is required. 
That there have been differences of opinion regarding the text 
and import of this Aphorism, may be seen upon consulting the Com- 
mentaries of Galen and Berends, and the note of M. Littre. It ap- 
pears to me that our author evidently refers to the treatment of the 
depraved appetite, and anorexia of convalescents. Compare Aph. ii., 
22, 31; Coac. i., 179; Aph. vi., 41, 45, vii., 64. 202 
GENUINE WORKS OF HIPPOCRATES. 
9. When one wishes to purge, he should put the body into a fluent 
state. 
That is to say, the body should be put into a state to admit read- 
ily of evacuations. For this purpose Galen mentions hydromel, in 
which some hyssop, majoram, or the'like, has been boiled. He ar- 
ranges this Aphorism immediately before the last of the first section, 
as well as here. Theophilus says the body is to be prepared for 
evacuations by giving attenuant and emollient articles. Compare 
Aph. iv., 13, vii., 70; IV. Morb. ix., 1; also Celsus, iii., 18. 
10. Bodies not properly cleansed, the more you nourish the more you 
injure. 
The meaning here is clear, and the rule of practice unexceptiona- 
ble. Compare Aph. vii., 65, 67; Vet. Med. xii., 11, 12, xix., 
10-14, etc. 
11. It is easier to fill up with drink than with food. 
The meaning is, that it is easier to recruit an emaciated body 
with liquid than with solid food. Among liquid articles of food 
Galen enumerates particularly thick and red wines. Berends has a 
most interesting Commentary on this Aphorism, but I regret that it 
is too bulky for my limits. See also, Vet. Med. xii., 3, 9; Aliment, 
xi., 5. 
12. What remains in diseases after the crisis is apt to produce relapses. 
That relapses are to be apprehended when the body is left in an 
unsound state by the illness, is sufficiently obvious. Compare Humor, 
vii., 16, 17; II. Epid. i., 81, iii., 72. 
13. Persons in whom a crisis takes place pass the night preceding the 
paroxysm uncomfortably, but the succeeding night generally more com- 
fortably. 
That a crisis is preceded by disturbance in the system is remarked 
by all the later authorities. See in particular Paulus JEgineta, 
Book II., 10. This truth is illustrated by an example related in the 
VI. Epidem. ii., 42. Galen informs us that the last part of the 
Aphorism was wanting in certain copies. Celsus gives a version of 
the whole sentence (iii., 5). See further, I. Epicl. iii.; zEg. vii., 13; 
III. Epicl. iii., 06. 
14. In fluxes of the bowels, a change of the dejections does good, un- 
less the change be of a bad character. 
Heurnius and Prosper Martian understand this Aphorism as re- 
ferring to critical diarrhoeas. When these, then, are of varied char- 
acters, they purge the body the more effectually. The bad charac- 
ters of the dejections are minutely given in the Prognostics (10), and 
Aphor. iv., 21. 
15. When the throat is diseased, or tubercles (phymatci) form on the APHORISMS. 
203 
body, attention must be paid to the secretions; for if they be bilious, the 
disease affects the general system; but if they resemble those of a healthy 
person, it is safe to give nourishing food. 
Upon reference to the Commentary of Berends and the notes of 
Heurnius, it will be seen that there have been different readings and 
interpretations of this Aphorism. Heurnius supposes that allusion is 
here made to critical abscesses in the parotid gland, of which an in- 
teresting description is given in the Third Book of the Epidemics. I 
am inclined to think that our author merely means to state the symp- 
toms by which it may be determined whether glandular swellings 
about the neck be of a local nature, or whether they are connected 
with constitutional disorder. A better rule for solving this question 
cannot well be imagined than to pay attention to the characters of 
the secretions; Tor by attending to this direction one need seldom com- 
mit mistakes in Such a case. See further, Aph. iii., 26. 
16. When in a state of hunger, one ought not to undertake labor. 
This Aphorism is well rendered by Celsus: " Si quibus de causis 
futura inedia est, labor omnis vitandus est." (i., 2.) Galen very 
ingeniously applies fhis rule to the treatment of invalids, and infers 
from it that when the system is debilitated from want of food, it is 
unsafe to pursue any active treatment, such as venesection, purging, 
vomiting, or any other means which would produce a great change 
in the body. He praises Hippocrates for always attending to the 
preservation of the vital powers. 
17. When more food than is proper has been taken, it occasions dis- 
ease; this is shown by the treatment. 
Galen, in a lengthy and very elaborate Commentary, gives what 
he holds to be the meaning of this Aphorism, namely, that it is 
meant as a particular illustration of the general truth announced in 
the fourth Aphorism of this section, and that it is intended to teach 
that too much food, like too much of anything, is hurtful to the 
body, and that this is shown by the mode of cure, which consists in 
evacuation. Heurnius thinks that it applies to the regimen of con- 
valescents. Lefebure emends the text, and instead of vovffov 
reads vavffirjv Ttoieei, and for i'r/ffis reads ivr/ffis, " inanition." He 
would then translate it thus: " when too much food is taken, it in- 
duces nausea; inanition shows this." I see no reason for departing 
from the interpretation given by Galen, which is adopted by The- 
ophilus and Damascius. Compare Aph. ii., 22; Vet. Med. viii., 16, 
xii., 10, xiii., 11, 24, xix., 6, 31; 1. Diaet. xxx., 15; III. Diset. xv., 
16; Loc. in Hom. lii., 8, 9. 
18. From food which proves nourishing to the body either immediately 
or shortly, the dejections also are immediate. 
Galen and the other Greek commentators understand this Aphor- 
ism to mean, that as liquid food, and especially wine, is soon digested 
and furnishes nourishment to the body, so is it speedily evacuated; 
whereas solid food, such as beef and shell-fish, as it is slowly digested, 204 
GENUINE WORKS OF HIPPOCRATES. 
so is it also slowly evacuated. This would appear to me to be de- 
cidedly the meaning. For the interpretation of Lefebure, see Ber- 
end's Commmentary. Compare Aliment, xi., 4, 5; VI. Epid. v., 
37, 53. 
19. In acute diseases it is not quite safe to prognosticate either death 
or recovery. 
Dr. Rush gives a similar advice to young practitioners of the Art; 
that is to say, not to treat any febrile case as being slight, nor aban- 
don any one as hopeless. No doubt it is a prudent maxim. Com- 
pare Decent. Ornat. x, 7, 8; and Celsus, ii., 6. 
20. Those who have watery discharges from their bowels when young 
have dry when they are old; and those who have dry discharges when 
they are young will have watery when they are old. 
Galen and the other Greek commentators wrote very long disser- 
tations on this Aphorism, which, however, enunciates as a general 
fact what will scarcely be admitted as such by any experienced phy- 
sician of the present day. Lefebure accordingly rejects it entirely as 
unworthy of the great Hippocrates. See further Berends. It is 
evidently closely connected with Aphorism 53 of this section. 
21. Drinking strong wine cures hunger. 
By hunger, in this place, Galen, Theophilus, and Damascius un- 
derstand an abnormal appetite for food. Galen, however, does not 
approve of restricting the term hunger here to the signification of 
bulimia. That strong wine, when drunk, removes hunger, all are 
agreed. See Celsus, i., 3. 
22. Diseases which arise from repletion are cured by depletion; and 
those that arise from depletion are cured by repletion; and in general, 
diseases are cured by their contraries. 
That diseases are cured by their contraries-or as it is expressed 
in Latin, "contraria contrariis curantur,"isa general rule frequently 
announced in the Hippocratic works, as in the treatise, De Locis in 
Homine. See the notice of that work in the Preliminary Discourse. 
That this rule is announced here would appear probable to me, but 
Berends is not satisfied with this interpretation. See his Commen- 
tary. See further, Nat. Human, xvii., 11, 12, 13; San. tuend. ad 
Dem. 8; VI. Epidem. viii., 16; 1. Aph. ii., 8; Flat, ii., 9-16, iii., 2, 3. 
23. Acute disease come to a crisis in fourteen days. 
We have here a distinct definition of what is meant by an acute 
disease, and of the time within which it will come to a crisis. See 
further, Aph. ii., 9; Judicat. iv., 12; Coac. i., 190, 211. 
24. The fourth day is indicative of the seventh; the eighth is the com- 
mencement of the second week; and hence, the eleventh being the fourth 
of the second week, is also indicative; and again, the seventeenth is in- APHORISMS. 
205 
dicative, as being the fourth from the fourteenth, and the seventh from 
the eleventh. 
For the ancient opinions on the Critical Days, see Paulus JEgi- 
neta, Book IL, 7, Syd. Soc. edit. Compare Aph. iv., 36, 71; Sept, 
viii., 6; Judicat. ii., 7-12; Prsenot. xx., 5-10; and Celsus, iii., 4. 
25. The summer quartans are, for the most part, of short duration; 
but the autumnal are protracted, especially those occurring near the ap- 
proach of winter. 
That summer fevers are generally short and mild is a well-known 
fact, at least with respect to those of warm climates. Compare Nat. 
Human, xxix., 5, 6, 7; I. Epid. iii., 17; Coac. i., 236. 
26. It is better that a fever succeed to a convulsion, than a convulsion 
to a fever. 
Galen and the other commentators explain the rationale of this 
rule as follows: Convulsions are connected either with repletion or 
inanition; when, then, in the former case, a convulsion takes place, 
a fever succeeding removes the thick humors which occasioned the 
convulsion, and in so far proves beneficial; whereas, in the latter case, 
when a convulsion seizes the body in a debilitated state from the 
fever, it is likely to prove fatal at once. Compare Coac. i., 232, iii., 
80, 82; I. Morb. vi., 13, 14; San. tuend. ad Dem. 10. 
27. We should not trust ameliorations in diseases when they are not 
regular, nor be much afraid of bad symptoms which occur in an irregular 
form; for such are commonly inconstant, and do not usually continue, 
nor have any duration. 
The meaning here is sufficiently obvious. Heurnius, although a 
remarkably good expounder of our author's sense in most cases, gives 
a most absurd interpretation of the first clause of this Aphorism, as 
if it were meant to exclude the use of amulets, and other superstitious 
modes of working upon the imagination, which, although they pro- 
duce a temporary amendment, are not followed by any good conse- 
quences. This interpretation is altogether fanciful. Our author, 
like a man of sense and experience, merely warns the physician not to 
form a wrong judgment in febrile cases from any irregular symptoms, 
either good or bad, which may come on. Compare I. Predict, vi., 
16, vii., 7; II. Predict, xxix., 6; Coac. i., 73, iii., 100, 109, 110; II. 
Epid. iii., 132. 
28. In fevers which are not altogether slight, it is a bad symptom for 
the body to remain without any diminution of bulk, or to be wasted be- 
yond measure; for the one state indicates a protracted disease, and the 
other weakness of body. 
The Greek commentators explain the facts here stated thus:- 
When the body is not wasted in proportion to the severity of the 
fever, this proceeds from the thickness of the morbific particles, or 
the condensation of the patient's cuticle; and, on the other hand, 206 
GENUINE WORKS OF HIPPOCRATES. 
when the emaciation is rapid, it is connected with thinness of the 
humors and rarity of the skin, either of which conditions is obviously 
unfavorable. Celsus renders these rules as follows:-He ranks it 
among the symptoms of a protracted fever, " ubi aeger pro spatio parum 
emacrescit," (ii., 5); and says elsewhere, <£mali etiam morbi signum 
est, nimis celeriter emacrescere." (ii., 4.) Compare Humor, iii., 
17; Aph. v., 55; Humor, iii., 52; also Celsus, ii., 2. 
29. If it appear that evacuations are required, they should be made at 
the commencement of diseases; at the acme it is better to be quiet. 
The rationale of this rule of practice is sufficiently explained in 
the next Aphorism. Compare Aph. i., 24, ii., 30; Loc. in Hom. 
xxxviii., 9, 10, 11; Purgant. iv., 1. 
30. Toward the commencement and end of diseases all the symptoms 
are weaker, and toward the acme they are stronger. 
The facts here stated are so obvious, that even Galen dismisses 
this Aphorism with a very brief Commentary. 
31. When a person who is recovering from a disease has a good appe- 
tite, but his body does not improve in condition, it is a bad symptom. 
The opinion here stated is consistent with general observation. 
Nowadays, in such a case, we should suspect organic disease in some 
part of the body. Compare Aphor. ii., 8; and Coac. i., 179. 
32. For the most part, all persons in ill health, who have a good appe- 
tite at the commencement, but do not improve, have a bad appetite again 
toward the end; whereas, those who have a very bad appetite at the com- 
mencement, and afterward acquire a good appetite, get better off. 
This Aphorism refers to convalescents; and it is a very important 
observation of our author, that too good an appetite at first in their 
case is anything but a favorable circumstance, since the appetite is 
greater than the digestion. Heurnius points out that, by " com- 
mencement," in this place, is meant the beginning of convalescence. 
See further, Coac. i., 179; Aph. vii., 6. 
33. In every disease it is a good sign when the patient's intellect is sound, 
and he is disposed to take whatever food is offered to him; but the con- 
trary is bad. 
The facts stated in this Aphorism, I need scarcely remark, are 
important and unquestionable. They are expressed by our author 
with wonderful brevity and force. Compare De Medic, iii., 9; Coac. 
i., 72; and Celsus, ii., 3. 
34. In diseases, there is less danger when the disease is one to which 
the patient's constitution, habit, age, and the season are allied, than when 
it is one to which they are not allied. 
The meaning here is obvious, and when fairly interpreted, there 
seems no reason to dispute the facts announced in it; yet it would APHORISMS. 
207 
appear that his immediate successor, Diodes, had strongly attacked 
our author on the score of the facts being incorrect. See the Com- 
mentary of Galen, and that of Stephanas. (Dietz, tom. ii., p. 327.) 
Surely, for example, the diseases of infancy are more dangerous when 
they attack the old than when they occur in the young; and it im- 
plies a more serious cause when the diseases of summer take place in 
winter, and vice versd. Compare further, Aph. vii., 82; Humor, vi., 
1-5; Dies Judic. i., 11-15; VI. Epid. viii., 43-46; Affect, vii., 3, 46. 
35. In all diseases it is better that the umbilical and hypogastric regions 
preserve their fullness; and it is a bad sign when they are very slender and 
emaciated; in the latter case it is dangerous to administer purgatives. 
From the reports of the cases contained in the Books of the Epi- 
demics, it will be remarked that our author paid great attention to 
the condition of the upper region of the abdomen in febrile diseases; 
that is to say, to the part which he calls the hypochondria; in this 
place he directs attention also to the hypogastric region, by which he 
meant the part of the abdomen between the umbilicus and pubes. 
See Galen and Heurnius. That it is a bad symptom when the abdo- 
men is excessively emaciated, every practical physician must know. 
Celsus renders this Aphorism thus: " Inter maii morbi testimonia 
esse, nimis celeriter emacrescere, et cutem circa umbilicum pubemque 
macram esse." (ii., 3.) That purgatives are contraindicated under 
such circumstances will readily be understood; and Galen wonders 
that our author did not also forbid emetics, but supposes that he 
took it for granted that they also would be understood to be pro- 
scribed. Compare Praeen. x., 2; Aph. ii., 28; I. Morb. Mulier. Ixxvii. 
9; Celsus ii., 3. 
36. Persons in good health quickly lose their strength by taking purga- 
tive medicines, or using bad food. 
This Aphorism announces an important fact, which deserves to 
be always kept in mind; but, although obvious when fairly stated, we 
often see it neglected. I once knew an excellent runner lose a race 
in consequence of being previously weakened by taking purgative 
medicines. Compare Aph. i., 3, ii., 37, iv., 16; Verat. Usus, i., 12. 
37. Purgative medicines agree ill with persons in good health. 
This, according to Galen, is merely an announcement in more 
general terms of the peculiar fact respecting purgatives which is 
stated in the preceding Aphorism. As he remarks, by the opera- 
tion of a purgative medicine, the fluids of the body are evacuated, 
and the solids melted down. Compare Aph. ii., 36, iv., 16; Verat. 
Usus, i., 5, 12. 
38. An article of food or drink which is slightly worse, but more palat- 
able, is to be preferred to such as are better but less palatable. 
This is evidently a wise rule in regimen, since, as Galen in his 
Commentary remarks, what is palatable is likely to be more readily 
digested by the stomach. Berends prudently observes, further, that 208 
GENUINE WORKS OF HIPPOCRATES. 
a physician often shows his skill most particularly by applying this rule 
in making a proper selection of those things which are peculiarly 
adapted to the tastes of his patient. See Sydenham, p. 344, Syd. 
Soc. edit. Compare de Arts, xii., 10; VI. Epid. iv., 26; IV. Morb. 
xii., 7; Affect, xlii., 1, 2; Vect. Acut. xv., 1, 2, xviii., 24. 
39. Ohl people, on the whole, have fewer complaints than young; but 
those chronic diseases which do befall them generally never leave them. 
One reason, as Galen remarks, why old people have fewer com- 
plaints than young is, that they are generally more guarded in their 
course of life. That chroic complaints in old age generally prove fatal, 
is confirmed by daily experience. Damascius, in his Commentary on 
the next Aphorism, says, in illustration, that nephritis, gout, arthri- 
tis, and ischiatic disease are incurable in old age. Compare I. Morb. 
xx., 13, 15; Aph., v., 7; Celsus, ii., 1-8. 
40. Catarrhs and coryzae in very old people are not concocted. 
This Aphorism, as Galen remarks, contains an illustration of the 
truth stated in the preceding one. By coryza is to be understood a 
catarrh seated in the nose. That these complaints in old age are 
never entirely got rid of is a well-known fact. 
41. Persons who have had frequent and severe attacks of swooning, 
without any manifest cause, die suddenly. 
This, I need scarcely say, is now a well-known fact, it being ascer- 
tained by post-mortem inspection, that in such cases there is generally 
some cardiac disease. One cannot but admire the accurate observa- 
tion of Hippocrates, who ascertained the fact so correctly, although 
he had not the same opportunities, as we now have, of accounting for 
it. To him may be applied the general maxim of Cicero: " Sufficit 
si quid fiat intelligamus, etsi quommodo quidve fiat nesciamus." I 
may mention here, however, that although the ancient physicians 
cannot have practiced inspections cadaverum very frequently, there 
can be no doubt that they did so occasionally; and it is a remarkable 
circumstance, that in the case of sudden death they referred the 
cause, as we now generally do, to cardiac disease. Theophilus, in 
his Commentary, mentions that Galen inferred this from finding dis- 
ease of the heart in the inferior animals that died suddenly. See 
Dietz, t. ii., p. 332, and Paulus zEgineta, B. 111., 34, Syd. Soc. 
edit. Compare Coac. i,. 83. 
42. It is impossible to remove a strong attack of apoplexy, and not easy 
to remove a weak attack. 
The experience of twenty-two centuries and upward affords no 
reason to call in question the prognosis here announced by our author. 
It is thus rendered by Celsus: il Isque morbus mediocris vix sanatur, 
vehemens sanari non potest." (ii., 8.) Galen has an interesting Com- 
mentary under this head, in which he attempts to explain how it hap- 
pens that the respiratory muscles in attacks of apoplexy, often con- 
tinue to perform their office, although the others are paralyzed. APHORISMS. 
209 
43. Of persons who have been suspended by the neck, and are in a state 
of insensibility, but not quite dead, those do not recover who have foam 
at the mouth. 
There are great diversities of opinion as to the reading and inter- 
pretation of this Aphorism, but upon these I have not room to enter. 
I may just mention, however, that I would have preferred reading 
jiaTadvofAsvauv as applying to persons who have been immersed in 
water, but dare not adopt it, as it appears not to be sanctioned by 
any of the MSS. On this Aphorism see the Commentary on Paulus 
yEginkta, B. III., 28, Syd. Soc. edit. Galen's Commentary is well 
worth being consulted. 
44. Persons who are naturally very fat are apt to die earlier than those 
who are slender. 
There seems no great reason to question the prognostic rule here 
laid down. Galen explains the rationale of it, upon the principle 
that fat persons have smaller blood-vessels, and consequently are less 
liberally supplied with the pn&uma, or vital spirit, than leaner persons. 
Compare Celsus, ii., I. 
45. Epilepsy in young persons is most frequently removed by changes 
of air, of country, and of modes of life. 
We may well exclaim with Berends, that this Aphorism embodies a 
most important statement of facts. 7/z.S' lengthy Commentary on this 
passage contains much interesting matter, which I regret that my 
limits preclude me from availing myself of: those of the ancient com- 
mentators contain nothing but what is common-place. Compare Aph. 
v., 7; JI. Predict, xvi., 123; Morb. Sac. xiii., 6; VI. Epid. vi., 36. 
46. Of two pains occurring together, not in the same part of the body, 
the stronger weakens the other. 
Experience, I need scarcely say, has amply confirmed the truth of 
the maxim here announced. It is a principle of extensive applicabil- 
ity in the practice of medicine. Consult Galen and Berends. Com- 
pare Humor, xi., 16, 17; Aliment, i., 11. 
47. Pains and fevers occur rather at the formation of pus than when it 
is already formed. 
This also is an announcement of an important and indisputable 
fact. Galen and the other ancient commentators all hold that pus is 
formed from blood. Compare Vet. Med. xxxiii., 8; Praanot. xvii., 
6; Ulcer, ii., 8-11. 
48. In every movement of the body, whenever one begins to endure 
pain, it will be relieved by rest. 
This is a self-evident, but, as Berends remarks, not an unimpor- 
tant fact. See Aph. ii., 22; Praecept. xiii., 4; Nat. Human xvii., 14, 
15; Flat, ii., 14. 
Vol. II.-14. 210 
GENUINE WORKS OF HIPPOCRATES. 
49. Those who are accustomed to endure habitual labors, although they 
be weak or old, bear them better than strong and young persons who have 
not been so accustomed. 
This Aphorism, it will readily be seen, is founded on the well- 
known effects of habit. It is thus rendered by Celsus: " Omnem 
laborem facilius vel puer, vel senex, quam insuetus homo sustinet." 
(i., 3.) See, also, Cicero Tuscul. Disput. ii., 17. 
50. Those things which one has been accustomed to for a long time, 
although worse than things which one is not accustomed to, usually give 
less disturbance; but a change must sometimes be made to things one is 
not accustomed to. 
This Aphorism contains a very proper exception to the general rule 
announced in the preceding Aphorism. Celsus describes very fully 
the most proper course of life, which, it will be remarked, he directs 
not to be tied down to too strict rules (i., 1), at the beginning. Com- 
pare Viet. Acut. xviii., 2, 6; II. Diaet. xliv., 4; Humor, iii., 115; 
Humid. Us. iii., 8. 
51. To evacuate, fill up, heat, cool, or otherwise, move the body in any 
way much and suddenly, is dangerous; and whatever is excessive is inim- 
ical to nature; but whatever is done by little and little is safe, more espe- 
cially when a transition is made from one thing to another. 
The rule of practice here stated is very tersely given by Celsus: 
" Ergo, quum quis mutare aliquid volet, paulatim debebit assuescere." 
(i., 3) Berends, in his Commentary, remarks, that although the pro- 
priety of this rule may appear to be self-evident, we often see it im- 
properly transgressed. Compare, in particular, VI. Epid. ii., 27; 
Viet. Acut. v., 22, x., 8. The same subject is often handled in the 
Hippocratic treatises. See further, A ph. iii., 1, v., 16, vi., 39; II. 
Diget. xliv., 5; Humor, viii., 17, 18; Humid. Us. iii., 7; VI. Epid. 
ii., 27. 
52. When doing everything according to indications, although things 
may not turn out agreeably to indication, we should not change to another 
while the original appearances remain. 
This Aphorism shows decidedly that our author's system of treat- 
ment was not empirical but founded upon reason. What he directs 
here evidently is not to change one's plan of treatment when 
grounded on a proper indication, although it may not turn out ac- 
cording to expectation. This is a rule which every physician must 
follow who would wish to support the dignity of the profession, and 
it is further consonant to reason. See further, Loc. in Hom. xx., 
11, 12; and Celsus. iii., 2. 
53. Those persons who have watery discharges from the bowels when 
they are young, come off better than those who have dry; but m old APIIOKISMS. 
211 
age they come off worse, for the bowels in aged persons are usually dried 
up. 
Galen dismisses this Aphorism with the remark that it is evident, 
and refers the reader to Aph. ii., 20. Celsus, with great propriety, 
has joined the two together: " Quibus juvenibus fluxit alvus, pler- 
umque in senectute contrahitur. Quibus in adolescentia fuit adstricta, 
ssepe in senectute solvitur. Melius autem in juvene fusior, in sene 
astrictior." (i., 3) There can be no doubt about the latter rule be- 
ing generally true, but the former is subject to many exceptions. 
Perhaps what our author means to say is, that the best rule of health 
is that the bowels should be rather loose in youth and rather confined 
in old age. That this generally holds true there can be no doubt. 
54. Largeness of person in youth is noble and not unbecoming; but in 
old age it is inconvenient, and worse than a smaller structure. 
Celsus renders this Aphorism as follows: " longa statura, ut in 
juventa decora est, sic matura senectute conficitur." (i.,1.) All 
the Greek commentators remark that old men are subject to gibbosity, 
that is to say, become bent forward. See further. Praecept. xi., 10. 
SECTION III. 
1. The changes of the season mostly engender diseases, and in the sea- 
sons great changes either of heat or of cold, and the rest agreeably to the 
same rule. 
This is an announcement of a fact pretty generally acknowledged 
and admitted in all ages, namely, that diseases or disorders in the con- 
stitution are mostly, or at least frequently, produced by changes of the 
seasons and changes of the weather. Berends has well remarked, in 
his Commentary on this Aphorism, that our author here lays the 
foundation of the doctrines more fully expanded and explained by 
Sydenham. Stoll, and other, modern authorities. This Aphorism 
agrees with Humor, viii., 15. Compare further, Aer. Aq. Loc. i., 
19; Viet. Acut. xvii., 9; Morb. Sac. xii., 7. 
2. Of natures {temperaments f), some are well- or ill-adapted for sum- 
mer, and some for winter. 
Galen and Theophilus, by " natures/' in this place, understand 
11 temperaments." That some of these agree better with summer and 
others with winter is indisputable. This is in accordance with the 
work Humor, viii., 20. See also, Vet. Med. xxxvii. 14; 1. Diget. xxv., 
12; HI. Diget. i., 6; Aer Aq. Loc. xxxiv., 9. 
3. Of diseases and ages, certain of them are well- or ill-adapted to differ- 
ent seasons, places, and kinds of diet. 
As here stated, there is no doubt as to the fact announced in this 
Aphorism. But Galen complains that it is rather confusedly ex- 
pressed in the original. Compare Humor, viii., 21; and Celsus, ii., 1. 212 
GENUINE WORKS OF HIPPOCRATES. 
4. In the seasons, when during the same day there is at one time heat 
and at another time cold, the diseases of autumn may be expected. 
The meaning here would appear to be, that very changeable weather 
at any season will induce diseases similar to those of autumn, which is 
a very changeable and unhealthy season. See the Commentaries of 
Stephanus and Theophilus, and of Heurnius and Berends, among the 
modern annotators. That autumn is an unhealthy season is declared 
by the poet Horace as follows: " Frustra per autumnos nocentem 
Corporibus metuemus austrum." Ovid, in like manner, expresses 
the effects of changeable weather on the health very correctly and strik- 
ingly: 
" Cum moclo frigoribus premimur, modo solvimur aestu, 
Tempore non certo, corpora languor habet." 
On this subject, see further Humor, viii., 21. 
5. South winds induce dullness of hearing, dimness of visions, heaviness 
of the head, torpor, and languor; when these prevail, such symptoms 
occur in diseases. But if the north wind prevail, coughs, affections of 
the throat, hardness of the bowels, dysuria attended with rigors, and 
pains of the sides and breast occur. When this wind prevails, all such 
symptoms may be expected in diseases. 
The same announcement is made at Humor, viii., 1. I shall 
merely notice a few things which appear to be somewhat obscure. 
By " hardness of the bowels," about the meaning of which expression 
Galen informs us that there had been some difference of opinion 
among the commentators, would appear to be meant constipation of 
the bowels. See also Theophilus. Dysuria, as they remark, is no 
doubt produced by the cold occasioning a deformation inwardly. 
Celsus translates this Aphorism literally, (ii., 1.) 
6. When summer is like spring, much sweating may be expected in 
fevers. 
See, in like manner, Humor, viii., 1. The reason assigned by 
Galen for the prevalence of sweats under the circumstances de- 
scribed is, that they are produced by the prevalence of humidity, and 
the absence of the heat which used to dissipate it. 
7. Acute diseases occur in droughts; and if the summer be particularly 
such, according to the constitution which it has given to the year, for the 
most part such diseases may be expected. 
According to Theophilus, in his very interesting Commentary on 
this Aphorism, by acute fevers in this place Ruff us understood, " pesti- 
lential " namely, such as are connected with buboes; for that these 
are occasioned in Libya by the excessive heat. (Dietz, ii. 353.) But 
none of the other commentators, ancient or modern, understand it as 
applying to pestilential fevers. Compare Humor., vii., 11; and Cel- 
sus, 36; ed. Milligan. 
8. In seasons which are regular, and furnish the productions of the APHORISMS. 
213 
season at the seasonable time, the diseases are regular, and come readily 
to a crisis; but in inconstant seasons, the diseases are irregular, and come 
to a crisis with difficulty. 
This agrees with Humor, vii., 3, 15. The meaning appears cer- 
tainly to be, that when the weather is suitable to the season of the 
year, that is to say, hot in summer, cold in winter, and so forth; and 
when the fruits of the earth are produced seasonably, the complaints 
are mild and regular; but when the weather is unseasonable the diseases 
are of an irregular character. This truth is admirably illustrated in 
the First and Third Rooks of the Epidemics. 
9. In autumn, diseases are most acute, and most mortal, on the whole. 
The spring is most healthy, and least mortal. 
See Epidem. ii., 1; and Prorrhet. ii., 13, 4. These characters 
of the two seasons are thus given by Celsus: " Igitur saluberrimum 
verest:-autumnus longe periculosissimus." (ii., 1.) On this subject 
I believe all tbe ancient authorities, professional and non-professional, 
are perfectly agreed. I might quote Horace, Juvenal, and a whole 
host of poets, who have celebrated the healthfulness of spring, and 
described the insalubrity of autumn. The rule, however, as is well 
known, does not apply to northern latitudes. 
10. Autumn is a bad season for persons in consumption. 
Popular opinion, at least, is in this country quite in unison with 
what is here stated by our author; and many medical authorities in 
modern times have declared in favor of it. See Riverius in Prax. xvii.; 
De Hectica, 3; Dolaeus de Phthisi, ii., 4. I am not aware that recent 
experience has furnished any ground for questioning this opinion. 
11. With regard to the seasons, if the winter be of a dry and northerly 
character, and the spring rainy and southerly, in summer there will 
necessarily be acute fevers, ophthalmies, and dysenteries, especially in 
women, and in men of a humid temperament. 
This is manifestly taken from the work, On Airs, etc., § 10. It 
is thus rendered by Celsus: " Si hiems sicca septemtrionales ventos 
habuit, ver autem austros et pluvias exhibet, fere subeunt lippitu- 
dines, tormina, febres, maximeque in mollioribus corporibus, ideoque 
praecipue in muliebribus." (ii., 1.) Galen has an interesting but 
rather lengthy Commentary upon it. 
12. If the winter be southerly, rainy, and calm, but the spring dry and 
northerly, women whose term of delivery should be in spring, have abor- 
tions from any slight cause; and those who reach their full time, bring 
forth children who are feeble, and diseased, so that they either die 
presently, or, if they live, are puny and unhealthy. Other people are 
subject to dysenteries and ophthalmies, and old men to catarrhs, which 
quickly cut them off. 
This, in like manner, is taken from the work, On Airs, etc., xxvi., 
10, ed. Linden. It is thus rendered by Celsus: " Si vero austri 214 
GENUINE WORKS OF HIPPOCRATES. 
pluviaeque hiemem occuparunt, ver autem frigidum et siccum est, 
gravidae quidem feminaa quibus turn adest partus, abortu periclitantur; 
eae vero qui gignunt, imbecillos, vixque vitales edunt: ceteros lippitudo 
arida, et, si seniores sunt, gravidites male habent." (ii., 1.) 
13. If the summer be dry and northerly and the autumn rainy and 
southerly, headaches occur in winter, with coughs, hoarsenesses, coryzae, 
and in some cases consumptions. 
This also is taken from the same chapter of the work, On Airs, 
etc., and is thus rendered by Celsus: "At si sicca aestas aquilones 
habuit, autumno vero imbres austrique sunt, tota hieme, qua proxima 
est, tussis, distillatio, raucitas, in quibusdam etiam tabes oritur." 
(ii., 1.) 
14. But if the autumn be northerly and dry, it agrees well with persons 
of a humid temperament, and with women; but others will be subject to 
dry ophthalmies, acute fevers, coryza, and in some cases melancholy. 
This is taken, with a few alterations, from the same chapter as the 
preceding. It is thus rendered by Celsus: Sin autem autumnus 
qudque aeque siccus iisdem aquilonibus perflatur, omnibus quidem 
mollioribus corporibus, inter qua muliebria esse proposui, secunda 
valetudo contingit: durioribus vero instare possunt et arid® lippitu- 
dines, et febres partim acutae, partim longae, et ii morbi, qui ex atra 
bile nascuntur." (ii., 1.) 
15. Of the constitutions of the year, the dry, upon the whole, are more 
healthy than the rainy, and attended with less mortality. 
This is partly taken from the § 4 of the work, On Airs. Celsus 
thus tersely renders it: " saluberrimi sunt sereni dies." (ii., 1.) 
That the fact is correctly stated by our author, no one, I suppose, 
will pretend to question. That dry seasons and dry countries are 
more healthy than humid, is consistent with universal experience and 
observation. The reason of this, as stated by the ancient commenta- 
tors, is, that in hot weather the humors are dissipated; whereas, in 
humid, that is to say, rainy, the humors are collected within the 
body, and engender putrid diseases. There is no doubt, however, as 
to the fact, in whatever way it is to be accounted for. 
16. The diseases which occur most frequently in rainy seasons are, pro- 
tracted fevers, fluxes of the bowels, mortifications, epilepsies, apoplexies, 
and quinsies; and in dry, consumptive diseases, ophthalmies, arthritic 
diseases, stranguries, and dysenteries. 
Galen explains at considerable length, upon the principles of the 
humoral pathology, his ideas respecting the manner in which rainy 
or dry weather produce the various diseases enumerated under this 
head. It will be seen from his Commentary, and that of Theophilus, 
that some connected the epithet "consumptive" with ophthalmies, 
and understood the meaning to be, "ophthalmies which lead to the 
destruction of the eye." Compare Celsus, ii., 1. APHORISMS. 
215 
17. With regard to the states of the weather which continue but for 
a day, that which is northerly, braces the body, giving it tone, agility, 
and color, improves the sense of hearing, dries up the bowels, pinches the 
eyes, and aggravates any previous pain which may have been seated in the 
chest. But the southerly relaxes the body, and renders it humid, brings 
on dullness of hearing, heaviness of the head, and vertigo, impairs the 
movements of the eyes and the whole body, and renders the alvine dis- 
charges watery. 
It is to be borne in mind, that our author here touches upon the 
effects of temporary conditions of the weather upon the health. As 
Theophilus then remarks, he has been unjustly blamed for tautology 
in this place. Celsus briefly renders the first part of this sentence as 
follows: " Aquilo sanum corpus spissat, et mobilius atque expeditius 
reddit." (ii., 1.) The latter clause is rendered rather freely: "Auster 
aures hebetat, sensus tardat, capitis dolorem movet, alvum solvit, 
totum corpus efticit hebes, humidum, languidum." (Ibid.) See 
further, Aph. v., 26. 
18. With regard to the seasons, in spring and in the commencement of 
summer, children and those next to them in age are most comfortable, 
and enjoy best health; in summer and during a certain portion of autumn, 
old people; during the remainder of the autumn and in winter, those of 
the intermediate ages. 
There is no obscurity about this Aphorism, nor any reason to 
controvert the facts as stated in it. It is thus elegantly rendered by 
Celsus: " Quod ad Mates vero pertinet, pueri proximique iis vere 
optime valent, et restate prima tutissimi sunt; senes restate et 
autumni prima parte: juvenes hyeme, quique inter juventam senec- 
tutemque sunt. Inimicior senibus hyems, sestas adolescentibus est." 
(ii., 1.) The Greek commentators explain all the facts, as stated in 
this Aphorism, upon their principles regarding the temperaments in 
humors. See Galen and Theophilus. 
19. All diseases occur at all seasons of the year, but certain of them 
are more apt to occur and be exacerbated at certain seasons. 
As Berends remarks, this Aphorism contains an undoubted and 
most important truth. Galen remarks in his Commentary, that if 
diseases had been connected solely with the temperament of the 
atmosphere, all would have been affected with such diseases as are 
peculiar to particular seasons; but since many diseases arise from 
errors of diet, these occur at all seasons. Constitution, as he further 
states, has much to do with the occurrence of disease. That certain 
diseases are more disposed to happen at certain seasons, he declares 
in subsequent Aphorisms. Compare Praenot. xxvi., 4; Aph. iii., 17; 
and Celsus, ii., Praef. 
20. The diseases of spring are, maniacal, melancholic, and epileptic dis- 
orders, bloody flux, quinsy, coryza, hoarseness, cough, leprosy, lichen 216 
GENUINE WORKS OF HIPPOCRATES. 
alphos, exanthemata mostly ending in ulcerations, tubercles, and arthritic 
diseases. 
I have little to say on the subject of this Aphorism, as the mean- 
ing is sufficiently plain, and the nature of the diseases here enumerated 
may be readily ascertained upon reference to the Index of the Syden- 
ham Society's edition of Paulus 2Egineta. Celsus gives a transla- 
tion of it, but not very literal; and it is worthy of remark, that he 
vaguely includes all the cutaneous diseases here noticed under the 
single term "pustulse." He has also chronic ophthalmy (or lippi- 
tudines), which does not occur in our author's list, (ii., 1.) 
21. Of summer, certain of these, and continued, ardent, and tertian 
fevers, most especially vomiting, diarrhoea, ophthalmy, pains of the ears, ul- 
cerations of the mouth, mortifications of the privy parts, and the sudamina. 
On most of the diseases contained in this list it will be unnecessary 
to make any remarks. I may mention, however, that the gangrene 
of the genital organs here noticed is minutely described in the Books 
of the Epidemics of which I have given a translation. Berends 
mentions, that some had regarded it as being of a venereal nature, 
but without any good reason. The sudamina are described by Galen 
as being a cutaneous disease of the skin produced by excessive sweat- 
ing. By the way, Celsus translates it in such terms, as would seem 
to imply that he did not at all understand it: " et quicquid sudore 
hominem resolvit." (ii., 1.) 
22. Of autumn, most of the summer, quartan, and irregular fevers, 
enlarged spleen, dropsy, phthisis, strangury, lientery, dysentery, sciatica, 
quinsy, asthma, ileus, epilepsy, maniacal and melancholic disorders. 
Celsus gives an elegant version of this Aphorism, on which I have 
only to remark, that he has omitted the maniacal and melancholic dis- 
orders from his list of summer diseases. (ii., 1.) How this happened 
it is impossible to find out. That these are engendered by black bile, 
and that it prevails in autumn, was held by all the ancient authorities. 
See the Commentaries of Galen and Theophilus. 
23. Of winter, pleurisy, pneumonia, coryza, hoarseness, cough, pains 
of the chest, pains of the ribs and loins, headache, vertigo, and apoplexy. 
About this Aphorism there can be no doubt nor difficulty. I 
have again to remark, that it is rendered by Celsus in so vague and 
indefinite terms, as would almost lead one to doubt whether he appre- 
hended correctly the meaning of our author: " Hyems autem capitis 
dolores, tussim, et quidquid in faucibus, in lateribus, in visceribus 
mali contrahitur, irritat." (ii., 1.) 
24. In the different ages the following complaints occur: to little and 
new-born children, aphthae, vomiting, coughs, sleeplessness, frights, in- 
flammation of the navel, watery discharges from the ears. 
There is little in this list of the common disorders which attack 
new-born children that requires comment. Celsus, in his translation, APHORISMS. 
217 
omits " frights," for what reason cannot be ascertained. Both Galen 
and Theophilus state, that these are connected with the stomach. I 
may mention that Phases, the Arabian, gives a pretty full treatise 
on the diseases of infancy. He describes twenty-four diseases 
altogether. 
25. At the approach of dentition, pruritus of the gums, fevers, convul- 
sions, diarrrhcea, especially when cutting the canine teeth, and in those 
who are particularly fat, and have constipated bowels. 
Among the Hippocratic treatises there is one on Dentition, of 
which I have given a brief analysis in the Preliminary Discourse. 
Celsus, in his version of this Aphorism, renders the disease named 
oSagiGpios by our author, and which Galen and Damascins distinctly 
explain to mean " pruritus of the gums," by " gingivarum exulcera- 
tiones." This seems another instance of mistranslation. 
2G. To persons somewhat older, affections of the tonsils, incurvation of 
the spine at the vertebra next the occiput, asthma, calculus, round worms, 
ascarides, acrochordon, satyriasmus, struma, and other tubercles 
(phymata), but especially the aforesaid. 
There are many things in this Aphorism which it might be in- 
teresting to examine, did not our limits preclude; in particular, the 
affection of the vertebrae here enumerated. Did our author mean the 
disease described by Sir Charles Bell under the head of li Inflamma- 
tion and laceration in the Atlas and Vertebra Dentata?" (Institutes 
of Surgery, p. 144.) See, also, V. Swieten, Comment, in Boerhaav. 
A ph. t. ii., de Angina Convulsiva. Or did he apply it to the less 
formidable affection called il the crick of the neck?" I am inclined 
to adopt the latter conjecture. See the Commentaries of Galen and 
Theophilus. All the other terms will be found explained in the 
Comment, on Paulus yEgtneta. See the Index. According to 
Heurnius and Berends, the satyriasmus here noticed was an affection 
of the glands of the neck. See, also, the note of M. Littre. 
27. To persons of a more advanced age, and now on the verge of man- 
hood, the most of these diseases, and, moreover, more chronic fevers, and 
epistaxis. 
According to Damascins, the period of life here referred to is 
that immediately following 14; but Galen applies it to the term of 
puberty, which, he says, may be at 12, 13, or 14. That epistaxis is 
common at this period of life is well known; but why fevers should 
be more protracted then than usual, does not appear clear. Heurnius 
ascribes them to voracity, which gives rise to a pituitous crudity, and 
to a certain acrimony which occasions putridity. Theophilus and 
Damascins seem to point to a similar explanation. 
28. Young people for the most part have a crisis in their complaints, 
some in forty days, some in seven months, some in seven years, some at 
the approach to puberty; and such complaints of children as remain, and 218 
GENUINE WORKS OF HIPPOCRATES. 
do not pass away about puberty, or in females about the commencement 
of menstruation, usually become chronic. 
There is little that requires elucidation in this Aphorism. It will 
be remarked that our author seems to attach a religious importance, 
so to speak, to the number seven. I have made some observations on 
this subject in the Analysis of the Hippocratic Treatise bearing this 
title. See Preliminary Discourse, § II. See further Aph. ii., 45; 
II. Predict. xvi., 1. 3. 
29. To persons past boyhood, haemoptysis, phthisis, acute fevers, 
epilepsy, and other diseases, but especially the afore-mentioned. 
With respect to the diseases mentioned in this Aphorism, the 
only one which we would hesitate in recognizing as being particularly 
common at this period of life, is epilepsy. Galen, in fact, wonders 
that his author placed it here, seeing he had formerly ranked epilepsy 
among the diseases of infancy, which sometimes disappear at puberty. 
A modern commentator, Riegerus, suggests, that by epilepsy he 
probably meant the hysterical convulsion. But perhaps it is better 
to consider our author's meaning that epileptical convulsions 
are apt to be exacerbated at this period. That haemoptysis and 
phthisis are most common at this period has been accurately deter- 
mined by recent statistics. By the way, the period of life here 
treated of is not so satisfactorily determined as could be wished. In 
M. Littre's translation, it is marked "from 21 to 25," but surely this 
last is a misprint for 35. It comprehends the " adolescentia " and 
" juvenes" of Celsus. (ii., 1.) Compare Aph. v., 9, viii., 7; Coac., 
iii., 260; Morb. Sac. xiii., 1. 
30. To persons beyond that age, asthma, pleurisy, pneumonia, lethargy, 
phrenitis, ardent fevers, chronic diarrhoea, cholera, dysentery, lientery, 
haemorrhoids. 
The period here treated of is that from 35 to 50. See Galen and 
Theophilus. There is not much in it requiring illustration. Galen 
is rather surprised that our author has omitted "melancholy" in 
this list of diseases. Compare Coac. iii., 395; Aer., Aq., Loc. iv., 
7; VII. Epid. xl., 19. 
31. To old people dyspnoea, catarrhs accompanied with coughs, dysuria, 
pains of the joints, nephritis, vertigo, apoplexy, cachexia, pruritus of the 
whole body, insomnolency, defluxions of the bowels, of the eyes, and of 
the nose, dimness of sight, cataract (glaucoma), and dullness of hearing. 
There is little to remark on the contents of this Aphorism, most 
of the diseases here enumerated being notoriously those of old age. 
I may mention that, as Galen states, the terms here used in refer- 
ence to diseases of the eyes apply both to amaurosis and cataract 
(v7toxvgia.) Compare Affection, xxix., 10; Coac. iii., 395. APHORISMS. 
219 
SECTION IV. 
1. We must purge pregnant women, if matters be turgid (in a state of 
orgasm ?), from the fourth to the seventh month, but less freely in the 
latter; in the first and last stages of pregnancy it should be avoided. 
The term significative of " being in a state of orgasm " occurs at 
Aphor. i., 22. It would appeal' to mean that the fluids, that is to 
say, the contents of the vessels, are ready to burst forth with plethora. 
That purging is unsafe in the earlier and later stages of pregnancy is 
consistent with common observation at the present day. I have 
translated the latter clause agreeably to the interpretation of it given 
by Theophilus. Compare Aph. i., 22, v., 29; Morb. Mui. xlii., 8. 
2. In purging we should bring away such matters from the body as it 
would be advantageous had they come away spontaneously; but those of 
an opposite character should be stopped. 
The meaning is obvious, and the propriety of the rule will scarcely 
be challenged. As Damascius remarks, the practice in this case 
imitates Nature. Galen further remarks, that upon this principle 
we administer cholagogues in diseases of a bilious nature. Compare 
Aph. i., 2. 
3. If the matters which are purged be such as should be purged, it is 
beneficial and well borne; but if the contrary, with difficulty. 
This is a repetition of the rule of practice given in Aphor. i., 25. 
It is evidently very much in place here, where the rules of practice 
respecting purging are treated of. Galen, however, mentions that 
some of the editors had expunged it. 
4. We should rather purge upward in summer, and downward in winter. 
This appears to be a very proper rule of practice, and it is accord- 
ingly approved of by all the ancient commentators. Celsus, however, 
seems to controvert it; he says: " Vomitus utilior est hieme quam 
restate." (i., 3.) Whether he opposes Hippocrates designedly or in 
ignorance, cannot be determined. 
5. About the time of the dog-days, and before it, the administration 
of purgatives is unsuitable. 
It is an important rule of practice, followed by all the Greek and 
Arabian authorities, not to give purgative medicines in hot weather. 
According to Galen, it is fighting against Nature to determine in- 
wardly by purgative medicines, whilst the heat is determining out- 
wardly. Damascius says, that the body being then enfeebled, cannot 
bear purgatives. Compare Aer., Aq., Loc. xxx., 2, 5, 8; Purg. v., 8. 
6. Lean persons who are easily made to vomit should be purged upward, 
avoiding the winter season. 
Galen and Theophilus approve of this rule of practice; the ration- 
ale of which they explain by stating that slender persons are bilious. 220 
GENUINE WORKS OF HIPPOCRATES. 
They both, however, approve of limiting the practice to those who 
vomit readily, and of avoiding the winter season. Celsus again 
appears to be opposed to our author, for he holds that " vomitus inu- 
tilis gracilibus." (i., 3.) I have not met with any satisfactory solu- 
tion of this apparent contradiction. Compare II. Morb. xiii., 12. 
7. Persons who are difficult to vomit, and are moderately fat, should 
be purged downward, avoiding the summer season. 
The rule here laid down is a natural inference from the preceding 
one. Here moderately fat is opposed to lean; to difficult to vomit, to 
easy to vomit, and the summer season, to winter. I have had occasion 
to state already that the ancients particularly avoided purgatives 
during the heat of summer. Compare II. Morb. xii., 35. 
8. We must be guarded in purging phthisical persons upward. 
It will be seen upon reference to the Commentaries of Theophilus 
and Damascius, as published by Dietz, that they joined this Aphorism 
to the last. I have followed Galen, as M. Littre has also done. Con- 
sidering how frequently phthisis is complicated with haemoptysis, it is 
a prudential rule, at all events, to avoid giving emetics in such cases, 
lest one should get the blame of causing the rupture of a blood-vessel. 
We have mentioned in an analysis of the work, On Diseases, that the 
author of it enumerates this among the awkward mistakes which 
a physician is liable to make. Compare Loc. in Hom. xxxv., 4; Int. 
Affect, iv., 26, xiii., 36. 
9. And from the same mode of reasoning, applying the opposite rule 
to melancholic persons, we must pruge them freely downward. 
It was an invariable rule of ancient practice to administer purga- 
tives, and more especially black hellebore (helleborus niger) in melan- 
choly, with the intention of carrying off the black bile downward. 
''The opposite rule," to which he refers, would appear to be that 
laid down in Aph. 6, respecting the treatment of persons to whom it 
is proper to give emetics. Compare Aer., Aq., Loc. xi., 2. 
10. In very acute diseases, if matters be in a state of orgasm, we may 
purge on the first day, for it is a bad thing to procrastinate in such cases. 
The meaning of this Aphorism is obvious, namely, that when 
there is great turgescence of the fluids, they should be purged off 
without delay. See Aph. 1 of this section. According to Galen, 
by " very acute diseases " he means such as terminate within seven 
days. Compare V. Epidem. xxv., 16, 17. 
11. Those cases in which there are tormina, pains about the umbilicus, 
and pains about the loins, not removed either by purgative medicines or 
otherwise, usually terminate in dry dropsy. 
We have the positive assurance of Galen that by " dry dropsy" 
Hippocrates meant that species of dropsy called tympanites, which 
is so named because in it the belly, when struck, sounds like a drum 
(tympanum). Although Prosper Martian, Berends, and other modern APHORISMS. 
221 
authorities, are sceptical on this point, I must say that I see no reason 
for doubting that it was the same as the tympanites of modern 
nosologists. See further, Paulus JEgineta, B. III., 48, Sdy. Soc. 
edit. Compare Coac, ii., 279, iii., 286. 
12. It is a bad thing to purge upward in winter persons whose bowels 
are in a state lientery. 
As Galen states, the disease being seated in the lower intestines, 
emetics can obviously do no good in lientery. But, moreover, it is 
contrary to rule to administer them in winter. See above, § 6. 
Berends, under this head, gives a very interesting, but very lengthy, 
dissertation on lientery. 
13. Persons who are not easily purged upward by the hellebores, should 
have their bodies moistened by plenty of food and rest before taking the 
draught. 
For a full account of all the ancient rules respecting the adminis- 
tration of hellebore, see Paulus JEgineta, B. VII., 10. One can 
readily understand that it would be a wise rule to give diluents before 
administering so violent an emetic as the veratrum album. Compare 
Aph. i., 22, ii., 9, vii., 70; II. Diset. xxxvi., 18; Loc. in Hom. xl., 
3; Verat. Us. i., 1; II. Morb. xiii., 10; Int. Affect, xxiii., 13; Morb. 
Mulier. xxv., 13, 14; Superfoet. xx., 1. 
14. When one takes a draught of hellebore, one should be made to move 
more about, and indulge less in sleep and repose. Sailing on the sea 
shows that motion disorders the body. 
The object being to procure ready vomiting, it was no doubt a 
good rule to move the patient about. That motion produces vomit- 
ing is illustrated, as he says, by the movements of a ship occcasioning 
sea-sickness. That such is his meaning, there can be no doubt. See 
the Commentaries of Galen and Theophilus. Compare Verat. Us., 
i., 2; VI. Epid. v., 45; Aph. ii., 51. 
15. When you wish the hellebore to act more, move the body, and when 
to stop, let the patient get sleep and rest. 
The argument contained in this Aphorism is manifestly a con- 
tinuation of the preceding one. Compare Veratr. Us. i., 4; Superfeet, 
xx., 1; VI. Epid. v., 45; Aph. v., 27; VI. Epid. v., 45. 
16. Hellebore is dangerous to persons whose flesh is sound, for it induces 
convulsion. 
This is little else but a repetition of Aphor. ii., 36. Celsus, in 
like manner, declares that emetics "non semper segris prodesse, 
sempei' sanis nocere." (ii., 13.) See Verat. Us, i., 5; Aph. ii., 36, 
37, vi. 222 
GENUINE WORKS OF HIPPOCRATES. 
17. Anorexia, heartburn, vertigo, and a bitter taste of the mouth, in a 
person free from fever, indicate the want of purging upward. 
The symptoms here enumerated are, no doubt, indicative of the 
presence of bile in the stomach, and consequently emetics must be 
proper in such a case. See Galen and Berends. Compare Verat. Us. 
i., 10; Affect, xiv., 12; II. Morb. Mulier. xxiv., 2, 3. 
18. Pains seated above the diaphragm indicate purging upward, and 
those below it, downward. 
I here follow the reading which Berends, Lefebure, and Littre 
have adopted from Bosquillon. The rule here laid down seems to 
be, that, in affections of the chest, emetics are to be administered; and 
in those of the abdomen, purgatives. That this rule would be a very 
proper one in many cases I can well believe, but as a general rule, I 
suppose we would now demur submitting to it. Compare Veratr. 
Us. i., 10, 11. 
19. Persons who have no thirst while under the action of a purgative 
medicine, do not cease from being purged until they become thirsty. 
The same remark is made in the little tract on the Administration 
of Hellebore. It is a well-known fact that the operation of a drastic 
purgative induces thirst. The rationale of the rule of practice 
founded upon it is explained by Theophilus to be, that until thirst 
takes place we must consider that the system has not been properly 
dried. See Veratr. Us. i., 11. 
20. If persons free from fever be seized with tormina, heaviness of the 
knees, and pains of the loins, this indicates that purging downward is 
required. 
This Aphorism is little else than a continuation of Aph. 18. The 
reader will remark that our author qualifies both by restricting purg- 
ing to those cases in which no fever is present. Compare Veratr. 
Us. i., 11. 
21. Alvine dejections which are black, like blood, taking place spon- 
taneously, either with or without fever, are very bad; and the more 
numerous and unfavorable the colors, so much the worse; when with 
medicine it is better, and a variety of colors in this case is not bad. 
The characters of the dejections given in this Aphorism, and some 
of the following, is taken partly from Prognost. §11, and Coac. Pr. 
§ 596, of Littre edition. The Commentaries of Galen and Theophilus 
are interesting, as showing us the manner in which the ancient au- 
thorities accounted for this appearance physiologically. They held 
that the office of the spleen being to attract the melancholic humor 
for its own purposes, when this viscus fails to perform its office, the 
superfluity deranges the liver; and hence this discharge is indicative 
of the greatest possible derangement of the internal viscera. Galen 
mentions that he found black dejections from the bowels a common 
symptom in the plague which prevailed in his time. APHORISMS. 
223 
22. When black bile is evacuated in the beginning of any disease what- 
ever, either upward or downward, it is a mortal symptom. 
This is a natural inference from the preceding Aphorism. Of 
course, as the commentators remark, a black discharge either upward, 
or downward at the commencement of a disease, indicates a very 
serious derangement of the system. Galen remarks that, in a more 
advanced stage of the disease, such an evacuation may be critical, and 
in that case favorable. See also Coac. i., 100. 
23. In persons attenuated from any diseases, whether acute or chronic, 
or from wounds, or any other cause, if there be a discharge eithei' of black 
bile, or resembling black blood, they die on the following day. 
Of the fatal nature of such dejections there can be no question. 
Hippocrates would, no doubt, be familiar with them in the fevers of 
his own country. In intertropical fevers, I need scarcely remark, 
they are looked upon as most mortal symptoms. 
24. Dysentery, if it commence with black bile, is mortal. 
Galen, in his Commentary, pronounces such a case to be as incur- 
able as cancer,-as, in fact, being produced by the same humor, that 
is to say, black bile. Theophilus makes the curious remark, that if 
black bile, when poured on the earth, occasions an effervescence, like 
vinegar, it may well be supposed that it will corrode the human body 
when confined in it. Compare Coac. i., 100, iii., 292; V. Epid. x., 2. 
25. Blood discharged upward, whatever be its character, is a bad symp- 
tom, but downward it is (more?) favorable, and so also black dejections. 
Upon reference to Dietz (Analec. tom. ii., p. 400) and Littre 
(CEuv. Hip. tom. iv., p. 510), it will be seen that there are different 
readings of this paragraph. As a general fact there is little to say to 
the announcement made in this Aphorism; for certainly discharges 
of blood upward are generally unfavorable, whereas those downward 
are less so. Galen understands the meaning to be, that discharges of 
blood, or black discharges, when they proceed from the hsemorrhoidal 
vessels, are favorable. Compare Aph. vii., 37; Coac. ii., 254, vi., 14. 
26. If in a person ill of dysentery, substances resembling flesh be dis- 
charged from the bowels, it is a mortal symptom. 
The dejection resembling the scrapings of the guts, is noticed at 
Prognost. §11, and. occurs among the symptoms of dysentery as given 
by Aretseus (Morb. Chron. i., 9), and the other authorities. All 
regard it as a fatal symptom, proceeding from excoriation of the 
bowels. See Aph. iv., 76. 
27. In whatever cases of fever there is a copious hemorrhage from what- 
ever channel, the bowels are in a loose state during convalescence. 
The rationale of this, as stated by Theophilus, is, that the discharge 
of blood having occasioned debility of the digestive powers, the food 
is not properly digested, and in consequence the chyle is evacuated 
from the bowels. See also Prorrh. i., 133; Coac. 149, 326, ed. Littre. 224 
GENUINE WORKS OF HIPPOCRATES. 
28. In all cases whatever, bilious discharges cease if deafness supervenes, 
and in all cases deafness ceases when bilious discharges supervene. 
As remarked by Galen, our author, in this place, evidently refers 
to symptomatic deafness in fevers, and other such complaints. The- 
ophilus explains, that such an affection, being occasioned by a metas- 
tasis of the bile upward, is naturally relieved by an evacuation of 
the same downward. See Coac. ii., 66, 103, vi., 77; Aph. iv., 60. 
29. Rigors which occur on the sixth day have a difficult crisis. 
The sixth was regarded by all the authorities as an unfavorable 
critical day. Theophilus compares the sixth to a tyrant, and the 
seventh to a king. See Galen De Crisibus; and Paulus zEgineta, 
B. II., 7, Syd. Soc. edit. Compare Coac. i., 23; VIII. Epid. xl, 20. 
30. Diseases attended with paroxysms, if at the same hour that the 
fever leaves it return again next day, are of difficult crisis. 
It will be seen upon reference to the Commentary of Galen, that 
there had been two different interpretations of this passage. As ren- 
dered here, the meaning seems sufficiently clear, and the diagnosis 
would appeal* to be very well founded. See Humor, iii., 91. 
31. In febrile diseases attended with a sense of lassitude, deposits form 
about the joints, and especially those of the jaws. 
See Humor, iii., 98; IV. Epidem. xviii., 16, 17. This Aphorism 
evidently bears reference to semeiology. As stated by Galen, the 
deposits here noticed are bubo and parotis. These, I need scarcely 
remind the reader, are frequently mentioned in the Epidemics. 
32. In convalescents from diseases, if any part be pained, there deposits 
are formed. 
See Humor, iii., 100. I need not say that deposits or abscesses 
(for they are nearly the same) are largely treated of in the different 
books of Epidemics. That in such a case a deposit should form in a 
part affected with pain, is what might be naturally expected. 
33. But if any part be in a painful state previous to the illness, there 
the disease fixes. 
As stated by Galen, this Aphorism is- closely connected with the 
two preceding ones. That any disease is apt to fix on a weak limb, is 
a well-known fact in semeiology. See Humor, iii., 101, IV. Epidem. 
xviii., 2, 3; Log. in Homin. xxxvi., 6. 
34. If a person laboring under a fever, without any swelling in the 
fauces, be seized with a sense of suffocation suddenly, it is a mortal 
symptom. 
This is evidently cynanche laryngitis, which is frequently noticed 
in the Hippocratic treatises. See Aph. iv., 25; Praenot. xxiii, 3, 4; 
Coac. i., 90, ii., 201, 202, 203, iii., 96; also Paulus zEglneta, B. III., APHORISMS. 
225 
27, Syd. Soc. edit. Galen gives a very interesting Commentary on 
this passage, in which he discusses the nature of the affection noticed 
in it. He distinctly refers it to inflammation spreading from the 
fauces to the larynx, and obstructing the passages to the lungs, that 
is to say, the bronchi. Theophilus gives briefly the same account 
of it. 
35. If in a person affected with fever, the neck become suddenly dis- 
torted, and he cannot swallow unless with difficulty, although no swelling 
be present, it is a mortal symptom. 
Allusion is evidently made here to dislocation of the upper verte- 
brae, an affection which we have had occasion to notice previously 
more than once. See Articulations, § 41; Epidem. ii., 24; Aphor. 
iii., 26; Prorrhet. i., 87; and Coac. 261. See also our analysis of 
Epid. ii., and Commentary on Aph. iii., 26. Galen's Commentary 
on this Aphorism is very interesting. He describes the affection as 
a form of dislocation forward of the upper vertebrae from an inflam- 
matory complaint about the fauces. Theophilus and Damascius give 
a similar account of the disease, which the former of these calls a 
species of cynanche, in which the vertebrae of the spine are affected 
sympathetically. It is noticed by Celsus in the following terms: 
" Cuive in eodem febris corporisque habitu cervix convertitur, sic ut 
devorare aeque nihil possit." (ii., 6.) 
36. Sweats, in febrile diseases, are favorable, if they set in on the third, 
fifth, seventh, ninth, eleventh, fourteenth, seventeenth, twenty-first, 
twenty-seventh, and thirty-fourth day, for these sweats prove a crisis to the 
disease; but sweats not occurring thus, indicate pain, a protracted disease, 
and relapses. 
The prognostics from sweats, and the critical days, are treated of 
in various parts of our author's works. See Praenot. v., 1, 2, 3; Coac. 
iv., 36, etc. See also the Commentary on Paulus JEgineta, B. II. 
7, Syd. Soc. edit. 
37. Cold sweats occurring along with an acute fever, indicate death; 
and along with a milder one, a protracted disease. 
The truth of this, Galen says, has been often proved by experi- 
ence; and the rationale of it he explains at considerable length, in this 
way, that cold sweats are occasioned by the innate heat being nearly 
overpowered by the humors which engender the fever. Theophilus 
gives a similar explanation. Compare Judicat. vi., 9, 10, viii., 1, 8; 
Praenot. v., 4, 5; Coac. iv., 40. 
38. And in whatever part of the body there is a sweat, it shows that 
the disease is seated there. 
That is to say, as Heurnius justly remarks, affections of the brain 
are indicated by sweats about the head, and those of the lungs by 
sweats about the chest. He treats here of symptomatic and partial 
sweats. See Aph. ii., 5, and Celsus, ii., 2. 
Vol. II.-15. 226 
GENUINE WORKS OF HIPPOCRATES. 
39. And in whatever part of the body heat or cold is seated, there is 
disease. 
All of the ancient commentators explain this upon the principle 
that the disease is connected with an unequal distribution of the in- 
nate heat in the, body, or, as they express, to a departure from the 
temperature (evxpaffia). Compare Judicat. viii., 3. 
40. And wherever there are changes in the whole body, and if the body 
be alternately cold and hot, or if one color succeed another, this indicates 
a protracted disease. 
From the varied characters of the affections, as the commentators 
remark, Nature-meaning the vis medicatrix natures-cannot ac- 
complish the removal of them in a short time. Celsus renders this 
Aphorism as follows: "Aut ubi corpus modo frigidum, modo cali- 
dum est, et color alius ex alio fit." (ii., 5.) Compare Aph. vii., 60; 
Humor, iii., 22, 53; Judic. viii., 4; Prsedict. vi.,4; Coac. i., 77, 177. 
41. A copious sweat after sleep occurring without any manifest cause, 
indicates that the body is using too much food. But if it occur when one 
is not taking food, it indicates that evacuation is required. 
As Galen and Theophilus explain his meaning, Hippocrates in- 
fers that a copious sweat must be occasioned by an effort of Nature 
to expel a superfluity from the system, which, as he states, is likely 
to be, either the consequence of too much food or of humors in the 
system requiring to be purged. Aph. vii. 61; Coac. iv. 36; V. 
Epid. xxv., 15; Aph. iii., 8. 
42. A copious sweat, whether hot or cold, flowing continuously, indi- 
cates, the cold a greater, and the hot a lesser disease. 
Copious, and more especially colliquative and cold sweats, are well 
known to be a very unfavorable symptom in fevers. See further 
Judicat. viii., 9; Coac. i., 21; Aphor. vii., 61; also, Pallus aEgin- 
eta, B. II., 47, Syd. Soc. edit. 
43. Fevers, not of the intermittent type, which are exacerbated on the 
third day, are dangerous; but if they intermit in any form, this indicates 
that they are not dangerous. . 
Our author here evidently draws the distinction between remit- 
tent and intermittent fevers, pronouncing on the former that they are 
dangerous, and of the latter that they are not so. Celsus seems to 
have had this Aphorism in view, when he gives in his list of dangerous 
diseases, " quaeve sic continuent, ut per accessiones increscant, per de- 
cessiones tantum molliantur, nec unquam integrum copus demittant." 
(ii., 4.) I need scarcely remark, that remittent fevers, which are the 
same as the continual fevers of the ancients, are well known to be 
of a very intractable nature. See further Aph. vii., 62; Coac. i., 
166; I. Epid. iii., 16; III. Epid. iii., 109; VII. Epid. xl., 19; Viet. 
Acnt. iii., 3. APHORISMS. 
227 
44. In cases attended with protracted fevers, tubercles (phymata) or 
pains occur about the joints. 
That protracted fevers are apt to terminate in collections of mat- 
ter, or pains in joints, must be well known to every one who is famil- 
iar with medical practice. They are noticed in several of the Hippo- 
cratic treatises, as, Aph. vii., 63; Humor, iii., 98; Prgenot. xxiv., 9, 
10, 11; II. Prorrhet. x., 7; Coac. i., 168, 169. By phymata in this 
place, our author evidently means, deposits, of which I need scarcely 
say that he treats in various parts of his works, more especially in the 
Epidemics. 
45. When tubercles (phymata) or pains attack the joints after fevers, 
such persons are using too much food. 
This seems a very natural inference if confirmed by experience; 
namely, that Nature being overloaded, endeavors to relieve herself, 
either by these tubercles, or effusion in the joints. See Aph. vii., 64. 
46. If in a fever not of the intermittent type a rigor seize a person already 
much debilitated, it is mortal. 
That a rigor attacking a patient reduced by fever is a very fatal 
symptom cannot be unknown to any person who is familiar with the 
treatment of these diseases. See Coac. ii., 65. 
47. In fevers not of the intermittent type, expectorations which are livid 
bloody, fetid and bilious, are all bad; but if evacuated properly, they are 
favorable. So it is with the alvine evacuations and the urine. But if 
none of the proper excretions take place by these channels, it is bad. 
We have here prognostics derived from the sputa, the alvine and 
the urinary discharges. Upon reference to the Commentary of Galen 
and the Notes of Littrc, it will be seen that very anciently there was a 
different reading of the last clause of this Aphorism. The subjects 
to which it relates are treated of in several of the Hippocratic treat- 
ises, as Aph. vii., 69; Coac.ii., 161, iii., 241; 2 Prorrhet. xv., 10. 
48. In fevers not of the intermittent type, if the external parts be cold, 
but the internal be burnt up, and if there be thirst, it is a mortal symp- 
tom. 
This Aphorism is thus rendered by Celsus: " Ant cui, febre non 
quiescente, exterior pars friget, interior sic calet, ut etiam sitim 
faciat." (ii., 6.) Galen accounts for the case here noticed in the 
following manner: when an inflammation or erysipelas is seated in the 
internal parts, blood from all parts of the body is attracted to the part, 
and hence the surface of the body is congealed. He gives the name 
of lipyria to a fever of this character. See Paulus JEgineta, B. IL, 
27, Syd. Soc. edit. Compare Aph. vii., 69; Coac. ii., 161, iii., 241; 
Prsenot. xv., 10; Aph. i., 25. 
49. In a fever not of the intermittent type, if a lip, an eye-brow, an 
eye, or the nose, be distorted; or if there be loss of sight or of hearing, 228 
GENUINE WORKS OF HIPPOCRATES. 
and the patient be in a weak state-whatever of these symptoms occur, 
death is at hand. 
This is partly derived from Coac. 72, ed. Littre. The most of the 
features here drawn are copied by Celsus, in his admirable chapter 
" On the evident symptoms of death:"-" eademque labra, et nares, 
oculique, et palpebrae, et supercilia, aliquave ex his pervertuntur. " 
(ii., 6.) As Theophilus remarks, the symptoms here noted indicate 
a loss both of the powers of motion and of sensibility. 
50. Apostemes in fevers which are not resolved at the first crisis, indi- 
cate a protracted disease. 
Galen does not hesitate to declare, that this is a self-evident truth, 
which it probably did not require an Hippocrates to announce. See 
Celsus, ii., 5. 
51. When in a fever not of the intermittent type dyspnoea and delirium 
come on, the case is mortal. 
In this case, as Galen remarks, both the brain and the lungs being 
affected, the danger must be of an urgent nature; in fact, either of 
them is a very unfavorable symptom, and a combination must neces- 
sarily be very mortal. Compare Judicat. viii., 17; Prsenot. iv., 10, 
xiv., 9, xv., 3. 
52. When persons in fevers, or in other illnesses, shed tears voluntarily, 
it is nothing out of place; but when they shed tears involuntarily, it is 
more so. 
Celsus ranks it among the unfavorable symptoms " sine voluntate 
lachrimare." (ii.) This Aphorism is repeated Epidem. iv., 27, and 
Prognost. ii., 15, ed. Linden. 
53. In whatever cases of fever very viscid concretions form about the 
teeth, the fevers turn out to be particularly strong. 
The appearance here noted is a well-known symptom of malignant 
fevers. See Coac. ii., 153; IV. Epidem. xxvii., 13. Celsus renders 
it thus: " Gravis morbi periculum est,-habere humoremglutinosum 
dentibus inhaerentem." (ii., 4.) 
54. In whatever case of ardent fever dry coughs of a tickling nature 
with slight expectoration are long protracted, there is usually not much 
thirst. 
Celsus gives the following version of this Aphorism: " Si quis 
autem in hujusmddi febre leviter tussit, is neque vehement! siti con- 
flictatur, neque biere aquam frigidam debet." (iii., 7.) According 
to Heurnius, the object of our author in this Aphorism is to warn the 
physician not to be deceived in a case of latent fever by the absence of 
thirst. See also VI. Epid. ii., 43. APHORISMS. 
229 
55. All fevers complicated with buboes are bad, except ephemerals. 
I have touched upon this important subject in my Annotations on 
the Epidemics, and elsewhere. See Epidem, ii., 3; also, in particular, 
Galen, ad Glauc. ii., and De Diff. Feb. 6. 
56. Sweat supervening in a case of fever without the fever ceasing, is 
bad, for the disease is protracted, and it indicates more copious humors. 
This prognosis is repeated, Judicat. viii., 6; Coac. iv., 36; II. 
Morb. xxxvi., 12; I. Prorrhet. vii., 8; Aphor. vii., 61. Galen con- 
siders it obvious that the repetition of the sweats in this case is an 
effort of Nature to get rid of a greater than usual amount of humors. 
57. Fever supervening in a case of confirmed spasm, or of tetanus, re- 
moves the disease. 
The truth of this prognosis is confirmed by many of the ancient 
authorities, but is denied by Ctelius Aurelianus. See Paulus JEgin- 
eta, B. iii., 20. Syd. Soc. edit. See further, Aph. ii., 26, v., 70; 
Log. in Hom. xlviii., 6; Judic. xii., 10; Coac. i., 231, iii., 80, 84; 
I. Morb. vi., 13, 14. 
58. A rigor supervening in a case of ardent fever, produces resolution 
of it. 
The fact here announced can be tested only by those who are 
familiar with the fevers of hot countries. See further, Judicat. xi., 
9,16; Coac. i., 188; also Celsus. ii., 8. 
59. A true tertian comes to a crisis in seven periods at furthest. 
Galen is at great pains to explain the rationale of this statement, 
but his doctrine of crises and critical days applies only to Greece and 
Italy. See further, Judicat. iv., 10; Coac. i., 212; 1. Epid. iii., 26; 
IL, Epid. iii., 82. 
60. When in fevers there is deafness, if blood run from the nostrils, or 
the bowels become disordered, it carries off the disease. 
Galen reverting to his Commentary on a preceding Aphorism, in 
which he states that deafness in this case is connected with the deter- 
mination of bilious superfluities to the brain, finds in that hypothesis 
a natural explanation of the prognostic contained in this Aphorism. 
See further, Aph. iv., 28; Judicat. xi., 11, 12, 13; Coac. ii.66, 99, 
100, 103, vi., 77, 78; and Celsus, ii., 8. 
61. In a febrile complaint, if the fever do not leave on the odd days, it 
relapses. 
Galen doubts if Hippocrates actually wrote this Aphorism, since 
examples are related in the Epidemics, of fevers being resolved on 
even days, without a relapse. This opinion of our author's, however, 
is alluded to in general terms in different parts of his works, as 
Humor, iii., 91; Judicat. ix., 11; Prsenot. xxiv., 8; Coac. i., 115, 
210; I, Epid. iii., 40; II. EpidAv., 30, vi., 18.; IV. Morb. xix., 10, 
11, xx. 8, 12, 15, 16; Celsus, iii., 4. 230 
GENUINE WORKS OF HIPPOCRATES. 
62. When jaundice supervenes in fevers before the seventh day, it is 
a bad symptom, unless there be watery discharges from the bowels. 
All the Greek authorities confirm the truth of this prognostic, but 
the Arabians call it in question. See the Commentary on Paulus 
JEgineTA, B. II., 4. See further, Judicat. iii., 5, 18, 20; Coac. i., 
172; I. Morb. vi., 2; Viet. Acut. liv., 3, 4; also Pliny, H. N. xxvi., 16. 
63. In whatever cases of fever rigors occur during the day, the fevers 
come to a resolution during the day. 
The meaning appears to me somewhat ambiguous, after consult- 
ing all the commentators; I am inclined, however, to think with 
Theophilus, that the prognostic applies to quotidians, in which, as 
there is a cold fit every day, so is there also a complete apyrexia. See 
further Judicat. xi., 16. 
64. When in cases of fever jaundice occurs on the seventh, the ninth, 
the eleventh, or the fourteenth day, it is a good symptom, provided the 
hypochondriac region be not hard. Otherwise it is not a good symptom. 
Galen thinks this Aphorism should have been joined to the 62d. 
Celsus alludes to it in the following terms: " Quern (morbum arqua- 
tum) Hippocrates ait si post septimum diem febricitante segro super- 
venit, tutum esse, mollibus tantummodo praecordiis substantibus: 
Diodes, ex toto, si post febrem oritur, etiam prodesse, si post hunc 
febris, occidere." (iii., 24.) See Judicat. iii., 5, 18, iv., 11; Coac. i., 
173; I. Epid. ii., 120; I. Morb. vi., 2; Aph. vi., 42. 
65. A strong heat about the stomach and cardialgia are bad symptoms 
in fevers. 
This Aphorism requires no illustration or comment. I may just 
mention that Damascius refers the heat in the stomach and heartburn 
to yellow bile in a heated state, which is lodged in the coats of the 
stomach. 
66. In acute fevers, spasms, and strong pains about the bowels are bad 
symptoms. 
Galen remarks that the spasms and violent pains of the bowels 
may be connected with inflammation, erysipelas, a strong obstruction, 
or an abscess, and from whatever of these causes they proceed, must 
necessarily be a bad complication in fevers. See further. Coac. ii., 
207; Aph. ii., 26; and Celsus, ii., 4. 
67. In fevers, frights after sleep, or convulsions, are a bad symptom. 
Galen informs us that, instead of frights (cpofJoi), some read 
pains (zroVoz). This Aphorism is in accordance with Aph. ii., 1. 
68. In fevers, a stoppage of the respiration is a bad symptom, for it 
indicates convulsions. 
By stoppage of the respiration (rd TtvevpaTtpoaxonrov} is meant 
a temporary suspension, or intermission, of the act of inspiration, or APHORISMS. 
231 
expiration, or of both. See Galen, Comment, h. 1. He justly 
ascribes it to an affection of the respiratory organs. We have seen 
it noticed in certain of the cases related in the First and Third 
Books of the Epidemics. Compare also Viet. Acut. xxi., 21; I. Morb. 
Mui. v., 7. The expression means literally "the breath tripping," 
and is borrowed from the race-course. See Vossius, Etymolog. in 
voce cespes. 
69. When the urine is thick, grumous, and scanty in cases not free 
from fever a copious discharge of thinner urine proves beneficial. Such 
a discharge more commonly takes place when the urine has had a sediment 
from the first, or soon after the commencement. 
Galen informs us that instead of grumous (ftpopfladdea), Numc- 
sianus and Dionysius read muddy, (fiopflopcdSea). My necessary 
limits will not permit me here to treat upon the important subject of 
the indications drawn from the urine, as given by the ancient authori- 
ties. See a succinct account of them in the Commentary on Paulus 
JEgineta, B. II., 14. Galen, in his Commentary, remarks that thick 
grumous urine may either be accompanied with fever or without it, 
and in either case it must be a favorable symptom when this secretion 
comes to its natural state. Compare Coac. v., 80, 81. 
70. When in fevers the urine is turbid, like that of a beast of burden, 
in such a case there either is or will be headache. 
Urine resembling that of cattle is noticed several times in the 
Epidemics. See the case of the wife of Dromeades, Epid. 1; also 
Epid. vi., 5., 13, and vii; Epid. liv, 5, 6, 10, 11. In all these cases 
it appears to have been connected with an affection of the brain. 
71. In cases which come to a crisis on the seventh day, the urine has a 
red nubecula on the fourth day, and the other symptoms accordingly. 
That in estimating the critical days, the fourth is to be looked 
upon as an index of the seventh, is a doctrine held by all the authori- 
ties. See Paulus JEgineta, B. II., 9, Syd. Soc. edit.; and Galen's 
Comment, h. 1. The ancients paid great attention to the nubeculse, 
or cloudy appearances in the urine. On this Aphorism, see further 
Judic. vi., 2 , ix., 8; Coac. i., 213, v., 5, 82; Aph. 1, 12. 
72. When the urine is transparent and white, it is bad; it appears 
principally in cases of phrenitis. 
Urine that is transparent and of a light color was held to be 
indicative of a complete stoppage of the digestive powers, and it was 
thought to be more particularly fatal in phrenitic cases, which were 
considered to be of a bilious character. See the Commentaries of 
Galen and Theophilus. 
73. When the hypochondriac region is affected with meteorism and 
borborygmi, should pain of the loins supervene, the bowels get into a loose 232 
GENUINE WORKS OF HIPPOCRATES. 
and watery state, unless there be an eruption of flatus or a copious evacua 
tion of urine. These things occur in fevers. 
Meteorism and borborygmi are well-known symptoms in fever. 
The Commentators state that they arise from flatulence and fluids 
collected in the hypochondriac region, which may either pass down- 
ward by the bowels, or be determined to the urinary organs. The 
Aphorism is thus rendered by Celsus: "Si inflatio in superioribus 
partibus dolorem tumoremque fecit, bonum signum est sonus ventris 
inde ad inferiores partes evolutus." (ii., 3.) These symptoms are 
alluded to in several parts of the Hippocratic treatises, as Coac. ii., 
240, 241, 257; Prognost. x, 14; Aph. v., 64. 
74. When there is reason to expect that an abscess will form in joints, 
the abscess is carried off by a copious discharge of urine, which is thick, 
and becomes white, like what begins to form in certain cases of quartan 
fever, attended with a sense of lassitude. It is also speedily carried off 
by a hemorrhage from the nose. 
This Aphorism is founded on two prognostics in the Sixth Book 
of Epidemics, § 4. See also Humor, xi., 13, 16, and Judicat. x., 4-7. 
That a deposit, or abscess, commencing in a joint should be carried 
off by the urine or a hemorrhage from the nose appears very natural. 
Galen and Theophilus call attention to the remark that the crisis by 
epistaxis carries off the affection much more speedily than that by 
the urine. From this Aphorism being given individually in the 
Epidemics and generally in the Aphorisms, the learned Fuchsins, in 
his Commentary on the Epidemics, infers that it is the earlier pro- 
duction. 
75. Blood or pus in the urine indicates ulceration either of the kidneys 
or of the bladder. 
That bloody and purulent urine, generally, is connected with 
ulceration in the kidneys or bladder will be admitted at the present 
day. Galen further remarks correctly, that the ulceration is gener- 
ally produced by a sharp calculus. This Aphorism is thus rendered 
by Celsus: " Si sanguis aut pus in urina est, vel vesica vel renes exul- 
ceratse sunt." (ii., 7.) See further Aph. iv., 78, 81; Int. Affect, 
xvi., 4, 5; Nat. Human, xxvi., 4; Praenot. xix., 11. 
76. When small fleshy substances like hairs are discharged along with 
thick urine, these substances come from the kidneys. 
The substances resembling hairs floating in the urine are described 
by Galen, Caelius Aurelianus, Avicenna, and other ancient authorities. 
See Paulus JEgineta, B. III., 45, Syd. Soc. edit. Galen pays a 
high compliment'to our author for having acutely remarked a morbid 
appearance, of which many practitioners in his time were ignorant. 
See further, Nat. Human, xxvi., 5; Aph. iv., 26. Celsus renders 
this Aphorism as follows: " Si h:ec crassa, carunculas quasdem exiguas 
quasi capillos habet," etc. (ii., 7.) APHORISMS. 
233 
77. In those cases where there are furfuraceous particles discharged 
along with thick urine, there is scabies of the bladder. 
By scabies vesicae as Galen explains in his Commentary, was meant 
an affection of the inner membrane of the bladder. Furfuraceous 
sediments were looked upon by all the authorities as an unfavorable 
symptom. See Paulus tEgineta, B. II., 14, Syd. Soc. edit.; and 
Nat. Human, xxvi., 6. 
78. In those cases where there is a spontaneous discharge of bloody 
urine, it indicates rupture of a small vein in the kidneys. 
This Aphorism is nearly allied to Aphor. 75. Galen, in his 
Commentary, remarks that the rupture of the vessel may either 
proceed from an external or an internal cause. By spontaneous is 
meant sudden. 
79. In those cases where there is a sandy sediment in the urine, there 
is calculus in the bladder (or kidneys). 
Galen informs us that there was no mention of the kidneys in the 
copies of Hippocrates then in use, whence he justly held that the 
Aphorism as not strictly correct. It is, of course, undeniable that 
sabulous urine may either be connected with disease of the bladder 
or of the kidneys. See further, IV. Morb. xxix., 13; Int. Affect, 
xv., 10, 11. 
80. If a patient pass blood and clots in his urine, and have strangury, 
and if a pain seize the hypogastric region and perineum, the parts about 
the bladder are affected. 
This Aphorism is repeated word for word, Aphor. vii, 39. 
of course, can have no hesitation in admitting the truth of it, when 
we take into account that, as explained by Galen, under the expression 
"the parts about the bladder," are comprehended all the urinary 
organs, namely, the bladder, kidneys, and urethra. 
81. If a patient pass blood, pus, and scales, in the urine, and if it have 
a heavy smell, ulceration of the bladder is indicated. 
This, it will be remarked, is very little different from Aphor. 
iv., 75. 
82. When tubercles form in the urethra, if these suppurate and burst, 
there is relief. 
By phymata there can be no doubt that Hippocrates understood 
small and indolent abscesses; the term, I need scarcely say, is fre- 
quently used by him in this sense. By urethra, in this place, ac- 
cording to Theophilus, was meant the neck of the bladder. I cannot, 
from my own personal information, give any account of these tuber- 
cles, but for a description of them I would refer the reader to the 
Commentary of Heurnius; and also to the works of Ambrose Pare, 
and, in particular, to Amatus Lusitanus, 4, cent. 19. See further, 
Coac. iii., 311, 312; and Celsus, ii., 8. 234 
GENUINE WORKS OF HIPPOCRATES. 
8B. When much urine is passed during the night, it indicates that the 
alvine evacuations are scanty. 
From this Aphorism it will be seen that our author regarded the 
urinary and alvine evacuations as vicarious, so that if the one was 
abnormally abundant, the other was of necessity deficient in as great 
a degree. Theophilus mentions that he says " during the night," 
because digestion takes place at that time. Compare II. Diset. xl., 
10-17; IV. Morb. vii., 4. 
SECTION V. 
1. A spasm from taking hellebore is of a fatal nature. 
We have had occasion repeatedly to remark that Hippocrates, in 
extreme cases, had. recourse to the hellebore, that is to say, the white 
hellebore, as Galen, in his Commentary, remarks. It was undoubtedly 
the veratrum album. See Paulus JEgineta, Vol. III., p. 107. He 
here states the danger of administering it unseasonably. As The- 
ophilus remarks, it sometimes brings on convulsion from sympathy 
with the stomach. Heurnius, in his Commentary, relates a case in 
point, which occurred' to his own knowledge. See further, Aph. vii., 
25; Coac. iv., 24; and Celsus, ii., 6. 
2. Spasm supervening on a wound is fatal. 
That spasm, that is to say, a tetanic affection supervening on a 
wound, is highly dangerous all experienced surgeons are well aware. 
Galen, in his Commentary, remarks that the spasm is an affection of 
the nervous parts in connection with the wound. He further remarks 
that by "fatal," in this place is merely meant "very 
dangerous." See further Coac. iii., 81, 382; Capit. Vulner. xxv., 5; 
Celsus, ii., 26. Tagaultius pointedly adverts to this interpretation 
of the Aphorism. Inst. Chirurg. ii. 
3. A convulsion, or hiccup, supervening on a copious discharge of blood 
is bad. 
Every person who is familiar with obstetrical practice will bear 
testimony to the truth of this Aphorism, as far as regards uterine 
hemorrhage; hence the danger of using violent remedies in such a 
case. Hiccup, as Galen remarks, is a spasm of the stomach. See 
further, Aph. vii., 9; Coac. iii., 57; Celsus, ii., 8. 
4. A convulsion, or hiccup, supervening upon hypercatharsis is bad. 
This is a natural inference from Aph. 1 and 3. See further, Aph. 
vii., 41; Coac. iv., 22; Verat. Us., i., 8; and Celsus, ii., 8. 
5. If a drunken person suddenly lose his speech, he will die convulsed, 
unless fever come on, or he recover his speech at the time when the con- 
sequences of a debauch pass off. 
We have here a very important fact announced to us respecting 
the effects of intoxication, and it is to be regretted that of such cases APHORISMS. 
235 
modern physicians have much greater experience than Hippocrates 
can have had, intoxication, it is too well known, being much more 
common now than in the days of the Greeks and Romans. Galen, 
in his Commentary, remarks that there is no limit for the effects of 
intoxication to pass off, that in some this takes place next day, and in 
others they last till the third day. See II. Morb. iv., 16, xxii., 2, 3, 
4; Celsus, ii., 6. 
6. Such persons as are seized with tetanus die within four days, or if 
they pass these they recover. 
No doubt this prognosis is generally applicable in hot countries. 
See further, Judicat. viii., 19; III. Morb. xiii., 11; Celsus, ii., 1. 
7. Those cases of epilepsy which come on before puberty may undergo 
a change; but those which come on after twenty-five years of age, for the 
most part terminate in death. 
The prognosis in this case is in accordance with Aphor. ii., 45. 
See further, II. Prorrhet. xvi., and Morb. Sac.; also Celsus, ii., 8, 
and iii., 23. It is to be lamented that, at the present day, no more 
favorable prognosis can be made in this case. 
8. In pleuritic affections, when the disease is not purged off in fourteen 
days, it usually terminates in empyema. 
This subject of empyema after acute inflammations of the chest is 
treated of in the annotations on the Prognostics. On this interesting 
subject, see further, Aph. v., 15; Loc. in Hom. xxvii., 4; Coac. iii., 
131, 132, 171; VII. Epid. xlvii., 16; I. Morb. iii., 29, x., 12, xi., 6-11, 
xxiii., 15, 16, xxiv., 10; III. Morb. xvi., 30; Affect, viii., 19, 20, ix., 
13; Int. Affect, i., 26; Viet. Acut. vii., 1, 2. The Commentary of 
Heurnius on this Aphorism is interesting. 
9. Phthisis most commonly occurs between the ages of eighteen and. 
thirty-five years. 
This agrees with Aphor. iii., 29. See further, viii., 7, and. Coac. 
iii., 260; also Celsus, iii., 22. It is to be borne in mind that the terms 
here specified comprehend the age of puberty and that 
of adults (vedviffxGJv). See the Commentary of Galen. I beg to 
quote, under this head, the opinion of our great English authority on 
Phthisis, I mean Sir James Clark: " The opinion of Hippocrates on 
this subject corresponds still more clearly with the results obtained 
from our tables; that accurate observer fixed the age at which phthisis 
most frequently occurs between the 18th and 35th year." (On Tuber- 
cular Phthisis.) Louis, as is too frequently the case with him, is 
undecided on this point. 
10. Persons who escape an attack of quinsy, and when the disease is 
turned upon the lungs, die in seven days; or if they pass these they 
become affected with empyema. 
We have here clearly the case of ulcerous sore throat referred to, 
in which the disease passes down to the lungs. That such cases 236 
GENUINE WORKS OF HIPPOCRATES. 
generally prove fatal in the course of a few days is well known; but 
that they terminate in empyema, according to the modern accepta- 
tion of that term, will not be so readily admitted. It is probable, 
however, that our author meant by the term any purulent expectora- 
tion from the lungs. In fact, the literal translation of the last clause 
would be, "they become purulent." Heurnius, by the way, relates 
a case in point. See his Commentary; also Prognost, xxiii., 15; 
Coac. iii., 100, 101, 105, 106; II.Morb. xxvii., 15-19; and Celsus, ii., 6. 
11. In persons affected with phthisis, if the sputa which they cough up 
have a heavy smell when poured upon coals, and if the hairs of the head 
fall off, the case will prove fatal. 
The test of phthisis here proposed is taken from Coac. iii., 252. 
It is approved of by Galen, and most of the commentators, even down 
to Heurnius in the 17th century, who relates an instance in which 
he founded a correct diagnosis upon it. Aretaeus, however, objects 
to it, Morb. Acut. i., 8. See further, II. Morb. xlvi., 16-20, lv., 20- 
23; Affect, viii., 19; also Celsus, ii., 8, and iii., 22. 
12. Phthisical persons, the hairs of whose head fall off, die if diarrhoea 
set in. 
The two symptoms here mentioned, are very characteristic of the 
last stage of phthisis. See further, Aph. v., 14, vii., 78; Coac. iii., 
144, 255; I. Morb. x., 36; II. Morb. xlvi., 12; also Celsus, ii., 8. 
13. In persons who cough up frothy blood, the discharge of it comes 
from the lungs. 
No doubt, as a general rule, this statement is true, and is confirmed 
by many of the ancient authorities. See those referred to in Com- 
mentary on Paulus JEgineta, B. III., 31; and further, Coac. iii., 
216, 250, 254, 273; II. Morb. Ii., 4. The Commentaries of Galen and 
Heurnius on this head are interesting, but too lengthy for my limits. 
The former of these informs us, that in some of the editions he 
found "vomit" (fpfovo'z), instead of "spit" (rtTvovdi). 
14. Diarrhoea attacking a person affected with phthisis is a mortal 
symptom. 
This symptom is already alluded to, Aph. v., 12. See further, 
vi., 17, vii., 78; Coac. iii., 244, 256; I. Morb. vi., 5., x., 36, 39, xi., 
41., xiv., 10; also Celsus, ii., 8, iii., 22. 
15. Persons who become affected with empyema after pleurisy, if they 
get clear of it in forty days from the breaking of it, escape the disease; 
but if not, it passes into phthisis. 
I need scarcely remark, that what is stated in this Aphorism 
strongly confirms the opinion expressed by me in my Annotations on 
the Prognostics, that our author applied the term empyema both to 
the purulent expectoration that follows inflammation of the lungs 
and pleurisy, and to that which proceeds from a cavity of the lungs APHORISMS. 
237 
in tubercular phthisis. See further, Aph. v. 12, vi., 16; Loc. in 
Hom. xxv., 10; Coac. iii., 141, 171, 209, 215; VII. Epidem. xlvii., 16, 
17; I. Morb. x., 15,17, 20; II. Morb. Iv., 23; III. Morb. xvi., 35; also 
Celsus, ii., 7. 
16. Heat produces the following bad effects on those who use it fre- 
quently: enervation of the fleshy parts, impotence of the nerves, torpor 
of the understanding, hemorrhages, deliquia, and, along with these, death. 
Upon reference to my analysis of the work " De Usu Humidorum," 
in the second section of the Preliminary Discourse, it will be seen that 
the contents of it are in a great measure identical with the series of 
Aphorisms (16-25) upon which we are now entering. It will also 
be seen from the Commentary of Galen, that there was a variety of 
readings with regard to the last words of the sentence here translated, 
"and, along with these, death." By " heat" is meant "hot water," 
or " a hot fomentation." The effects here described apply, of course, 
only to the immoderate use of it. See further, Humid. Us. iii., 2, 
3; Ofific. Medic, viii., 14; Artic. Ivii., 3; Aphor. 1-23. Celsus tersely 
renders it thus: " (Calor) si nimius est, corpus effoeminet, nervos 
emollit, stomachum solvit." (i., 9.) 
17. Cold induces convulsions, tetanus, mortification, and febrile rigors. 
See Aph. v., 20; Humid. Us. iii., 4, iv., 5; Tract, xxxvii., 6; 
Artic. Ixxiv., 10. 
18. Cold is inimical to the bones, the teeth, the nerves, the brain, and 
the spinal marrow, but heat is beneficial. 
See Humid. Us. iv., 1, 4, and Celsus, i., 9. The commentators, 
and especially Theophilus, explain that the parts of the body here 
mentioned are of a cold nature, as being possessed of little vascularity, 
and hence they are readily hurt by cold, and are benefited by heat. 
19. Such parts as have been congealed should be heated, except where 
there either is a hemorrhage, or one is expected. 
See further, Aph. ii., 22, v., 23; Humid. Us., i., 21, xi., 28. The 
practice here recommended is obviously founded on the rule " con- 
traria contrariis." 
20. Cold pinches ulcers, hardens the skin, occasions pain which does 
not end in suppuration, blackens, produces febrile rigors, convulsions, 
and tetanus. 
The only expression here of ambiguous meaning is odvvr/v 
avsx7tV7]Tov Ttoiei, the import of which would seem either to be, 
"that it aggravates painsnot connected with suppuration," as ex- 
plained by Theophilus, or " that it prevents painful parts from com- 
ing to suppuration," as explained by Heurnius. See Aph. v., 17; 
Humid. Us. iii., 4, ix., 5, xi., 15; Tract, xxxvii., 6; Artic. Ixxiv., 10; 
also Celsus, i., 9. 238 
GENUINE WORKS OF HIPPOCRATES. 
21. In the case of a muscular youth having tetanus without a wound, 
during the midst of summer, it sometimes happens that the affusion of a 
large quantity of cold water recalls the heat. Heat relieves these diseases. 
We have here as safe directions as can be well imagined for the 
application of the cold affusion in tetanus, and very different from 
the circumstances under which it was proposed by Dr. Currie, of 
Liverpool. It is only in the case of a muscular person, and when 
unconnected with a wound, that he recommends the practice; and 
even under these circumstances it was discontinued by succeeding 
authorities. See the Commentary on Paulus TEgineta, Book III., 
20. See further, Humid. Us. xi., 16; Aphor. v., 25; III. Morb. xiv., 
17-xv. Galen, in his Commentary, explains that the cold acts in 
this place, not by extinguishing, but by rousing the vital heat. 
22. Heat is suppurative, but not in all kinds of sores, but when it is, it 
furnishes the greatest test of their being free from danger. It softens the 
skin, makes it thin, removes pain, soothes rigor, convulsions, and tetanus. 
It removes affections of the head, and heaviness of it. It is particularly 
efficacious in fractures of the bones, especially of those which have been 
exposed, and most especially in wounds of the head, and in mortifications 
and ulcers from cold; in herpes exedens, of the anus, the privy parts, the 
womb, the bladder, in all these cases heat is agreeable, and brings matters 
to a crisis; but cold is prejudical, and does mischief. 
The important matters contained in this Aphorism are also treated 
in the following parts of the Hippocratic Collection; Humid. Us. xi., 
18-28, xi., 10, i., 10, 19, v., 13, vi., 2, 3; Ulcer, v., 1; I. Morb. vi., 
14. Galen and Theophilus, among the ancients, and Heurnius, 
among the modern commentators, have given some very interesting 
observations on this Aphorism, but they are far too lengthy for my 
limits. Heat, it will be remarked, is said to be a test, as it were, of 
ulcers, whether they are of a mild nature or not; for if it produces 
suppuration, they may be regarded as mild, but if otherwise, as malig- 
nant. 
23. Cold water is to be applied in the following cases; when there is a 
hemorrhage, or when it is expected, but not applied io the spot, but 
around the spot whence the blood flows; and in inflammations and inflam- 
matory affections, inclining to a red and sub-sanguineous color, and con- 
sisting of fresh blood, in these cases it is to be applied, but it occasions 
mortification in old cases; and in erysipelas not attended with ulceration, 
as it proves injurious to erysipelas when ulcerated. 
I need scarcely remark, that the good and bad effects of cold, when 
applied medicinally, are here given with admirable judgment. What 
a valuable fact is here stated with regard to the effects of cold in 
checking hemorrhage 1 And how excellent the advice not to apply 
it to the wound, for this might occasion pain and increase vascular 
action, but to the parts around! It will be remarked, that he fur- 
ther recommends cold applications to inflammation, and to erysipelas, APHORISMS. 
239 
when not ulcerated. Popular opinion is against the use of it in the 
latter case, but very probably without much cause. The substance 
of this Aphorism is given by Celsus, i., 9. No part of this Aphorism 
is to be found in the treatise De Humid.Us., and the only passage 
which is at all parallel to it is Aph. v., 19. 
24. Cold things, such as snow and ice, are inimical to the chest, being 
provocative of coughs, of discharges of blood, and of catarrhs. 
The matter contained in this important Aphorism is also to be 
found at Humid. Us. iv., 8, v., 16; VI., Epid. iii., 22. Although 
intensely cold applications to the chest are condemned by all the 
ancient authorities, moderately cold applications are recommended by 
many of them. But even these, Galen affirms, have sometimes the 
contrary effect to what they are intended to produce. (Meth. Med., 
v., 6.) See the Commentary on Paulus zEgineta, Book III., 26, 
Syd. Soc. edition. I could remark in this place, as confirmatory of 
the views laid down by our author in this and the preceding Aphor- 
ism, that, in my opinion, snow and ice, when applied in uterine 
hemorrhage, often do harm rather than good. I am confident that 
the hemorrhage is to be checked, not by intensely cold, but by cooling 
things; for I verily believe, with Hippocrates, that ice and snow, by 
creating pain and bringing on a violent reaction, may often increase 
the hemorrhage rather than allay it. " Ubi dolor ibi fluxus." 
25. Swellings and pains in the joints, without ulceration, those of a 
gouty nature, and sprains, are generally improved by a copious affusion 
of cold water, which reduces the swelling, and removes the pain; for a 
moderate degree of numbness removes pain. 
See further, Humid. Us. x., 14, 15. With the exception of gouty 
swellings, it will scarcely be questioned, at the present day, that the 
practice advocated in this Aphorism is sound and judicious; and even 
in the gout there have not been wanting modern authorities who have 
advocated the practice of Hippocrates, including Kinglake, the cele- 
brated Harvey, and Mason Good. See Dr. Copland's Dictionary of 
Practical Medicine, under Gout, § 65. It should be kept in mind, 
moreover, that it is not cold applications, but the affusion of cold 
water which our author recommends in these cases; and that all the 
commentators hold that it acts, not by producing cold, but by rousing 
the vital heat of the part. See, in particular, the very interesting 
commentaries published by Dietz, Anecdota Graeca, tom. ii., 458. 
26. The lightest water is that which is quickly heated and quickly 
cooled. 
See Aer., Aq., Loc., xvii., 1; II. Epid, ii., 29; Celsus, ii., 8. 
27. When persons have intense thirst, it is a good thing if they can 
sleep off the desire of drinking. 
This I believe to be a very judicious rule of practice, whether the 
thirst be occasioned by drinking wine or by the presence of fever. As 
Galen remarks, if the thirst be intense, a moderate quantity of liquids 240 
GENUINE WORKS OF HIPPOCRATES. 
is to be taken; and if less so, drink is to be abstained from altogether, 
and the person should be left to sleep off his thirst. See the Com- 
ment. of Galen; also VI., Epid. iv., 42. 
28. Fumigation with aromatics promotes menstruation, and would be 
useful in many other cases, if it did not occasion heaviness of the head. 
This agrees with what is said, Natur. Mulieb. xix., 161-187. All 
the ancient authorities trusted much to fomentations and pessaries, 
consisting principally of aromatics, for the cure of amenorrhoea. See 
the Commentary on Paulus JEgineta, Book III., 71. The aromat- 
ics, being of a diffusible nature, affect the heads of delicate women 
when so applied. Those mentioned by Galen are costus, cassia, cin- 
namon, and amomum, on which see Dierbach, as to the medicinal 
articles used by Hippocrates, and Paulus JEgineta, Vol. III., Syd. 
Soc. edit. 
29. Women in a state of pregnancy may be purged, if there be any 
urgent necessity (or, if the humors be in a state of orgasm ?), from the 
fourth to the seventh month, but less so in the latter case. In the first 
and last periods it must be avoided. 
Galen, in his Commentary, remarks, that this Aphorism occurs 
previously, among those relating to purging, and is here repeated 
among those devoted to female complaints. He adds, however, that 
some had suppressed it. See Celsus, ii., 6. 
30. It proves fatal to a woman in a state of pregnancy, if she be seized 
with any of the acute diseases. 
How often have I seen the truth of this prognosis verified! Galen 
instances epilepsy, apoplexy, spasm, and tetanus; and Theophilus, 
phrenitis and pleurisy, as diseases particularly fatal when they attack 
a pregnant woman. See further, I. Morb. iii., 9; I. Epidem. ii., 
141; also Celsus, ii., 6. 
31. If a woman with child be bled, she will have an abortion, and this 
will be the more likely to happen, the larger the foetus. 
That a large evacuation of blood, by depriving the foetus of its 
pabulum, should prove fatal to it, seems very natural, and accord- 
ingly most of the ancient authorities as a general rule, forbid preg- 
nant woman to be bled. Celsus mentions it as a recent discovery, 
that a vein might be opened even in a woman with child, (ii., 10.) 
Heurnius accounts for the difference between modern views and those 
of Hippocrates on this head, from the difference in the mode of liv- 
ing, which he supposes must have been very simple in the age of 
Hippocrates, and consequently persons could not bear the loss of blood 
so well as they do in modern times, when the diet is more full and 
luxurious. Perhaps this is the proper way of reconciling the rules 
of Hippocrates and Celsus. APHORISMS. 
241 
32. Haemoptysis in a woman is removed by an eruption of the menses. 
The very same prognosis occurs at I. Morb. vi. 11. Galen ex- 
plains the relief obtained in this case upon the principle of revulsion, 
and states that, in imitation of this natural cure, he had often opened 
a vein with the same intention, and with good effects. 
33. In a woman when there is a stoppage of the menses, a discharge of 
blood from the nose is good. 
See, in like manner, V irgin. Morb., iii., 2. This also looks like a 
natural cure of the plethora induced by the suppression of the men- 
strual discharge. Galen remarks, that it points out the propriety of 
letting blood from other parts of the body in such a case. 
34. When a pregnant woman has a violent diarrhoea, there is danger of 
her miscarrying. 
See, in like manner, II. Predict. xxx., 14; Coac. iii., 416; I. Morb. 
Mulier. xxxvii., 5; xli., 3, 6. The danger of abortion when a woman 
is seized with a violent discharge from the bowels is well known. 
35. Sneezing occurring to a woman affected with hysterics, and in 
difficult labor, is a good symptom. 
The meaning of hysterics in this Aphorism is somewhat ambigu- 
ous. Damascius understands by it " the secundines," 
and refers the case to retention of the placenta. Galen rejects this 
interpretation, and also that of those commentators who applied it to 
all diseases of the uterus, whereas he contends it is only applicable to 
uterine suffocation, that is to say, the hysterical fit. That in it, and 
in certain cases of tedious labor, sneezing, by rousing the natural 
powers, may prove useful, can be well conceived. On this subject, 
see further, Aph. v., 49; Prsenot. xiii., 11; Coac. iii., 175; Morb. 
Mulier. xciii., 1, 6, 7. 
36. When the menstrual discharge is of a bad color and irregular, it 
indicates that the woman stands in need of purging. 
It appears from Galen, that in his time both the reading and 
meaning were considered doubtful. From the nature of the remedy, 
one may conjecture that it means to apply to deficient menstruation, 
the discharge being deficient both in quantity and quality. The term 
purging may also apply either to purgatives of the bowels, or to those 
which act upon the uterus, that is to say, emmenagogues. In these 
cases hellebore was used by the Hippocratists. (De Verat. Us. 1, 11.) 
Emmenagogues, in the form of a pessary, were usually administered 
in like manner. See the Commentary on Paulus Book 
III., 61, Syd. Soc. edit. 
3?. In a pregnant woman, if the breasts suddenly lose their fullness, 
she has a miscarriage. 
The prognostic contained in this Aphorism no doubt generally 
holds true, and is still much relied upon by females themselves. See 
further, in connection with this Aphorism, Aph. v., 53; II. Epid. 
i., 42; I. Morb. Mulier. xliv., 1, 2, 3 
Vol. II.-16. 242 
GENUINE WORKS OF HIPPOCRATES. 
38. If, in a woman pregnant with twins, either of her breasts lose its 
fullness, she will part with one of her children; and if it be the right breast 
which becomes slender, it will be the male child, or if the left, the 
female.. 
This Aphorism is founded on the physiological notion which 
generally prevailed in antiquity, that the uterus consists of two cavit- 
ies, a right and a left, and that the male foetus was contained in the 
formerj and the female in the latter. See, in particular, Theophilus, 
ed. Dietz., ii., p. 469. However, Moschion, Soranus, and Galen 
would appear to have been better informed. See Comment, on 
Paulus JEgineta, Book HL, 65, Syd. Soc. edit. 
39. If a woman who is not with child, nor has brought forth, have 
milk, her menses are obstructed. 
Galen and Theophilus enter into a physiological explanation of 
the reason of the fact here stated, the summary of which amounts to 
this, that there is a strong sympathy between the uterus and mammae, 
according to Theophilus, owing to a vascular connection between 
them. Galen's Commentary is very interesting, but too lengthy for 
my limits. See further, II. Prorrhet. xxxv., 5. 
40. In women, blood collected in the breasts indicates madness. 
This prognosis is repeated, Epidem. ii., at the end. Galen, how- 
ever, states, that he had never seen such a case, and declares that if 
ever such do occur, it must be very rarely. But supposing it true, 
he attempts to explain the rationale of it. A commentary published 
by Dietz (tom. ii., p. 465) states, that Galen rejected this Aphorism, 
as being false and supposititious. I can well believe, however, that 
it refers to some rare cases of puerperal mania, which is often con- 
nected with disorders of the mammse. 
41. If you wish to ascertain if a woman be with child, give her hydro- 
mel to drink when she is going to sleep, and has not taken supper, and if 
she be seized with tormina in the belly, she is with child, but otherwise 
she is not pregnant. 
This test is founded on the nervous irritability which is so common 
in the state of pregnancy. See also Steril. vi., 6, 7, 8, 11. There is 
some incongruity, as M. Littre remarks, between the text and the 
Commentary of Galen, which would lead to the supposition that the 
text may be corrupted. 
42. A woman with child, if it be a male, has a good color, but if a 
female, she has a bad color. 
Women, in some parts of the country, still repose confidence in 
this diagnostic rule, and it was admitted by all the commentators 
which have come down to us. It is repeated, Steril. vii., 1. Am- 
brose Parc quotes it with approbation, (xxiii., 12.) APHORISMS. 
243 
43. If erysipelas of the womb seize a woman with child, it will probably 
prove fatal. 
Galen remarks that not only erysipelas, but also inflammation, when 
it attacks the impregnated uterus, gbnerally proves fatal. In fact, as 
stated formerly, all acute diseases which attack pregnant women are 
usually fatal. See Aph. v., 30; I. Morb. iii., 9; Natur. Mui. xii., 
17, 27; II. Morb. Mui. Iviii., 12, 29. 
44. Women who are very lean, have miscarriages when they prove with 
child, until they get into better condition. 
It will be seen by the Commentary of Galen, that this Aphorism 
had been differently interpreted. That in women who are much 
emaciated, the foetus should perish for want of food is a very natural 
supposition, and yet I know from experience that it does not always 
happen. None of the ancient authorities, however, venture to ques- 
tion the truth of this prognostic. 
45. When women, in a moderate condition of body, miscarry in the 
second or third month, without any obvious cause, their cotyledones are 
filled with mucosity, and cannot support the weight of the foetus, but are 
broken asunder. 
The term cotyledones was originally applied to the uterine glandulse 
of the sheep, with which their placentulae are connected. It was 
afterward applied also first to the ruminants and then to the tufts of 
the human placenta. All the ancient physiologists believed that the 
band of connection between the mother and the foetus, in ruminants 
and in women, is analogous. It was supposed, then, that abortion 
was occasioned by the weakness and softness of the parts which con- 
nect the uterus and foetus. See further, Nat. Mulier. xxvii., 1-5; I. 
Morb. Mulier. Ixxxiv., 1, 2, 3. 
46. Such women as are immoderately fat, and do not prove with child, 
in them it is because the epiploon {fat blocks up the mouth of the 
womb, and until it be reduced, they do not cqnceive. 
Our author would seem to use epiploon here as being synonymous 
with fat, as is stated in the Commentary of Theophilus. See further, 
Aer., Aq., Loc., ix., 12; II. Predict, xxxiii., 12; Nat. Mulieb. xix., 
4, 5, 7; Steril. x., 7. 
47. If the portion of the uterus seated near the hip-joint suppurate, it 
gets into a state requiring to be treated with tents. 
Our author evidently treats of chronic abscess of the womb, which, 
as I have seen, is apt to end in a sinous ulcer. This is what he means 
by an ulcer requiring to be treated by tents. See Nat. Mulier. vi., 
5; I. Morb. Mulier. xci., 32. 
48. The male foetus is usually seated in the right, and the female in the 
left side. 
I have referred to the anatomical opinions of the ancients with 
respect to the uterus at Aph. v., 38. 244 
GENUINE WORKS OF HIPPOCRATES. 
49. To procure the expulsion of the secundines, apply a sternutatory, 
and shut the nostrils and mouth. 
This is the popular practice in the north of Scotland at the present 
day. The object evidently is to rouse the action of the uterus and 
abdominal muscles to expel the placenta. Theophilus, in his Com- 
mentary, remarks, that if the placenta be not expelled, it becomes 
putrid, and occasions much mischief. See further, Aph. v., 35; 
Coac. iii., 175; Praenot. xiii., 11; II. Epid. v., 42; I. Morb. Mulier. 
Ixxvi., 6, 7, xciii., 1, 6, 7; II. Morb. Mulier. xliii., 6, 7. 
50. If you wish to stop the menses in a woman, apply as large a cupping 
instrument as possible to the breasts. 
I need scarcely remark that we have here given a most important 
rule of practice, founded on the connection and sympathy between 
the uterus and mammae. Upon this principle, as Heurnius in his 
Commentary remarks, we may see the advantage of determining to 
the mammae in uterine hemorrhage aftei' delivery. It is well known 
that, in modern practice, the child is generally applied, which often 
proves very efficacious, by producing a rush of fluids to the breasts. 
On this head, see further II. Epid. vi., 33; II. Morb. Mulier. i., 4, 
11, 17. 
51. When women are with child, the mouth of their womb is closed. 
The great anatomical authority, Heophilus, stated, that in preg- 
nancy the mouth of the womb is so closely shut up, that it cannot 
admit the end of a probe. See Dietz, etc., tom. ii., p. 470. 
52. If in a woman with child, much milk flow from the breasts, it indi- 
cates that the foetus is weak; but if the breasts be firm, it indicates that 
the foetus is in a more healthy state. 
This Aphorism is also evidently founded on the same principle. 
See further, II. Epid. vi., 35, 36. 
53. In woman that are about to miscarry, the breasts become slender; 
but if again they become hard, there will be pain, either in the breasts, 
oi- in the hip-joints, or in the eyes, or in the knees, and they will not 
miscarry. 
The drift of this Aphorism is somewhat obscure to me, after 
reading the elaborate Commentaries of Galen, Heurnius, and others, 
both ancient and modern. I am much inclined to adopt one of the 
interpretations given by Galen, namely, that of supposing that 
"again" (7r<xbzr), in this place, signifies " on the contrary," and 
that the swelling up of the mamma? announces, that the danger of 
abortion is over, while the pains mentioned in other organs indicate 
that the mischief had passed to them. On the connection between 
pain in the hip-joint and pregnancy, see further, II. Epid. ii., 42. APHORISMS. 
245 
54. When the mouth of the uterus is hard, it is also necessarily shut. 
Allusion seems to be here made to amenorrhoea connected with 
organic disease of the uterus. See the Commentaries of Galen and 
Theophilus. Heurnius holds this to be a very important Aphorism, 
as it indicates the source of the many bad consequences which women 
experience from retention of the menses connected with a cause 
which the obstetric practitioner has it in his power to remove. See 
further, II. Morb. Mulier. xlv., 11, 12, xlvi., 1, 2, 1., 1, 2. 
55. Women with child who are seized with fevers, and who are greatly 
emaciated, without any (other?) obvious cause, have difficult and dan- 
gerous labors, and if they miscarry, they are in danger. 
Upon reference to Galen, Theophilus, Heurnius, and Littre, it 
will be seen that there is considerable uncertainty respecting the 
meaning of this Aphorism. I am inclined to think that what is meant 
is this, that pregnant women who are greatly emaciated by fevers are 
apt to have either dangerous deliveries or abortions. Compare Aph. 
v., 30 43; Coac. iii., 408. 
56. In the female flux {immoderate menstruation?), if convulsion and 
deliquium come on, it is bad. 
The term " female flux " was applied by the ancient authorities to 
any vitiated state of the menstrual discharge. See the Commentary 
on Paulus JEgineta, Book III., 63, Syd. Soc. edit. The danger from 
convulsions and deliquium, in such cases, is well understood. See, in 
connection with this Aphorism, Aph. v., 36; Coac. iii., 424; II. 
Morb. Mulier. xiii., 7, 9. 
57. When the menses are excessive, diseases take place, and when the 
menses are stopped, diseases from the uterus take place. 
This Aphorism is rather ambiguously expressed, as may be seen 
on reference to the Commentaries of Galen and Theophilus. Per- 
haps all that is meant is, that diseases are engendered both by im- 
moderate menstruation and by a stoppage of the same. There are 
many parallel passages in the Hippocratic Collection, such as Nat. 
Mui. xiii., 5, xxxix., 1, 2, 5, 6, xl., 2, 5, 6; I. Morb. Mulier. xiv., 
1, 12; IL Morb. Mulier. iii., v., vi., etc.; Nat. Puer. vi., 14, xiii., 1; 
Virg. Morb. ii., 5-14; Nat. Mui. iii., 1, x., 1-5. 
58. Strangury supervenes upon inflammation of the rectum, and of the 
womb, and strangury supervenes upon suppuration of the kidney, and 
hiccup upon inflammation of the liver. 
This important Aphorism is so plain as not to stand in need of any 
comment. See further, in connection with it, Haemorrhoid, iii., 1, 
iv., 1; Aph. vii., 13; Int. Affect, xli., 6. 
59. If a woman do not conceive, and wish to ascertain whether she can 
conceive, having wrapped her up in blankets, fumigate below, and if it 246 
GENUINE WORKS OF HIPPOCRATES. 
appear that the scent passes through the body to the nostrils and mouth, 
know that of herself she is not unfruitful. 
This practice of fumigating the uterus, either on account of the 
state of the menstrual discharge, or for the purpose here indicated, is 
adverted to in various parts of the Hippocratic treatises; as Nat. Mui. 
vii., 9; I. Morb. Mui. cvii., 1; II. Morb. Mui. xl., 20, 21; Steril. 
vi., 3; Superfeet, ix., 3, x., 9, 11. Theophilus describes the process 
very minutely, but it will readily be understood that it consisted in 
introducing the fumes of strong-smelling things, such as frankin- 
cense, spikenard, cassia, and storax, into the vagina by means of a 
funnel. As a remedial means in certain diseases of the uterus, I can 
think of nothing more likely to prove efficacious. Whether or not it 
would prove a suitable test of a woman's capability for conceiving, I 
am not able either to affirm or deny. As Galen remarks, Plato refers 
to this practice in his Theaetetus. 
60. If woman with a child have her courses, it is impossible that the 
child can be healthy. 
See, in connection with this Aphorism, Nat. Puer. v., 3; I. Morb. 
Mui. xi., 2, 5, 9, 11, xliv., 4, 5, 6, xcix., 2; Theophilus has a very 
interesting Commentary on this head, in which he states that it is 
a fact ascertained by experience, that, during pregnancy, there is 
sometimes a discharge up to the fifth or sixth month; but, he prop- 
erly remarks, in such a case the blood does not come from the inside 
of the uterus, but from the veins situated in the neck of it. Galen 
expresses himself to the same effect, but not so fully. 
61. If a woman's courses be suppressed, and neither rigor nor fever has 
followed, but she has been affected with nausea, you may reckon her to 
be with child. 
I need scarcely remark that, as a general ru±e, what is here stated 
by our author holds good. See further, Aph. v., 41; I. Morb. Mulier. 
xcix, 2, Steril. vi., 9, 10. 
62. Women who have the uterus cold and dense (compact?') do not 
conceive; and those also who have the uterus humid, do not conceive, for 
the semen is extinguished, and in women whose uterus is very dry, and 
very hot, the semen is lost from the want of food; but women whose 
uterus is in an intermediate state between these temperaments prove 
fertile. 
The principal cause of sterility, it will be remarked, is here held 
to be the intemperaments of the uterus. Galen has given a very 
lengthy dissertation on this subject in his Commentary, and the sub- 
sequent authorities all adopt the views of our author. See Paulus 
JEgineta, Book III., 74, Syd. Soc. edit. Compare I. Morb. Mulier. 
xxvi., 27, xxxiii, 5, xxxiv., 1; II. Predict, xxxiii., 2-6. 
63. And in like manner with respect to males; for either, owing to the 
laxity of the body, the pneuma is dissipated outwardly, so as not to propel APHORISMS. 
247 
the semen, or, owing to its density, the fluid (semen?) does not pass out- 
wardly; or, owing to coldness, it is not heated so as to collect in its proper 
place (seminal vessels ?), or, owing to its heat, the very same thing happens. 
Galen finds many things in this Aphorism altogether foreign to 
the doctrines of Hippocrates, and, in a word, does not hesitate to 
pronounce it to be supposititious. Theophilus and Damascius adopt 
the same views as Galen regarding it. 
64. It is a bad thing to give', milk to persons having headache, and it 
is also bad to give it in fevers, and to persons whose hypochondria are 
swelled up, and troubled with borborygmi, and to thirsty persons; it is bad 
also, when given to those who have bilious discharges in acute fevers, and 
to those who have copious discharges of blood; but it is suitable in phthisi- 
cal cases, when not attended with very much fever; it is also to be given 
in fevers of a chronic and weak nature, when none of the aforementioned 
symptoms are present, and the patients are excessively emaciated. 
I need scarcely call attention to this Aphorism as containing most 
excellent rules for the use of a very important article both in regimen 
and medicine. Milk, it will be seen, is said to be prejudical in febrile 
and bilious complaints; but is beneficial in phthisical cases, and when 
there is much emaciation without any acute fever. See, in connec- 
tion with this subject, III.Epid. iii.; JEgr. xiii., 7; I. Morb. Mulier, 
Ixxxviii., 22; Aph. iv., 73; Int. Affect, iv., 35, xi., 2; II. Morb. Mui. 
viii., 21; also the Commentaries of Galen and Theophilus, which are 
interesting, although they contain no new views on the subject. 
65. When swellings appear on wounds, such cases are not likely to be 
attacked either with convulsions, or delirium, but when these disappear 
suddenly, if situated behind, spasms and tetanus supervene, and if before, 
mania, acute pains of the sides, or suppurations, or dysentery, if the 
swellings be rather red. 
This Aphorism evidently relates to the consequences of metastasis 
in wounds, or ulcers. It is founded on II. Epidem. iii., 129, and is 
thus translated by Celsus: " Si tumores super ulcera subito esse de- 
sierunt, idque a tergo incidit, vel distensio nervorum, vel rigor timeri 
potest; et si a priore parte id evenit, vel lateris acutus dolor, vel in- 
sania expectanda est; interdum etiam ejusmodi casum, quae tutissima 
inter hsec est, profusioalvi sequitur." (ii., 7) The greatest difficulty 
about it is the distinction which is recognized among the affections ac- 
cording as the wound is situated in the fore or back part of the body. 
Galen says, in explanation, that the back parts are nervous, and hence 
the affections are spasm and tetanus; while the fore parts are vascu- 
lar, that is to say, contain many arteries and veins; and hence, when 
the metastasis is upward, it produces mania; when to the chest, 
pleurisy and empyema: and when to the bowels, bloody dysentery, 
that is to say, an evacuation of pure blood by the bowels. See 
Paulus tEgineta, B. III., 42. See the Annotations of M. Nasse on 
this passage in M. Littre's edition, tom. iv., p. 550, which, however, 
do not appear to me to throw much light on the subject of this 
Aphorism. 248 
GENUINE WORKS OF HIPPOCRATES. 
66. When no swelling appears on severe and bad wounds, it is a great 
evil. 
See II. Epidem. iii., 128, xxiii., 1. Galen, in his Commentary; 
explains that by "bad" is meant, in this place, wounds situated in 
nervous and muscular parts, wounds of which, it is well known, are 
apt to prove dangerous. The Aphorism is evidently connected with 
the preceding one. 
67. In such cases, the soft are favorable; and crude, unfavorable. 
This Aphorism is also clearly connected with the two preceding. 
By " crude" is meant tumors which are hard, and have not come to 
a suppuration. 
68. When a person is pained in the back part of the head, he is bene- 
fited by having the straight vein in the forehead opened. 
This practice is also alluded to at Loc. in Homine, xlix., 10; VI. 
Epid. ii., 48; Affect, ii., 10, 11. The practice here recommended 
is founded on the principle of evacuation by revulsion. Galen, in his 
Commentary, mentions, that, from analogy, he had often bled by 
cupping the back part of the head in the affections of the eye. By 
" the straight vein in the forehead " our author evidently means either 
the temporal vein or artery; but which of these, it is impossible to 
say, as he applies the term vein(<y>A£//') in the modern sense of "blood- 
vessel." Seethe Commentary on Paulus JEgineta, B. VI., 5, Syd. 
Soc. edit. 
69. Rigors commence in women, especially at the loins, and spread by 
the back to the head; and in men also, rather in the posterior than the 
anterior side of the body, as from the arms and thighs; the skin there is 
rare, as is obvious from the growth of hair on them. 
See II. Epid. iii., Ill; VI. Epid. iii., 30-35; Nat. Puer. xvii., 2, 
3, 14, xviii., 1. There is considerable ambiguity in this sentence, on 
which compare the Commentaries of Galen and Theophilus with the 
Annotations of M. Littre (tom. iv., p. 561). In my opinion the 
meaning is this:-rigors commence in those parts of the body which 
are coldest, as the back in women, and back parts of the arms and 
legs in men; that the back parts are coldest is evident from their 
rarity, as not being covered with hair so much as the anterior parts. 
70. Persons attacked, with quartans are not readily attacked with con- 
vulsions, or if previously attacked with convulsions, they cease if a quar- 
tan supervene. 
This Aphorism is founded upon a highly important principle which 
our author announces elsewhere, namely, that a quartan fever is not 
only free of danger, itself, but often carries off other serious diseases 
of the system, I. Epidem. iii., 18. In connection with this important 
fact in therapeutics, consult further, Aph. ii., 26; VI Epid. vi., 16, 
viii., 96, 97; San. Tuend. 12; Aph. iv., 57. The commentator 
Damascius by convulsions here understands epilepsy, and all the com- APHORISMS. 
249 
mentators explain the cure in this case upon the principle, that the 
viscid and pituitous humor which occasions the convulsion is excreted 
and concocted by the fever. In a word, our author means that the 
fever proves an alterative of the system. I need scarcely remark that 
this subject, that is to say, the removing of fatal diseases by the sub- 
stitution of others less dangerous, has been lately attracting the 
attention of the profession. 
71. In those persons in whom the skin is stretched, and parched and 
hard, the disease terminates without sweats; but in those in whom the skin 
is loose and rare, it terminates with sweats. 
Theophilus applies this observation both to favorable and fata] 
crises, but Galen restricts it to the latter. Heurnius and Littre follow 
Galen. See further, VI. Epidem. vi., 29. 
72. Persons disposed to jaundice are not very subject to flatulence. 
The reason of this, assigned by Galen, is, that flatulence is engen- 
dered by a pituitous humor, whereas icterus is of a bilious nature. 
Heurnius understands the Aphorism to refer to persons of a bilious 
temperament. 
SECTION- VI. 
1. In cases of chronic lientery, acid eructations supervening when there 
were none previously, is a good symptom. 
See further II. Epid. 49, 50, 51; I. Morb. vi., 10. By lientery was 
meant a rapid passage of undigested food through the bowels, as is 
fully explained by Galen in his elaborate Commentary, which contains 
a great variety of interesting matters regarding the opinions of Erasi- 
stratus, Herophilus, Diodes, and other of the ancient commentators, 
but little that bears on the subject in question. The rationale of the 
fact stated in this Aphorism would appear to be, as stated by Jacobus 
Forliviensis in his Commentary, that lientery being a preternatural 
determination of the matters downward, acid eructations indicate that 
the stomach is resuming its tone. On lientery, see further, Paulus 
EEgineta, Book III., 50, Syd. Soc. edit. 
2. Persons whose noses are naturally watery, and their seed watery, 
have rather a deranged state of health; but those in the opposite state, a 
more favorable. 
That is to say, as Galen in his Commentary explains, persons of a 
humid temperament are subject from slight causes to catarrhal affec- 
tions in the head, throat, and lungs, and perhaps to dysenteries. He 
adds, that this subject is treated of in the works. On Airs, Waters, 
and Places, and in those On Diseases, and On Affections. See further, 
VI. Epid. vi., 37. 
3. In protracted cases of dysentery, loathing of food is a bad symptom, 
and still worse, if along with fever. 
As Galen, in his Commentary, remarks, the anorexia indicates 
that the intestinal derangement extends upward as far as the stomach. 250 
GENUINE WORKS OF HIPPOCRATES. 
A fever of course adds an additional feature to the unfavorable aspect 
of the case. See further, VI. Epid. viii., 1; Coac. vi., 100. 
4. Ulcers, attended with a falling off of the hair, are mail moris. 
The falling off of the hair, as Galen remarks, indicates that the 
humors causing the ulcer are of a very vitiated nature. See further, 
VI. Epid. viii., 2. 
5. It deserves to be considered whether the pains in the sides, and in 
the breasts, and in the other parts, differ much from one another. 
I need scarcely remark, that the question here put is one of vital 
importance in the treatment of diseases. It is previously alluded to, 
as Galen remarks, in the work On Regimen in Acute Diseases. See 
lii., 1, 2, 3, ed. Linden; also VI. Epid. vi., 82; and II. Prsedic. xvii., 
4, xix., 6, 7, xx. 4. Galen under this head has many interesting ob- 
servations on the nature of pain, and the different kinds of it, but 
they are too lengthy for my limits. Theophilus remarks, that 
Hippocrates evidently recognized diagnosis as the foundation of thera- 
peutics. See further Littre. 
6. Diseases about the kidneys and bladder are cured with difficulty in 
old men. 
Galen remarks, that the office of the kidneys and bladder being 
incessant, these parts, if diseased, having no rest, can scarcely get 
well when in state of ulceration, or when inflamed, especially in old 
persons. The fact here stated is but too well known. See further 
VI. Epid. viii., 4. 
7. Pains occurring about the stomach, the more superficial they are, 
the more slight are they; and the less superficial, the more severe. 
The meaning seemingly is, that in diseases about the epigastric 
region, the more superficial they are, that is to say, the nearer to the 
surface, they are in so far less serious. Galen remarks that all diseases 
situated external to the peritoneum are held to be superficial. No 
practical physician will doubt the importance of the fact indicated in 
this Aphorism; for who has not seen an incipient abscess in the ab- 
dominal muscles confounded with serious disease of the deeper-seated 
parts ? 
8. In dropsical persons, ulcers forming on the body are not easily healed. 
This is a well-known fact, and the Aphorism needs no comment. 
Heurnius, however, properly remarks, that this should render the 
physician cautious in forming artificial ulcers in dropsical patients, 
as he had known such terminate in gangrene. 
9. Broad exanthemata are not very itchy. 
It is difficult to determine what disease is here meant by exan- 
thema; most probably, however, it was a pustular disease, as under- 
stood by Jacobus Forliviensis and Heurnius. The former of these 
insinuates that it was scabies; and this conjecture is in so far applica- APHORISMS. 
251 
ble, that the kind of itch in which the pustules are small, is known 
to be attended with more tingling than when the pustules are broader. 
The Commentaries of Galen, Theophilus, and Damascius supply no 
information of any interst. See further, VI. Epid. ii., 52. 
10. In a person having a painful spot in the head, with intense cephal- 
algia, pus or water running from the nose, or by the mouth, or at the ears, 
removes the disease. 
This Aphorism occurs again at Judicat. xii., 3, See further, Coac. 
ii., 25, 26, 27, 59. Three natural modes of cure in severe cephalalgia 
are here indicated, namely, a discharge by the nose, the ears, and the 
mouth. Heurnius remarks, that this fact has furnished a hint toward 
the artificial modes of cure now adopted. 
11. Hemorrhoids appearing in melancholic and nephritic affections are 
favorable. 
The truth of the fact announced in this Aphorism is not ques- 
tioned by any of the ancient authorities, and is further attested by 
many modern, such as Plater, Obs. i., 1; A. Vega, de Art. Med. ii., 
4; Zacut. Lusit. Prax. Hist, ii., 6; Primros. de Vu]g. Error, iv., 51; 
Horstius, ii., 7; Salmuth. i., 72; River. Prax. xi., 6; Albertus de 
Hasmorrh. See further, in confirmation of our author's opinion, 
Copland's dictionary, art. Haemorrhoids, p. 128. 
12. When a person has been cured of chronic hemorrhoids, unless one 
be left, there is danger of dropsy or phthisis supervening. 
See the authorities quoted under the preceding Aphorism; also 
Humor, xi., 3; IV. Epid. xxxi., 1, 2; V. Epid. x., 18-21; VI. Epid. 
iii., 65. The ancient commentators explain the fact, upon the hy- 
pothesis that the hemorrhoidal discharge is an effort of Nature to 
relieve the system of impurities, and that when the outlet is entirely 
stopped, they are determined either to the liver, and produce dropsy, 
or the lungs, and produce phthisis. See Galen and Theophilus. 
13. Sneezing coming on, in the case of a person afflicted with hiccup, 
removes the hiccup. 
See further Pnenot. xiii., 11; Coac. iii., 175; Celsus, ii., 8. . The 
ancient commentators state, that hiccup is a spasmodic affection of the 
stomach, connected either with repletion or inanition. The present 
Aphorism refers to it when connected with plethora. The fact here 
stated is notorious. 
14. In a case of dropsy, when the water runs by the veins into the 
belly, it removes the disease. 
I need scarcely remark, that the fact here stated is a most im- 
portant one, namely, that dropsy is cured naturally by a spontaneous 
discharge of water from the bowels. As stated by Galen, the cure of 
dropsy by hydragogues is founded on it. Of these, the most effica- 
cious are said by Heurnius to be elaterium and euphorbium. See his 252 
GENUINE WORKS OF HIPPOCRATES. 
Commentary on this Aphorism. Compare Aph. vii., 29; Flat, xvii., 
8, 9; Judicat. xi., 10; Coac. iii., 285, 289; I. Morb. vi., 7; II. Morb. 
Ixix., 11, 12. 
15. In confirmed diarrhoea, vomiting, when it comes on spontaneously, 
removes the diarrhoea. 
As Galen states in his Commentary, this is an example of a natural 
cure, upon the principle of revulsion. See further, II. Diget. xxvi., 
15, 16; Loe. in Hom. xlv., 8; Coac. iii., 7; I. Morb. vi., 10; vii., 7; 
also Celsus, ii., 8. 
16. A diarrhoea supervening in a confirmed case of pleurisy or pneu- 
monia is bad. 
Galen, in his Commentary, makes the acute remark, that although 
in an incipient attack of pleurisy or pneumonia a diarrhoea may prove 
critical, in a case where the patient is mastered by the disease, a 
diarrhoea may be set down as being occasioned by the liver's sympa- 
thizing with the organs of respiration, and the process of sanguifica- 
tion being thus deranged, Nature makes an effort to expel the de- 
praved humors by the intestines. The explanation given by the other 
commentators, ancient and modern, is to the same effect. See further, 
Aph. v., 12., 14; Log. in Hom. xxix., 15, 16, 17; I. Morb. vi., 5, x., 
41; III. Morb. xvii., 59. 
17. It is a good thing in ophthalmy for the patient to be seized with 
diarrhoea. 
Every experienced physician must be able to confirm the truth of 
this remark. Galen, in his Commentary, states that, in imitation of 
this natural method of cure, physicians were in the practice of deter- 
mining to the bowels by clysters and purgatives. See further, Judi- 
cat. xii., 9; Coac. ii., 130, 133. 
18. A severe wound of the bladder, of the brain, of the heart, of the 
diaphragm, of the small intestines, of the stomach, and of the liver, is 
deadly. 
Galen, in his Commentary on this Aphorism, gives a variety of 
interesting remarks, which I regret that my limits do not admit of 
my copying entire. He states, in the first place, that the term used 
by our author in this place signifies a great or severe wound, and that 
the epithet " deadly" is often applied in the sense of " very danger- 
ous." He further remarks, that although wounds of the heart and 
diaphragm be necessarily fatal, those of the brain, the liver, the 
bowesl, and the bladder are not necessarily so. In proof of this, he 
mentions cases of wounds of the brain which he had known not to 
prove fatal, and refers to the operation of lithotomy, as a proof that 
the muscular part of the bladder, that is to say, its neck, may be cut 
without occasioning death. The other commentators add nothing of 
much interest. See further, Aph. vi., 24; II. Prsedict. xix., 2-6, 11, 
12, xxii., 1; Coac. iii., 387, 388, 389; I. Morb. iii., 4, vii., 21; and 
Celsus, v., 26. This commentary is well illustrated by Tagaultius, 
De Vulner. ii., and also by Dinus de Garbo, in his Commentary on 
Avicenna, ed. Venet. p. 59. APHORISMS. 
253 
19. When a bone, cartilage, nerve, the slender part of the jaw, or pre- 
puce, are cut out, the part is neither restored, nor does it unite. 
Galen, Theophilus, and Damascius understand the meaning of this 
Aphorism to be, that when any portion of a bone, or other part here 
enumerated, is fairly taken away, the substance by which the loss is 
supplied is not exactly the same as the part which is lost. For ex- 
ample, callus is not exactly bone. Still Galen admits that there is 
some difficulty in reconciling the terms used by our author with the 
facts of the case. See further, Aph. vii., 28; Coac. iii., 379-382; II. 
Predict, xxiv., 1; I. Morb. iii., 32, 33; vii., 21; Celsus, ii., 10; Aris- 
tot. H. N. i. 13.. Tagaultius makes some good remarks on this 
Aphorism. He holds that it is meant that a part is fairly cut out. 
(Inst. Chirurg. ii.) 
20. If blood be poured out preternaturally into a cavity, it must neces- 
sarily become corrupted. 
By cavity in this place is to be understood, as elsewhere, not only 
the stomach, but the chest, the ventricles of the brain, etc. Our 
author, like all the ancient authorities, holds *that pus is corrupted 
blood. See further, Aph. vii., 38; Flat, xvii., 3; I. Morb. iii., 37, 
x., 42-48, xii., 4; xv., 4; Celsus, ii., 7. 
21. In maniacal affections, if varices or hemorrhoids come on, they re- 
move the mania. 
AH the commentators are agreed that by maniacal affections in 
this place our author understands melancholy. The cure is to be 
referred to the principle of metastasis. See further, Aph. vii., 5; 
Humor, xi., 1. 
22. Those ruptnres in the back which spread down to the elbows are 
removed by venesection. 
By ruptures in this place Galen understands pains; and Theophilus 
has this reading. That these severe pains will be removed by bleed- 
ing, on the principle of revulsion, seems very likely. See further, 
II. Morb. lix., 22; Celsus, ii., 10. 
23. If a fright or despondency lasts for a long time, it is a melancholic 
affection. 
That mental emotions, when long protracted, are morbid, may 
generally be concluded; and in such cases, the ancients ascribed the 
disease to the melancholic humor. See Galen and the other com- 
mentators. 
24. If any of the small intestines be transfixed, it does not unite. 
This is a mere repetition of the general statement made in Aph. 
vi., 18; and Galen thinks the present Aphorism deserves to be erased. 254 
GENUINE WORKS OF HIPPOCRATES. 
25. It is not a good sign for an erysipelas spreading outwardly to be 
determined inward; but for it to be determined outward from within is 
good. 
This is an important and now generally admitted fact. Consult, 
in particular, Copland's Dictionary of Medicine, under Erysipelas, 
§ 33. See further, Pramot. vii., 3, xxiii., 9; Coac. iii., 103; I. Morb. 
vi., 8, 9; and Aph. vi., 37. 
26. In whatever cases of ardent fever tremors occur, they are carried off 
by a delirium. 
Galen is not at all satisfied with this Aphorism, and hints at its 
being an interpolation. At all events, he states that it is well known 
that a delirium coming on after shivering in fevers, does not carry off 
th e fever, so that he holds the meaning must be understood to be 
that the tremors are replaced by the delirium, that is to say, delirium 
succeeds to the tremors. He and Theophilus attempt to explain the 
rationale of this rule physiologically. Heurnius entertains the notion 
(but it appears to me fanciful) that Hippocrates in this case uses the 
word "carries off" (A.t>ez) ironically, and that he means that the de- 
lirium carries off the patient, not the disease. 
27. Those cases of empyema or dropsy which are treated by incision or 
the cautery, if the water or pus flow rapidly all at once, certainly prove 
fatal. 
This, I need scarcely remark, is a most important rule in practical 
surgery. By empyema, as Galen remarks, our author principally 
means a collection of matter between the thorax and the lungs. 
1 (See the Annotations on the Prognostics.) He and Theophilus ac- 
count for the fatal termination upon the principle that a great evacu- 
ation of the fluids is attended with a fatal loss of the animal and vital 
spirits. On the subject of empyema and ascites, see further, Aph. ii., 
51, vii., 44; Coac. iii., 91, 92; II. Morb. xlv., 24-28; III. Morb. 
xxvii., 1, 8,14; Int. Affect, iv., 30, x., 20-23, xxv., 30-36, xxvii., 5; 
VI. Epid. vii.., 62; also Celsus, ii., 8. 
28. Eunuchs do not take the gout, nor become bald. 
According to Galen, the reason is, that eunuchs, by being emas- 
culated, become of cold temperament like women. He states, how- 
ever, that although it was true that in the age of Hippocrates 
eunuchs did not take the gout, they were exposed to the disease in 
his time, owing to their indolence and effeminacy. He gives a most 
ingenious and philosophical explanation of the origin of the disease, 
which he ascribes to debauchery, intemperance, and an hereditary 
taint. The freedom of eunuchs from baldness, the commentators 
ascribe in like manner to the coldness of their temperament. See 
further, Nat. Puer. xviii., 4, 5, 6, xix., 1; Celsus, iv., 24. 
29. A woman does not take the gout, unless her menses be stopped. 
Galen, in his Commentary, states that, in his age, women, from 
excess of luxury, had become subject to the gout; and Seneca affirms APHORISMS. 
255 
the same of his age. (Epid. xcv.) See V. Epid. xxxiii., 4; VI. 
Epid. viii., 98-101; VII. Enid, xlix., 12; I. Morb. Mulier. xiii., 6, 
11. 
30. A young man does not take the gout until he indulges in coition. 
This will still be generally admitted to be true. All the ancient 
authorities hold that venery is a great predisposing cause of gout. 
31. Pains of the eyes are removed by drinking pure wine, or the bath, 
or a fomentation, or venesection, or purging. 
This Aphorism contains, as Galen remarks, an empirical enumera- 
tion of the various means used for the cure of ophthalmy. He gives 
most interesting observations on the subject in his Commentary, 
which, however, is so lengthy, that I cannot introduce its contents 
in this place. He relates a most instructive case, in which he imme- 
diately succeeded in appeasing the pains of the eyes by the warm bath, 
after an oculist had failed to relieve them by cooling applications. 
When the pain is connected with plethora, he says it is to be cured 
by venesection, when with cacochymy, by purging, and when with 
debility, by drinking wine, which attenuates and discusses thick 
humors in the eye. The commentaries published by Dietz are also 
well deserving of being consulted on this head. See further Aph. 
vii., 46; II. Epid. vi., 26; Celsus, vi., 26. 
32. Persons whose speech has become impaired are likely to be seized 
with chronic diarrhoea. 
The commentators explain this Aphorism as follows:-An impedi- 
ment in the speech is occasioned by a fullness of the brain (as is illus- 
trated in the case of a drunken man), and Nature often endeavors to 
relieve this state by a determination downwards. Compare Praecept. 
xii., 1-5; Coac. ii., 147; Veratr. Us. i., 12; and see Foes, Annot. h. 1. 
33. Persons having acid eructations are not very apt to be seized with 
pleurisy. 
Galen and the other commentators account for this fact from 
acidities of the stomach being connected with phlegm, whereas 
pleurisy is connected with yellow bile; and, moreover, acidity of the 
stomach is of a cold nature, whereas pleurisy is an inflammation. 
As Galen remarks, Hippocrates has stated in his work, On Airs, 
Waters, and Places, that persons who have a humid stomach are not 
subject to pleuritic diseases. 
34. Persons who have become bald are not subject to large varices; but 
should varices supervene upon persons who are bald, their hair again 
grows thick. 
Taken literally, as Galen states, this Aphorism is ridiculous and 
inadmissible; for who does not know that baldness is not cured by 
the supervention of varices in the limbs ? He supposes, however, that 
allusion may be made to the diseases alopecia and ophiasis {porrigo 
decalvans ?), and that these may be cured by the determination of the 
humors which occasion them to the veins of the limbs. 256 
GENUINE WORKS OF HIPPOCRATES. 
35. Hiccup supervening in dropsical cases is bad. 
The hiccup supervening in an advanced stage of dropsy is attrib- 
uted, by the commentators, to the increase of the watery humors, so 
as to intercept the trachea, and hence hiccup, and danger lest the 
patient be suffocated. From whatever cause it originate, there can 
be no doubt of the fact that hiccup in dropsy, and other diseases of a 
like nature, is a fatal symptom. See further, Aph. vii., 47; II. 
Predict, xi., 1-16; II. Epid. v., 28; Celsus, ii., 8. 
36. Venesection cures dysuria; open the internal veins of the arm. 
Galen is not at all satisfied with this Aphorism, and hints that it 
is interpolated. In the first place, it is not true that venesection will 
remove dysuria, unless connected with inflammation and a redundance 
of humors. Then he holds that bleeding in the arm is not appli- 
cable in diseases below the diaphragm, but in the ankle. Theophilus 
in the present instance supposes that it is the inner vein of the arm, 
but Damascius of the ankle. 
37. It is a good symptom when swelling on the outside of the neck 
seizes a person very ill of quinsy, for the disease is turned outwardly. 
As Galen remarks, the reason of this fact is obvious, namely, a 
determination outwardly of the humors which necessarily relieves 
the internal complaint. See Aph. vii., 49, and Celsus, iv., 4. This 
rule holds good frequently, but not universally, in epidemical sore 
throat. 
38. It is better not to apply any treatment in cases of occult cancer; 
for, if treated, the patients die quickly; but if not treated, they hold out 
for a long time. 
All the ancient commentators explain, that by " occult" may be 
meant either " not ulcerated " or " deep seated." The latter seems 
the better interpretation, and then the meaning will be, that when 
the cancer is superficial, it admits of being removed by an operation, 
that is to say, by the knife or the cautery; but when the disease is 
deep seated, it is better to let it alone. Galen's Commentary contains 
many interesting remarks on cancel' See further, II. Praadict. xviii., 
5, 9, xxi., 5; II. Morb. xxiii., 25. 
39. Convulsions take place either from repletion or depletion; and so it 
is with hiccup. 
I need scarcely remark, that this is a most important fact both in 
therapeutics and prognostics. How important is it, for example, in 
puerperal convulsions! The whole treatment turns upon the ques- 
tion whether the convulsion be connected with plethora or inanition. 
It is evidently the same with hiccup. 
40. When pains, without inflammation, occur about the hypochondria, 
in such cases, fever supervening removes the pain. 
The commentators hold that it is by attenuating and dissipating 
the flatus or humor causing the obstruction, that a fever operates 
the cure in this case. Aph. vii., 52; Coac. iii., 272; Celsus, ii., 8. APHORISMS. 
257 
41. When pus formed anywhere in the body does not point, this is 
owing to the thickness of the part. 
According to Galen some of the commentators read thickness of 
the pus (/rdof) and some of the place (tottov). See further, Coac. 
iii., 238, 239, II. Morb. xlv., 14; III. Morb. xxvii., 1. 
42. In cases of jaundice, it is a bad symptom when the liver becomes 
indurated. 
It is a well-known pathological fact, that jaundice attended with 
scirrhus of the liver is necessarily all but hopeless. See further, Aph. 
iv., 641; Coac. ii., 223, 225-229; also Celsus, ii., 8. 
43. When persons having large spleens are seized with dysentery, and 
if the dysentery pass into a chronic state, either dropsy or lientery super- 
venes, and they die. 
There can be no doubt as to the fatal nature of dropsy or lientery 
supervening upon dysentery complicated with enlarged speen. The 
ancient authorities generally hold that enlargement of the spleen is a 
common cause of dropsy. See further, Aph. vi., 48; Coac. iii., 295, 
296; I. Morb. iii., 2?; Affect, xxi., 23. 
44. When ileus comes on in a case of strangury, they prove fatal in 
seven days, unless, fever supervening, there be a copious discharge of 
urine. 
This Aphorism is of ambiguous meaning, and Galen finds so many 
things in it which he cannot admit to be true, that he hesitates 
whether he should sustain it as genuine. Celsus seems to understand 
the meaning to be, that a fever alleviates ileus connected with diffi- 
culty of water, if by its heat it promotes the flow of urine. M. Lalle- 
mand, as quoted by Littre (h. 1.), understands our author to mean, 
that when fever sets in, the case proves fatal, unless an abundant flow 
of blood take place. This seems the most likely explanation. It is 
reported totidem verbis at Coac. iii., 314. 
45. When ulcers continue open for a year or upward, there must nec- 
essarily be exfoliation of bone, and the cicatrices are hollow. 
There can be no doubt that, as here stated, the majority of ulcers 
which are slow of healing are complicated with disease of a bone, 
which must be cast off before the sore can heal, and in that case there 
must necessarily be a hollow in the place from which the bone has 
separated. See further Fract. xxx., 2; Ulcer, v., 4. 
46. Such persons as become hump-backed from asthma or cough before 
pubeity, die. 
The subject of spinal disease is treated of at Articul. xxxvii., 
xxxviii., and Moch. xxi., 6. Galen and Theophilus give interesting 
commentaries on this Aphorism, but they contain little or nothing 
that is not to be found in the part of the Articulations referred to. 
Whether derangement of the spine be occasioned by external violence, 
or by disease, it must prove fatal when it occasions pressure on the 
chest and difficulty of breathing. 
Vol. IT.-17. 258 
GENUINE WORKS OF HIPPOCRATES. 
47. Persons who are benefited by venesection or purging, should be 
bled or purged in spring. 
See further Aph. vii., 53. Galen, in his interesting Commentary 
on this head, gives an account of various cases of confirmed disease, 
such as gout, epilepsy, elephantiasis, and so forth, which were greatly 
benefited by being put under a course of treatment by bleeding and 
purging in the spring. That this, in fact, is the season of plethora 
both in vegetables and in animals, is well known; and hence Virgil, 
describing spring, truly says, " Superat tener omnibus humor/' I 
may here remark that the month of April is the time when birch 
trees are bled (so to speak) in order to procure their juice for making 
birch wine. Spring also is the season at which the temperature is 
intermediate between the extremes of cold and heat, when all great 
evacuations are to be avoided. The soundness of the rule of practice 
here laid down cannot be doubted. See Sanctorius, ii., 48, 49; Fer- 
nel, ii., 1, de Ven. Sect.; Fallopius de Med. Purg. 24. 
48. In enlargement of the spleen, it is a good symptom when dysentery 
comes on. 
See under Aph. vi., 43; also Coac. iii., 295; I. Morb. vi.. 7; and 
Celsus, ii., 8. 
49. In gouty affections, the inflammation subsides in the course of forty 
days. 
This Aphorism evidently refers to prognostics and the critical 
days. See Praedict. vi., 3; and Celsus, iv., 24. Forty days are meant as 
the utmost limit, provided no error in treatment be committed. 
50. When the brain is severely wounded, fever and vomiting of bile 
necessarily supervene. 
As Galen remarks, the vomiting of bile is evidently produced by 
the stomach's sympathizing with the brain, in consequence of its con- 
nection with that organ by means of a pair of considerable nerves. 
Fever is no doubt a likely consequence of a severe wound of the brain, 
and the term used by our author implies a severe injury. See II. 
Prsedict. xxii., 12, 16, xxiii., 5-11; Coac. iii., 271, 383, 384; I. Morb. 
iii., 35; Celsus, v., 26. 
51. When persons in good health are suddenly seized with pains in the 
head, and straightway are laid down speechless, and breathe with stertor, 
they die in seven days, unless fever come on. 
The state here described is evidently apoplectic. Stertor, as Galen 
remarks, is indicative of strong apoplexy, and is occasioned by debility 
of the nervous energy. Galen says, when it proceeds from a pitu- 
itous (or serous) humor, it is dissipated by the heat of the fever. 
Theophilus gives the same explanation of this Aphorism. See further, 
Judicat. xii., 4; Coac. ii., 6, iii., 320-323; II. Morb. vi. 1, 2, 3, 4, 
7, xxi., 2-12; III. Morb. viii., 2; I. Predict. x., 13, xii., 8. APHORISMS. 
259 
52. We must attend to the appearances of the eyes in sleep, as presented 
from below; for if a portion of the white be seen between the closed eye- 
lids, and if this be not connected with diarrhoea or severe purging, it is a 
very bad and mortal symptom. 
This Aphorism is entirely taken from the Prognostics. See § 2 of 
this edition, also Prorrhet. xi., 2; Coac. ii., 121; Celsus, ii., 6. In 
the edition of the Aphorisms published by Dietz, with the Scholia of 
Theophilus and Damascius, this and the preceding Aphorism are 
joined toegther. 
53. Delirium attended with laughter is less dangerous than delirium 
attended with a serious mood. 
According to Galen, delirium attended with laughter is connected 
with yellow bile, and the same attended with despondency is produced 
by black bile. See further, Coac. i., 141; Celsus, iii., 18. 
54. In acute diseases, complicated with fever, a moaning respiration is 
bad. 
Galen gives several conjectural explanations of the cause of this 
moaning respiration; such as that it proceeds from coldness of the 
nerves, hardness of the muscles about the chest, or a spasmodic move- 
ment of the chest;-at the present time we would suspect valvular 
disease of the heart. 
55. For the most part, gouty affections rankle in spring and in autumn. 
In Aphorism iii., 20, arthritic diseases are enumerated among 
those of spring. In autumn, exacerbations take place, owing to the 
inequality of temperature and unhealthiness of that season. The- 
ophilus explains the autumnal exacerbation as being occasioned by 
an effort of Nature to expel to the extremities the cacochymy, or 
peccant humor, engendered during the summer. See Celsus, ii., 
1, 16, iii., 24. 
50. In melancholic affections, determinations of the humor which occa- 
sions them produce the following diseases: either apoplexy of the whole 
body, or convulsion, or madness, or blindness. 
This Aphorism contains a statement of the diseases which were 
supposed by the ancients to be connected with the prevalence of black 
bile, namely, apoplexy, spasm, mania, and blindness. The subject 
is treated of in an interesting manner by Galen, in his work, On Black 
Bile. See further, Aph. vii., 40; Viet. Acut. xlv., 3; II. Predict, 
xiii., 3; Coac. iii., 316, 317. 
57. Persons are most subject to apoplexy between the ages of forty and 
sixty. 
That apoplexy is a disease most common in declining years, is a 
fact quite well known and admitted by the best of our modern author 
ities. Hippocrates ranks it among the diseases of old age, at Aph. 
iii., 31. All the ancient commentators ascribe the frequency of the 
disease in old age to the prevalence of black bile. 260 
GENUINE WORKS OF HIPPOCRATES. 
58. If the omentum protrude, it necessarily mortifies and drops off. 
Galen and all the other commentators understand this Aphorism 
as referring to protrusion of the epiploon through a wound. When 
a piece of it, then, has protruded, and has been allowed to remain so 
for some time, and has become much cooled, it will necessarily 
mortify, and should be cut off before having recourse to the gastro- 
rhaphe; but, as stated by Galen and the others, if reduced imme- 
diately, the Aphorism does not hold true. Galen remarks, that in 
this, as in many other of the Aphorisms, our author states the com- 
mon results as the general rule, but does not think it necessary to 
mind the exceptions. Compare Coac. iii., 378; I. Morb. iii., 36. 
59. In chronic diseases of the hip-joint, if the bone protrude and return 
again into its socket, there is mucosity in the place. 
The subject of dislocation at the hip-joint from disease is fully 
treated of in the work On the Articulations. See the Argument, 
Compare I. Morb. iii., 16; Int. Affect. Iviii., 2; Aer. Aq., Loc., xlviii., 
5; Affect, xxx., 12; and Celsus, iv., 23. 
60. In persons affected with chronic disease of the hip-joint, if the 
bone protrude from its socket, the limb becomes wasted and maimed, 
unless the part be cauterized. 
This also is treated of in the same work; in fact, as Galen states, 
this Aphorism and the preceding should have been joined together. 
1. In acute diseases, coldness of the extremities is bad. 
I need scarcely remark that coldness of the extremities is a symp- 
tom often noticed in the febrile cases related in the Epidemics. All 
the ancient commentators account for the coldness of the extremities, 
from the congestion of the febrile heat in the internal viscera. See 
further, Aph. iv., 48, vii., 26; Prsenot. xv., 9; Coac. i., 165; VI. 
Epid. viii., 93; Celsus, ii., 4, 6. 
SECTION VII. 
2. Livid flesh on a diseased bone is bad. 
This Aphorism would seem to refer to gangrene along with dis- 
ease of the bone. The case, however, is not quite clear, and the 
commentators do not supply much information under this head. 
3. Hiccup and redness of the eyes, when they supervene on vomiting, 
are bad. 
The commentators ascribe the hiccup either to inflammation of 
the stomach or an affection of the brain, with which the stomach 
sympathizes. The redness of the eyes, they hold to be symptomatic 
of a cerebral affection. See also, Coac. iv., 20; Celsus, ii., 4. 
4. A chill supervening on a sweat is not good. 
This is a well-known fact. Galen explains it as indicating that 
Nature is overpowered by the disease. See Predict. vii., 14, 15; 
Celsus, ii., 4. APHORISMS. 
261 
5. Dysentery, or dropsy, or ecstacy coming on madness is good. 
The commentators explain, that by dysentery or dropsy superven- 
ing in a case of mania, a metastasis of the disease takes place. By 
ecstacy, they understand a violent exacerbation of the maniacal symp- 
toms, which brings the disease to a crisis. 
6. In a very protracted disease, loss of appetite and unmixed discharges 
from the bowels are bad symptoms. 
That loss of appetite is a bad symptom in protracted diseases can 
admit of no doubt. By " unmixed discharges" our author probably 
means " colliquative diarrhoea," which, of course, is also a very bad 
symptom in all such cases. In the edition of Dietz often referred 
to above, the reading would signify, " unmixed vomitings and bilious 
dejections," but it does not appear to have been recognized by Galen. 
7. A rigor and delirium from excessive drinking are bad. 
This seems clearly a case of delirium tremens. The chill is ex- 
plained by Damascius as being occasioned by the extinction of the 
innate heat, induced by the immoderate drinking of wine. 
8. From the rupture of an internal abscess, prostration of strength, 
vomiting, and deliquium animi result. 
The term i)liyma is explained by the Greek commentators to sig- 
nify, in this place, an internal abscess either in the chest or in the 
belly. The symptoms of collapse here enumerated are said by Galen 
to be superinduced by an escape of the vital pneuma (or breath). No 
one can question the fact, however it may be explained. 
9. Delirium or convulsion from a flow of blood is bad. 
This is nearly allied to Aphor. v., 3. See also Coac. iii., 57. Galen 
remarks, that this is an important Aphorism, as intimating to us 
that delirium may be connected with inanition, like tremors in the 
limbs, which are produced by weakness of the motor powers. 
10. Vomiting, or hiccup, or convulsion, or delirium, in ileus, is bad. 
The symptoms here mentioned are known to be very fatal in ileus. 
See Coac. iii., 303; Celsus, ii., 8. 
11. Pneumonia coming on pleurisy is bad. 
That it is a bad symptom, when the disease extends from the 
pleura to the lungs, cannot be doubted. See Coac. iii., 172; Affect, 
ix., 12; Celsus, ii., 7. 
12. Phrenitis along with pneumonia is bad. 
No one will question the truth of this prognosis. Damascius 
remarks that the fumes of the disease in this case ascend from the 
lungs to the brain. 262 
GENUINE WORKS OF HIPPOCRATES. 
13. Convulsion or tetanus, coming upon severe burning, is bad. 
There are different readings and interpretations of this Aphorism, 
as may be seen on consulting Galen. By burning may either be 
meant exposure to great heat, or burning by the cautery. 
14. Stupor or delirium from a blow on the head is bad. 
This also will be admitted as an unquestionable fact. See Coac. 
ii., 8; Cap. Vuln. xv., 1; and Celsus, ii., 7. 
15. From a spitting of blood there is a spitting of pus. 
That hsemoptysis is frequently either the cause or the index of 
consumption is now well ascertained. Still, as Galen remarks, spitting 
of blood is not always followed by consumption. Compare Nat. Hum. 
xxiii., 1; II. Prsedict. xiv., 13. 
16. From spitting of pus arise phthisis and a flux; and when the sputa 
are stopped, they die. 
The phenomena of phthisis here stated are now well known and 
admitted. Compare Coac. iii., 257.; I. Morb. x., 17, 20, xi., 40. 
17. Hiccup in inflammation of the liver is bad. 
Perhaps, in this case, as suggested by Galen, the enlarged liver 
presses on the stomach, and occasions the hiccup. See Aph. v., 58. 
18. Convulsion or delirium supervening upon insomnolency is bad. 
Insomnolency, according to Galen, is connected with a dry in- 
temperament of the brain, and hence convulsion or delirium super- 
vening on such a condition of it is necessarily bad. He states, how- 
ever, that in some of the copies, "delirium" was omitted. Compare 
Celsus, ii., 7. 
18.* Trembling upon lethargus is bad. 
This Aphorism is omitted in the editions of Galen, but occurs in 
the edition of the Aphorisms published by Dietz, with the Commen- 
taries of Theophilus and Damascius. Theophilus states that the 
lethargus is attended with a low fever, and a disposition not to be 
roused. A trembling in such a febrile disease would now be suspected 
to be connected with a typhoid form of the affection. 
19. Erysipelas upon exposure of a bone (is bad?). 
This Aphorism is to be understood as referring principally to the 
bones of the cranium, and in that case I need not say that erysipelas 
is a very serious affair. See Cap. Vuln. xxvii., 4. 
20. Mortification or suppuration upon erysipelas is bad. 
This Aphorism needs no comment, as everybody will admit that 
either gangrene or suppuration is a most untoward termination of 
erysipelas. APHORISMS. 
263 
21. Hemorrhage upon a strong pulsation in wounds is bad. 
By pulsation in this place is evidently meant a violent throbbing 
of the arteries; or, as the commentators explain it, a painful feeling 
connected with the action of the arteries. It applies then to hemor- 
rhage connected with increased action of the vessels, and it is now 
well known that in such cases the flow of blood is violent. 
22. Suppuration upon a protracted pain of the parts about the bowels 
is bad. 
The ancient commentators naturally understand this Aphorism as 
referring to inflammation terminating in suppuration. 
23. Dysentery upon unmixed alvine discharges is bad. 
See Aph. vii., 6. Galen remarks, that in such a case, there is 
danger lest a portion of the intestine may be corroded. I need scarcely 
remark, that it is now well know, that in dysentery, there is danger of 
the gut being completely ulcerated, so as to allow of the escape of its 
contents. 
24. Delirium upon division of the cranium, if it penetrate into the 
cavity of the head, is bad. 
There is a good deal of uncertainty as to the reading and meaning 
of this Aphorism. See Galen, Littre, and Foes. Most probably it 
refers to a severe fracture of the skull extending its violence to 
the membranes. 
25. Convulsion upon severe purging is mortal. 
This is little else than a repetition of Aph. v., 1. 
26. Upon severe pain of the parts about the bowels, coldness of the 
extremities coming on is bad. 
Without doubt this Aphorism refers to inflammation of the bowels 
ending in mortification. In this case, as it is well known, the fatal 
termination is preceded by coldness of the extremities. See Aph. iv., 
48, vii., 1, 22. 
27. Tenesmus coming on in a case of pregnancy causes abortion. 
Damascius remarks that this proceeds from sympathy of the 
uterus with the rectum. 
28. Whatever piece of bone, cartilage, or nerve (tendon is cut off, it 
neither grows nor unites. 
This is a repetition of Aph. vi., 19. 
29. When strong diarrhoea supervenes in a case of leucophlegmatia, it 
removes the disease. 
By leucophlgmatia was understood incipient anasarca. See Galen's 
Commentary, h. ]., and Celsus, iii., 21. It will readily be understood 264 
GENUINE WORKS OF HIPPOCRATES. 
that a violent diarrhoea may carry off such a disease. See further Flat, 
xviii., 8, 9; Judicat. xi., 21; Coac. iii., 285, 326; I. Morb. vi., 7; II. 
Morb. Ixix,, 11, 12; Int. Affect, xxiii., 12. 
30. In those cases in which frothy discharges occur in diarrhoea there 
are defluxions from the head. 
There is not perhaps in the whole collection an announcement so 
difficult to reconcile with modern ideas, and so thoroughly based on 
hypothesis, as that contained in the present Aphorism. It is alto- 
gether founded on the humoral pathology, of which traces may be 
recognized in many other parts of our author's work. We shall see a 
pretty distinct explanation of it in the work, On the Sacred Disease. 
See Vol. II., 353, ed. Linden. It also occurs in the Coacse Prsenotiones, 
v., 13,14. I cannot afford room for an exposition of its principles in this 
place. See the Commentary of Galen, h. 1.; and the note of Littre, 
h. L, and tom. i., p. 193; also Paulus aEgineta, Book III., 29, 
Syd. Soc. edit. 
31. When there is a farinaceous sediment in the urine during fever, it 
indicates a protracted illness. 
Farinaceous sediments were held to be unfavorable by all the 
authorities on the subject. See Paulus JEgineta, Book II., 14. 
Galen, in his Commentary, pronounces the most of these cases to be 
fatal. Compare Praenot. xi.,7; Coac. ii. 199, v., 12, 64, 65. 
32. In those cases in which the urine is thin at first, and the sediments 
become bilious, an acute disease is indicated. 
It will be seen, upon reference to the Commentaries of Galen and 
Theophilus, and also to those of Marsilius and Littre in modern 
times, that there is an ambiguity in this Aphorism; that the words 
(JxvgdOsv ds XsTtrai), which are here rendered "thin at first," may 
also signify " thin above." I incline to adopt the former interpreta- 
tion, which is also favored by Galen and Theophilus. I have re- 
peatedly desired to call the attention of the profession to the state, 
and in particular to the specific gravity, of the urine in febrile diseases. 
Compare Coac. v., 6, 8; I. Morb. xxvii., 28; Viet. Acut. liv., 5. 
33. In those cases in which the urine becomes divided there is great 
disorder in the body. 
Galen and the modern expositors, Heurnius and Marsilius, feel at 
a loss how to explain this Aphorism; but for my own part I see no 
difficulty about it, for I believe it to refer to a condition of the urine 
which I have seen in cases of organic disease of the liver, where the 
sediment is so thick that there is a strongly-marked line of separation 
between it and the watery part. Such a state of the urine would no 
doubt be much more common in warm climates, where intermittent 
and remittent fevers prevail, and consequently it was not likely to 
escape the acute observation of Hippocrates. APHORISMS. 
265 
34. When bubbles settle on the surface of the urine, they indicate 
disease of the kidneys, and that the complaint will be protracted. 
It can scarcely admit of a doubt, that our author here refers to 
albuminous urine, which it is well known is also frothy, and is now 
generally admitted to be connected with disease of the kidneys. See 
Paulus JEgineta, Vol. I., p. 352, and the authorities there quoted. 
35. When the scum on the surface is fatty and copious, it indicates 
acute diseases of the kidneys. 
It appears from Galen, that in some copies he found epistasis, 
and in others hypostasis, the one evidently referring to the scum on 
the surface, and the latter to the sediment: he favors the former 
reading, and understands it to refer to melting of the fat in the 
neighborhood of the kidneys. Compare Prasnot. xii., 1, 2; Coac. v., 
43; IV. Epid. vi., 12, 13. 
36. Whenever the aforementioned symptoms occur in nephritic diseases, 
and along with them acute pains about the muscles of the back, provided 
these be seated about the external parts, you may expect that there will 
be an abscess; but if the pains be rather about the internal parts, you may 
also rather expect that the abscess will be seated internally. 
This Aphorism evidently refers to what is supposed by our author 
to be abscess in the region of the kidneys; the symptoms by which it 
may be ascertained whether the abscess will point externally or inter- 
nally are clearly given. On Kenai Abscess, see in particular Ruffus 
Ephesius. De Ves. Ren. Affect.) Galen and Theophilus both state 
that the matter sometimes points behind, and sometimes in the direc- 
tion of the psoas muscle. I am inclined therefore to believe that 
lumbar abscess may be comprehended under this head. 
27. Use matemesis, without fever, does not prove fatal, but with fever it 
is bad; it is to be treated with refrigerant and styptic things. 
As a general rule, no doubt, as stated by our author, haematemesis 
unattended with fever is not often dangerous; whereas, when it occurs 
in the last stage of fever, danger may be inferred. Compare the 
prognosis in hemorrhage from the stomach as given by Dr. Copland 
in the Dictionary of Practical Medicine, vol. iv., p. 97. Cooling and 
astringent things are recommended, evidently under the impression 
that the disease is connected with relaxation of the exhalents of the 
stomach. 
38. Defluxions into the cavity of the chest suppurate in twenty days. 
In this Aphorism we recognize traces of the humoral pathology 
referred to above. See further Aph. vi., 20; Loc. in Homin. xviii., 
7; I. Morb. xi., 2, 3. The doctrine that catarrhs are defluxions 
from the head to the chest is sanctioned by the great discoverer of the 
system of auscultation, Laennec. See Paulus aEgineta, A ol. I., p. 
474. 266 
GENUINE WORKS OF HIPPOCRATES. 
39. When a patient passes blood and clots, and is seized with strangury 
and pain in the perineum and pubes, disease about the bladder is indicated. 
This Aphorism is nearly word for word the same as Aph. iv., 80. 
40. If the tongue suddenly lose its powers, or a part of the body be- 
come apoplectic, the affection is of a melancholic nature. 
By apoplectic, in this place, our author evidently means paralyzed. 
(See Paulus JEgineta, Book III., 18.) Even Galen admits that 
he is at a loss to account for Hippocrates setting down apoplexy as a 
disease connected with melancholy or black bile, for, he says, cancer, 
elephantiasis, leprosy, psora, and black alphos are known to be dis- 
eases which originate in black bile, but apoplexy has seemingly no 
alliance to them. Compare II. Peedict. xvi., 12; Coac. iii., 87, 88, 
315, 317. Damascius the commentator also says that he cannot ac- 
count for the disease being called melancholic. 
41. In hypercatharsis, of old persons, hiccup supervening is not a good 
symptom. 
Hypercatharsis being dangerous in persons of all ages, must be 
peculiarly so in the case of old men, owing to their infirmities. 
Hence, as Heurnius remarks, we see the propriety of being guarded 
in administering drastic purgatives to old men. 
42. In a fever, which is not of a bilious nature, a copious affusion of 
hot water upon the head removes the fever. 
We have seen from the work, On Regimen in Acute Diseases, that 
our author used the affusion of hot water on the head in febrile dis- 
eases; here he speaks favorably of it, unless when the fever originates 
in bile. According to Damascius, he is to be understood as point- 
ing to ephemeral fevers, excepting those connected with inflammation 
of important parts, and those from putrefaction of the humors. 
Galen's elaborate Commentary comes to the same conclusion. Celsus 
speaks of this practice as being equivocal in the treatment of tertian 
fevers. These, we know, are connected with bile. 
43. A woman does not become ambidexterous. 
The only reason for women not having a dexterous use of both 
arms is, that being of a feeble constitution, they do not exercise both 
arms. The fact, however, may be questionable. 
44. When empyema is treated either by the cautery or incision, if pure 
and white pus flow from the wound, the patients recover; but if mixed 
with blood, slimy and fetid, they die. 
We have seen on several previous occasions that the ancients 
opened the chest in empyema either by the cautery or perforator. I 
have also stated in the Commentary on the Prognostics, that the 
ancients applied the term empyema not only to the collection of pus 
between the chest and the lungs, but also to cavities of the lungs 
arising from tubercular ulceration. It is worth remarking, that a APHORISMS. 
267 
few years ago a London surgeon attempted to introduce the operation of 
opening cavities in the lungs, which form in tubercular consumption. 
This, then, was but a revival of the ancient practice in such cases; 
but both in empyema, properly speaking, and in cavities of the lungs, 
paracentesis thoracis is a very equivocal operation. 
45. When abscess of the liver is treated by the cautery or incision, if the 
pus which is discharged be pure and white, the patients recover, (for in 
this case it is situated in the coats of the liver;) but if it resemble the lees 
of oil as it flows, they die. 
The account here given of the operation of opening an abscess in 
the liver is sufficiently intelligible of itself. One can readily believe 
that the result of the operation will depend upon whether the pus be 
good or not, and whether it be situated in the membrane or in the 
substance of the liver. Compare Celsus, ii., 8. For the results of 
modern experience on the subject of hepatic abscesses, see the Cyclo- 
paedia of Anatomy, Abnormal Anat. of the Liver. 
4G. Pains of the eyes are removed by drinking undiluted wine, plenteous 
bathing with hot water, and venesection. 
This is an abridgment of Aphor. vi., 31. Galen makes some 
very interesting remarks on this Aphorism, and the application of the 
various methods of treatment here enumerated, in the second chap- 
ter of the Third Book of Therapeutics. 
47. If a dropsical patient be seized with hiccup the case is hopeless. 
This is nearly the sanje as Aph. vi., 35. Theophilus does not 
hesitate to pronounce this, and all the Aphorisms which are repeated, 
to be supposititious, and not the work of Hippocrates. 
48. Strangury and dysuria are cured by drinking pure wine, and vene- 
section; open the vein on the inside. 
The ancient commentators explain this Aphorism as follows: 
When the diseases in question are connected with inflammation in the 
bladder, or a congestion of humors which obstruct the passage, the 
remedy is bleeding in the veins of the inner ankle or ham; but when 
produced by flatulent and viscid humors, they are best dispelled by 
drinking pure wine. 
49. It is a good sign when swelling and redness on the breast seize a 
person very ill of quinsy, for in this case the disease is diverted outwardly. 
This Aphorism is nearly the same as Aph. vi., 37. Galen sug- 
gests that it is supposititious. 
50. When the brain is attacked with sphacelus, the patients die in three 
days; or if they escape these, they recover. 
I have given my opinion regarding sphacelus of the brain pre- 
viously in this work, and at Paulus Book III., 7. The 268 
GENUINE WORKS OF HIPPOCRATES. 
commentators are all agreed that it signifies incipient mortification; 
it can mean nothing else in this place seemingly but ramollissement 
of the brain. See II. Morb. v., 2, 21, xx., 2, 8, 9, 10; VII. Epid. 
xxx., 7. It is proper to mention, however, that Heurnius and Littre 
prefer referring it to caries of the bone. 
51. Sneezing arises from the head, owing to the brain being heated, or 
the cavity (ventricle) in the head being filled with humors; the air con- 
fined in it then is discharged, and makes a noise, because it comes through 
a narrow passage. 
Galen gives an elaborate discussion on the subject of sneezing, but 
it contains little worth taking notice of. He held it to be a natural 
effort to expel substances which are creating irritation in the nasal 
passages, in like manner as coughing is for the like purpose in the 
respiratory. 
52. Fever supervening on painful affections of the liver removes the 
pain. 
The commentators are agreed that this Aphorism is not generally 
applicable in diseases of the liver; for example, in cases of inflamma- 
tion, but that it is to be restricted to those cases which are of a flatu- 
lent nature, or connected with obstruction. 
53. Those persons to whom it is beneficial to have blood taken from 
their veins, should have it done in spring. 
This is a repetition of Aph. vi., 47, with a slight omission. Galen 
contends that it must be supposititiorft. 
54. In those cases where phlegm is collected between the diaphragm 
and the stomach, and occasions pain, as not finding a passage into either 
of the cavities, the disease will be carried off if the phlegm be diverted to 
the bladder by the veins. 
We learn from Galen that Marinus, the celebrated anatomist, 
found difficulty in deciding where the phlegm was supposed to be 
lodged, and it does not appear quite clear what place is meant. Galen 
describes it as being below the diaphragm, and within the peritoneum of 
the epigastric region. It will be readily perceived from this Aphor- 
ism, that our author looks upon the veins as being the great instru- 
ments of absorption. 
55. When the liver is filled with water and bursts into the epiploon, in 
this case the belly is filled with water and the patient dies. 
Galen understands this case to refer to hydatids of the liver, but 
finds difficulty in explaining how they can burst into the epiploon 
unless by ulceration. It would seem as if our author meant the 
cavity of the peritoneum. See Galen and Littrc. Compare Praenot. 
viii., 6; Coac. iii., 276, 278; Affect, xxiii., 3-10; Int. Affect, xxvi., 2. APHORISMS. 
269 
56. Anxiety, yawning, rigor,-wine drunk with an equal proportion of 
water, removes these complaints. 
This Aphorism is based on the humoral pathology; the symptoms 
here mentioned are supposed to be connected with the prevalence of 
a flatulent humor, which is attenuated and dispelled by the hot wine. 
The construction of the sentence, as Galen remarks, resembles a 
solecism. Compare II. Epid. vi., 45; II. Morb. xxxviii., 6; Int. 
Affect, v., 14; II. Morb. Mui. Ixxxviii., 2. 
57. When tubercles (phymatd) form in the urethra, if they suppurate 
and burst, the pain is carried off. 
This is a repetition of Aph. iv., 82. 
58. In cases of concussion of the brain produced by any cause, the 
patients necessarily lose their speech. 
That a severe concussion of the brain, by occasioning a rupture of 
the nerves, will superinduce loss of speech cannot be doubted. The 
term here used (o'ezo'#/)), implies that the concussion was supposed to 
be violent. Compare Coac. iii., 370; I. Morb. iii., 34. 
59. In a person affected with fever, when there is no swelling in the 
fauces, should suffocation suddenly come on, and the patient not be able 
to swallow, except with difficulty, it is a mortal symptom. 
Galen remarks that this Aphorism is nearly the same as Aph. iv., 
40. It therefore does not stand in need of any commentary. 
59.* 1 In the case of a person oppressed by fever, if the neck be turned 
aside, and the patient cannot swallow, while there is no swelling in the 
neck, it is a mortal sign. 
This is nearly the same as Aph. iv., 35. 
60. Fasting should be prescribed for those persons who have humid 
flesh; for fasting dries bodies. 
By humid flesh is meant flesh abounding with humors. That 
fasting produces desiccative effects on the body is generally held by 
our author. Compare II. Diget. xxxviii., 1, 2; III. Diget. xvi., 12, 14; 
II. Prgedict. viii., 8., 13; Insomn. xv., 14, 15; Affect, xxviii., 2., 
xli., 7, 8, 11, 12. 
61. When there are changes in the whole body, and the body becomes 
sometimes cold and sometimes hot, and the color changes, a protracted 
disease is indicated. 
This is the same as Aph. iv., 40. 
62. A copious sweat, hot or cold, constantly flowing, indicates a super- 
1 Bis. It is so in Littre's edition. 270 
GENUINE WORKS OF HIPPOCRATES. 
abundance of humidity; we must evacuate then, in a strong person 
upward, and in a weak, downward. 
This Aphorism is nearly allied to Aph. iv., 42. On febrile sweats, 
see further Aph. iv., 41, 46, i., 21. It will be remarked that the 
treatment is founded on our author's favorite principle of revulsion; 
that is to say, of determining, in the present instance, from the skin 
to the internal viscera. Galen, however, inclines to think that it is 
interpolated. 
63. Fevers, not of the intermittent type, if they become exacerbated 
every third day are dangerous; but if they intermit in any form whatever, 
this shows that they are not dangerous. 
This is the same as Aph. iv., 43. Galen thinks it an interpola- 
tion here. 
64. In cases of protracted fever, either chronic abscesses or pains in the 
joints come on. 
This is the same as Aph. iv. 44. Galen thinks it an interpolation 
here. 
65. When chronic abscesses (phymatd) or pains in the joints take place 
after fevers, the patients are using too much food. 
This is the same as Aph. iv., 45. Galen thinks it an interpola- 
tion here. 
66. If one give to a person in fever the same food which is given to a 
person in good health, what is strength to the one is disease to the other. 
This most important principle in Therapeutics is strongly brought 
forth in the treatise On Ancient Medicine; indeed, our author, in 
that work, holds that it is the foundation of the whole art of 
medicine. See further, the treatise On Regimen in Acute Diseases, 
and more especially what is said in the Argument and notes on the 
administration of food in fevers. Galen is of opinion that the text 
has been tampered with; but it is not easy to make out exactly 
in what way, as the text of his commentary would appear to have 
undergone alterations. Compare Aph. ii., 10, vii., 67; Vet. Med. 
xii., 11. 
67. We must look to the urinary evacuations, whether they resemble 
those of persons in health; if not at all so, they are particularly morbid, 
but if they are like those of healthy persons, they are not at all morbid. 
Galen states certain verbal abjections to this Aphorism, which 
make him suppose that the language is not that of Hippocrates; it 
is evidently derived, however, from the great principle upon which 
the Hippocratic system of prognostics was founded, namely, the com- 
parison of morbid with healthy appearances. 
68. When the dejections are allowed to stand and not shaken, and a 
sediment is formed like scrapings (of the bowels), in such a case it is APHORISMS. 
271 
proper to purge the bowels; and if you give ptisans before purging, the 
more you give the more harm you will do. 
Galen holds decidedly that this Aphorism is supposititious. His 
Commentary contains many interesting things, but as they principally 
relate to verbal criticism, I shall not think of introducing them in 
this place. 
69. Crude dejections are the product of black bile; if abundant, of 
more copious, and if deficient, of less copious collections of it. 
This Aphorism is evidently supposititious, as maintained by Galen. 
It would appear, however, to be of very ancient date, since the very 
earliest of the commentators, namely, Herophilus, Bacchius, Hera- 
clides, and Zeuxis had found it in the copies which they used. Com- 
pare Aph. i., 22; and Judicat. viii., 12. Although I wish to avoid 
discussions on the text as much as possible, I cannot omit saying in 
this place, that I have not adopted the emendation of M. Littre, on 
the text of Galen, and that I prefer reading the passage relating to 
the earliest commentators as follows: car sgtiv 6 'HpocpiXos, Ba;t- 
Xeios-, 'HpaiiXsiSps, n. r. A. The article is joined to the name of 
Herophilus, to mark his greater celebrity than the others. Galen 
was in the practice of prefixing the article to the name of Herophilus. 
See the preface • to his work, entitled Explantio vocum Hippocratis. 
This, in fact, is in accordance with the classical usage of the article 
as a prefix to proper names. I have stated my opinions on this 
subject, fin Hermes Philologicus, p. 58, and English and Greek 
Lexicon, Edinburgh, 1840, under Master. 
70. The sputa in fevers, not of an intermittent type, which are livid, 
streaked with blood, and fetid, are all bad, it is favorable when this 
evacuation, like the urinary and alvine, passes freely; and whenever any 
discharge is suppressed and not purged off it is bad. 
This Aphorism is nearly the same as Aph. iv., 47. 
71. When you wish to purge the body, you must bring it into a state 
favorable to evacuations; and if you wish to dispose it to evacuations up- 
ward, you must bind the belly; and if you wish to dispose it to evacua- 
tions downward, you must moisten the belly. 
The first part of this Aphorism is taken from Aph. ii., 9; the 
remainder is supposed by Galen to be supposititious. 
72. Sleep and watchfulness, both of them, when immoderate, consti- 
tute disease. 
This Aphorism is repeated from Aphor. ii., 3. It would appear 
from Galen that he found it wanting in some of the copies which he 
had consulted. 
73. In fevers which do not intermit, if the external parts be cold, and 
the internal burning hot, and fever prevail, it is a mortal sign. 
This aphorism is copied from Aph. iv., 48., with certain alterations 
which are anything but improvements, as Galen has remarked. 272 
GENUINE WORKS OF HIPPOCRATES. 
74. In a fever which does not intermit, if a lip, the nose, or an eye be 
distorted, if the patient lose his sense of sight or of hearing, while now 
in a weak state,-whatever of these symptoms occurs it is mortal. 
This aphorism is repeated from Aph. iv., 49, which is founded on 
Prognost. iii. 
75. Upon leucophlegmatia dropsy supervenes. 
By leucophlegmatia, as formerly stated by me, was understood that 
state of the health which often precedes dropsy. See Aph. vii., 29. 
76. Upon diarrhoea dysentery. 
This is a repetition of Aph. vii., 6, but evidently, as Galen holds, 
much altered for the worse. 
77. Upon dysentery lientery. 
This, as remarked by Galen, is a portion of Aph. vi., 43. 
78. Upon sphacelus exfoliation of the bone. 
As Galen remarks, the word " supervenes" (eTtiyivETai) is to be 
understood in this as in the three preceding Aphorisms. He further 
remarks that there is an ambiguity in the term sphacelus, which may 
either apply to disease of the bone (that is to say caries or necrosis), 
or to that of the soft parts (meaning gangrene). 
79 and 80. Upon vomiting of blood consumption, and a purging of pus 
upward; upon consumption a defluxion from the head; upon a defluxion 
diarrhoea; upon diarrhoea a stoppage of the purging upward; upon the 
stoppage of it death. 
As is remarked by Galen in his Commentary, the present Aphorism 
is evidently made up from Aph. vii., 15, 16, incorrectly put together. 
81. In the discharges by the bladder, the belly, and the flesh (the skin ?) 
if the body has departed slightly from its natural condition, the disease is 
slight; if much, it is great; if very much, it is mortal. 
This, according to Galen, is the last of the Aphorisms in most of 
the copies, and yet, he adds, some of them have certain others com- 
posed from the genuine Aphorisms of our author, with more or fewer 
additions. The present Aphorism, he states, is composed of several 
of the preceding Aphorisms, which embody our author's doctrines 
respecting the evacuations. 
82. Persons above forty years of age who are affected with frenzy, do 
not readily recover; the danger is less when the disease is cognate to the 
constitution and age. 
This Aphorism is founded on Aph. ii., 34, and Aph. ii., 39. APHORISMS. 
273 
83. In whatever diseases the eyes weep voluntarily, it is a good symp- 
tom, but when involuntarily, it is a bad. 
This is a repetition of Aph. iv., 52. It is thus rendered by Celsus, 
" sine voluntate lacrimare," ii., 4. By " voluntarily " is meant seem- 
ingly " from a motive." 
84. When in quartan fevers blood flows from the nostrils it is a bad 
symptom. 
This Aphorism is legitimately founded on the following passages: 
Coac. ii., 37, 38., iii., 433, VI. Epid. ii., 40. I see no reason, then, 
why it should not be received as genuine. 
85. Sweats are dangerous when they do not occur on critical days, when 
they are strong, and quickly forced out of the forehead, either in the form 
of drops or in streams, and if excessively cold and copious; for such a 
sweat must proceed from violence, excess of pain, and prolonged squeez- 
ing (affliction?') 
This Aphorism is doubtfully formed from the following passages: 
Judicat. vi., 9; Praenot. v., 4; I. Praedict. v., 7; Coac. iii., 91., iv., 
38, 39; Viet. Acut. liii., 8, 9. 
86. In a chronic disease an excessive flux from the bowels is bad. 
I know not whence this Aphorism is derived, and the language 
creates a suspicion as to its genuineness. The expression here used 
for " an excessive flux of the bowels " (noikir/s naracpopf), does not 
occur elsewhere, as far as I am aware. 
87. Those diseases which medicines do not cure, iron (the knife ?) cures; 
those which iron cannot cure, fire cures; and those which fire cannot cure, 
are to be reckoned wholly incurable. 
This Aphorism is celebrated in modern literature, but as far as I 
can recollect, it is nowhere alluded to by any ancient author, and 
being transferred to this place from Section viii., there must be ad- 
mitted to be considerable reason to question its genuineness. It is 
valuable, however, as containing a striking classification of the reme- 
dial means used in the practice of medicine. The only passage in 
the Hippocratic treatises at all parallel to it, is contained in the work 
De Arte, xiii., 12-18. 
Vol. II.-18. THE OATH. THE OATH. 
THE ARGUMENT. 
This piece, as was stated in the Preliminary Discourse, is often referred 
to by ancient authors, and there seems little or no reason for questioning 
its authenticity. It is an interesting document, as exhibiting the practi- 
tioners of medicine in a very remote age, already formed into a regular cor- 
poration, bound by an oath to observe certain regulations, and having 
regular instructors in the art. The present piece would seem to be an 
indenture between a physician and his pupil; and it is most honorable to 
the profession, that so ancient a document pertaining to it, instead of 
displaying a narrow-minded and exclusive selfishness, inculcates a generous 
line of conduct, and enjoins an observance of the rules of propriety, and 
of the laws of domestic morality. 
There are few things in it which require either illustration or comment. 
M. Littre finds some difficulty in accounting for the circumstance that 
the noviciate in the art is interdicted from the practice of lithotomy. It 
is certain, however, that this operation was in antiquity always practiced 
by a separate class of operators, and that the regular members of the pro- 
fession never meddled with it, on any account. Hence, in the whole 
compass of ancient medical literature, there is not a single description of 
the operation by a person who himself had actually performed it. Thus 
no mention of it is made in the Hippocratic treatises, although there is 
the clearest evidence that our author used to perform all the regular 
operations then recognized by the profession as legitimate. Galen also 
speaks of bold operations performed by him on the head and chest, but 
he never once hints that he meddled with the operation of lithotomy. 
The descriptions of the operation given by Celsus and Paulus JEgineta are 
evidently copied. The Arabians were, if possible, still more prejudiced 
against lithotomy; for Avenzoar pronounces the operation be to one, 
which no respectable physician would witness, and far less perform.1. 
And even in this country, at least in the North of Scotland, not perhaps 
much more than a hundred years ago, it was common for lithotomy to be 
performed by non-professional persons. Thus I remember having been 
told in my youth, by an old man residing in the district of Aberdeen- 
shire, called Cromar, that in his younger days there was a miller in that 
Hi., 27. 278 
GENUINE WORKS OF HIPPOCRATES. 
part of the country who was very famous for cutting persons for the stone. 
In many parts of the East the operation is still cultivated as a separate 
branch of the profession. See the Commentary on Paulus JEgineta, 
Vol. II., p. 363. One, therefore, need not be at all surprised at our 
author's interdicting his pupils from the performance of an operation 
which, at that time, was not reckoned respectable. It is true that, as will 
be seen in our notice of the Books on Diseases, he makes mention there 
of the process of sounding a patient for the purpose of discovering whether 
or not there was a stone in the bladder; we can well suppose, however, 
that the general practitioner might be called upon to pronounce upon the 
nature of a case, although he had nothing to do with a particular opera- 
tion practiced for the relief of it. At all events, there can be no doubt 
that, in ancient times, lithotomy was intrusted to a set of operators sepa- 
rate from the general profession. Why this operation in particular was 
proscribed, cannot indeed be satisfactorily ascertained; but the fact is as 
I have stated, that, through all antiquity, the higher medical authorities 
had nothing to do with it. The conjecture then advanced by Rene 
Moreau,1 that castration, and not lithotomy, was meant in this place, 
appears to me utterly inadmissible, and is rejected by M. Littre in his 
Argument to this piece. 
THE OATH. 
I swear by Apollo the physician, and 2Esculapius, and Health, and 
All-heal,5 and all the gods and goddesses, that, according to my ability 
'Th. Bartholini Epist., Cent. I., epist. Ixxxi. 
2 Every person who is at all acquainted with ancient literature must be aware 
that Apollo, in the mythology of the Greeks and Romans, was regarded as the 
healing god. In this capacity he appears in the very beginning of the Iliad, as the 
divinity who causes and removes the pestilence; and in the Homeric Hymn to 
Apollo he is introduced in the same capacity. Hence the epithet " healing " (h/Zof) 
is applied to him by Sophocles (CEd. Tyr., 154.); and its synonyme, "the healer" 
or "the physician" (ir/rpbc), by our author in this place. The beautiful lines of 
Ovid, in reference to the healing powers of Apollo, are in everybody's mouth: 
" Inventum Medicina meum est; opiferque per orbem 
Dicor, et herbarum subjecta potentia nobis." (Met. i., 521.) 
Aesculapius was universally represented as the son of Apollo, according to 
Pindar, the contemporary of our author, by the nymph Coronis (Pyth. hi.); but 
according- to the later myths, by Arsinoe (Apollodor. Bibl. hi., 10). I need scarcely 
say that he was the patron-god of the Asclepiadse, or priest-physicians, to which 
order Hippocrates belonged. In the ancient systems of mythology he is described 
as having two sons, Podalirius and Machaon, and four daughters, AZgle, Jaso, 
Hygeia, and Panacea. Of these it will be remarked that our author notices only 
the two last, whose names are here rendered Health and All-heal. Sprengel 
(Hist, de la M6d. tom. i., p. 468, and ix., 208) argues from this invocation of Apollo THE OATH. 
279 
and judgment, I will keep this Oath and this stipulation-to reckon him 
who taught me this Art equally dear to me as my parents, to share my 
substance with him, and relieve his necessities if required; to look upon his 
offspring in the same footing as my own brothers, and to teach them this 
art, if they shall wish to learn it, without fee or stipulation; and that by 
precept, lecture,1 and every other mode of instruction, I will impart a 
knowledge of the Art to my own sons, and those of my teachers, and to 
disciples bound by a stipulation and oath according to the law of medi- 
cine, but to none others. I will follow that system of regimen which, 
according to my ability and judgment, I consider for the benefit of my 
patients, and abstain from whatever is deleterious and mischievous. I 
will give no deadly medicine to any one if asked, nor suggest any such 
counsel; and in like manner I will not give to a woman a pessary to 
produce abortion.2 With purity and with holiness I will pass my life and 
as a healing divinity, along with Hygeia and Panacea, that this treatise must 
have emanated from the school of Alexandria; I can see no force, however, in this 
argument. 
1 There has been considerable difference of opinion what the two kinds of in- 
struction are which Hippocrates adverts to here. See Zuinger, Foes, and Littre. 
The most probable supposition appears to be, that the former applies to general 
precepts, and the latter to professional lectures. Of the one we have a good speci- 
men in the Hippocratic treatise entitled the Preecepts (napay-yeMac), and of the 
other in the Auscultationes Naturales (aKp6aoEQ of Aristotle. That our 
author delivered public lectures in the cities he visited there can be no doubt, for 
he is so represented by his contemporary, Plato, in his Protagoras. It will be 
seen, however, from this piece, that he his instruction to his own family 
and that of his teachers, .and to such pupils as were bound by a regular stipula- 
tion or indenture. 
2 We have here another notable instance how much our author was superior to 
his age in humanity as well as in intelligence; for his contemporary, or rather his 
immediate successor, Aristotle, though the son of a physician, and although there 
be some reason to suppose that he was a dabbler in drugs before he betook himself 
to philosophy, treats very gravely of the practice of procuring abortion, and does 
not at all object to it, if performed before the child had quickened. (Polit. vii., 
21.) Plato also alludes to the practice. (Thesetetus.) Juvenal, in his Sixth Satire, 
speaks of artificial abortion as being a very common practice among the higher 
class of females in his time. The mode of procuring abortion is regularly de- 
scribed by Avicenna (iii., xxi., 212), and by Phases (Contin. vii., 2),-not, however, 
to be applied for any wicked purpose, but in the case of women of small stature 
who had proved with child. The means recommended by these authors are, 
severe bleeding, especially from the ankle; leaping from a height; the adminis- 
tration of emmenagogues; the application of pessaries medicated with hellebore, 
stavisacre, mezereon, and the like; but more especially forcible dilatation of the 
os tineas with a roll of paper, or a tube made of polished wood, or a quill. There 
can be no doubt, in short, that the ancients had anticipated all our modern 
methods of inducing premature delivery. Avicenna, moreover, also speaks of 
accomplishing the same purpose by fumigations, a mode which I believe has not 
been thought of in recent times since this operation was revived, but which one 280 
GENUINE WORKS OF HIPPOCRATES. 
practice my Art. I will not cut persons laboring under the stone, but 
will leave this to be done by men who are practitioners of this work. Into 
whatever houses I enter, I will go into them for the benefit of the sick, 
and will abstain from every voluntary act of mischief and corruption; 
and, further, from the seduction of females or males, of freemen and 
slaves. Whatever, in connection with my professional practice or not, in 
connection with it, I see or hear, in the life of men, which ought not to 
be spoken of abroad, I will not divulge, as reckoning that all such should 
be kept secret. While I continue to keep this Oath unviolated, may it 
be granted to me to enjoy life and the practice of the art, respected by all 
men, in all times I But should I trespass and violate this Oath, may the 
reverse be my lot 1 
can readily suppose well calculated to destroy the foetus when that was the inten- 
tion. I may mention, by the way, that fumigation of the uterus was freely prac- 
ticed by the medical authorities of the sixteenth century. An excellent drawing 
of an apparatus for this purpose is given in the works of Ambrose Pare, xxiii., 48. THE LAW. THE LAW. 
THE ARGUMENT. 
It is not easy to define accurately what the object of this little tract 
is, nor the exact sense in which the term "Law" is to be here taken. 
The writer, apparently, wishes to sketch the beau ideal of a perfect 
physician, and in this point of view the title of the work would rather 
deserve to be rendered "the Standard" than "the Law." Zuinger, in 
his annotations on it, remarks that, as in civil society there is an universal 
precept, applying to all the citizens, the arbiter of right and wrong, so in 
the medical commonwealth, there is a certain law which serves as a rule, or 
gnomon, by which true physicians are distinguished from the false. This 
piece, then, as I have said, is apparently meant as an ideal sketch of what 
a true physician ought to be, and it gives the traits by which the real are 
to be distinguished from the false. No one will venture to deny that the 
outline is drawn with great ability, and therefore the work cannot fail to 
be read with interest, whether it be regarded as the production of Hip- 
pocrates himself or of one of his immediate successors. 
THE LAW. 
1. Medicine is of all the Arts the most noble; but, owing to the 
ignorance of those who practice it, and of those who, inconsiderately, 
form a judgment of them, it is at present far behind all the other arts. 
Their mistake appears to me to arise principally from this, that in the 
cities there is no punishment connected with the practice of medicine (and 
with it alone) except disgrace,1 and that does not hurt those who are 
familial- with it. Such persons are like the figures2 which are introduced 
1 In this passage it would seem to be asserted, that in the time of the writer 
there was no punishment of mala praxis except the disgrace which it entailed. 
Many other passages in the Hippocratic treatises would lead to the inference that 
a more severe responsibility attached to the physician for unfortunate practice; 
as we often find the practitioner warned not to have anything to do with certain 
cases. Here the author of this treatise seems to reg'ret the want of a proper med- 
ical police. 
2 It is not quite clear what is meant by figures (7rpo<TW7ro«7i) in this place. Zuin- 284 
GENUINE WORKS OF HIPPOCRATES. 
in tragedies, for as they have the shape, and dress, and personal appear- 
ance of an actor, hut are not actors, so also physicians are many in title 
but very few in reality. 
2. Whoever is to acquire a competent knowledge of medicine, ought 
to be possessed of the following advantages: a natural disposition; instruc- 
tion; a favorable position for the study; early tuition; love of labor; 
leisure. First of all, a natural talent is required; for, when Nature opposes, 
everything else is in vain; but when Nature leads the way to what is most 
excellent, instruction in the art takes place, which the student must try 
to appropriate to himself by reflection, becoming an early pupil in a place 
well adapted for instruction. He must also bring to the task a love of 
labor and perseverance, so that the instruction taking root may bring 
forth proper and abundant fruits.1 
3. Instruction in medicine is like the culture of the productions of 
the earth. For our natural disposition is, as it were, the soil; the tenets 
of our teacher are, as it were, the seed; instruction in youth is like the 
planting of the seed in the ground at the proper season; the place where 
the instruction is communicated is like the food imparted to vegetables by 
the atmosphere; diligent study is like the cultivation of the fields; and it 
is time which imparts strength to all things and brings them to maturity.2 
4. Having brought all these requisites to the study of medicine, and 
having acquired a true knowledge of it, we shall thus, in traveling through 
the cities,3 be esteemed physicians not only in name but in reality. But 
ger understands by it the mutes introduced on the stage along with the real ac- 
tors who spoke their part. Foes rather understands it as applying to masks, 
or inanimate figures, and this seems to me the most natural interpretation of the 
term. 
1 The requisite advantages towards acquiring eminence in the art of medicine 
are here given with much precision. There is a manifest resemblance between 
this passage and the description given by Quintilian of the requisites which the 
student of rhetoric ought to possess in order to attain eminence in his art. 
The passage in question is so striking, that I shall not scruple to introduce it here, 
and shall only remark beforehand, that as Quintilian was certainly not unacquain- 
ted with the works of Hippocrates (Inst. Orat. III., 6), he may have had the pres- 
ent tract in view when he wrote as follows: " Illud tamen in primis testandum 
est, nihil praecepta atque vires valere, nisi adjuvante natura. Quapropter ei cui 
deerit ingenium, non magis haec scripta sunt, quam de agrorum cultu sterilibus 
agris. Sunt et aliaingenita quidem adjumenta, vox, latus patiens laboris, vale- 
tudo, Constantia, decor: quae si modica obtigerunt, possunt ratione ampliari; sed 
nonnunquam ita desunt, ut bona etiam ingenii studiique corrumpant: sicut et haec 
ipsa sine doctore perito, studio pertinaci, scribendi, legendi, dicendi multa etcon- 
tinua exercitatione, per se nihil prosunt." Inst. Orat. Proem. (6.) 
2 The points of comparison in this paragraph are placed in a striking point of 
view, but the style of writing rather savors of a later age than that of our au- 
thor. 
3 The author here evidently refers to the practice of the periodeutce, or travel- 
ing physicians. 285 
THE LAW. 
inexperience is a bad treasure, and a bad fund to those who possess it, 
whether in opinion or reality,1 being devoid of self-reliance and contented- 
ness, and the nurse both of timidity and audacity. For timidity betrays 
a want of powers, and audacity a want of skill. There are, indeed, two 
things, knowledge and opinion, of which the one makes its possessor really 
to know, the other to be ignorant. 
5. Those things which are sacred, are to be imparted only to sacred 
persons; and it is not lawful to impart them to the profane until they 
have been initiated in the mysteries of the science. 
1 See Foes, CEc. Hipp, in voce wrap. ON ULCERS. ON ULCERS. 
THE ARGUMENT. 
I have stated in the Second Section of the Preliminary Discourse, the 
reasons which determined me to allow this treatise a place among the 
genuine works of Hippocrates, and I need only add further here, that a 
careful reconsideration of the subject has confirmed me in the judgment 
on it which I then announced. When we take into account the positive 
manner in which Galen, on very many occasions, dwells upon its contents 
with the fullest confidence that they are the opinions of our author, and 
reflect that all the subsequent authorities, including those of the Arabian 
and Roman periods, and the learned restorers of ancient surgery in the 
fifteenth and sixteenth centuries, agreed in recognizing it as authentic, I 
cannot see how, consistently with the principles upon which it is now 
generally admitted that questions regarding the genuineness of ancient 
works should be settled we could be at all warranted in rejecting it without 
disputing the claims of the greater number of treatises contained in the 
small list of the. Hippocratic works which are still acknowledged as 
genuine. Certain it is, at all events, that the evidence in support of this 
treatise is far greater than that upon which the treatises " On Ancient 
Medicine," and " The Law, " have been sustained as being the produc- 
tions of Hippocrates. We shall be better able, however, to judge whether 
the external evidence in this case be confirmed or neutralized by the in- 
ternal, when we have taken a careful inspection of its contents. 
In the beginning of it there is given an exposition of the principles 
upon which ulcers are to be treated. Agreeably to the great rule of 
medical practice, so often inculcated in the Hippocratic treatises, namely, 
that " diseases are to be cured by their contraries," he argues that as a 
sound part of the body is dry, and an ulcerated, moist, drying or desic- 
cant things are indicated in the cure of wounds and sores, and conse- 
quently we must avoid using all liquid things, with the exception of wine, 
for which he claims an especial indulgence, owing, no doubt, to its being 
possessed of desiccant powers. A low diet is particularly enjoined when 
a sore shows any tendency to gangrene, and especially in ulcers of the 
joints and thigh, when there is danger of spasm (tetanus ?), and in injuries 
of the head, when complicated with fracture. Rest is particularly en- 
joined, and all severe exercise proscribed. Two opposite modes of practice 
Vol. IL-19. 290 
GENUINE WORKS OF HIPPOCRATES. 
are mentioned in the treatment of recent wounds,-either to promote a 
healthy suppuration or to use means for preventing the formation of pus. 
The discharge of blood from a fresh wound is to be encouraged, and in 
old ulcers the callous edges are to be scarified in order to evacuate the 
unhealthy blood. After the discharge of the blood, the part is to be 
covered with a piece of sponge, and some slender leaves placed over it. 
As a general rule, oil, and all greasy things, are to be avoided in the 
treatment of ulcers. But, if used at all, they answer best in cold and hot 
weather. (See § 1.) 
Gentle purging is recommended for most ulcers, and in wounds of the 
head, belly, and joints, in gangrenous and other intractable sores, and in 
those requiring sutures. The sore is to be frequently wiped with a sponge, 
and a dry piece of clean cloth is to be applied. Mild weather is favorable 
to the healing of wounds, and heat is preferable to cold. Ulcers which 
are foul, will not heal until they are cleansed. When the parts adjoining 
to a sore are inflamed or gangrenous, or when there is a varix in a part, 
the sore will not heal. (§ 2.) 
Circular sores are to be treated by having their edges scarified. When 
erysipelas supervenes, emetics or purgatives are to be administered. 
When the parts around the sore are swollen, a cataplasm is to be applied 
to the adjoining parts, but not to the sore itself, in order to allow a free 
discharge of the pus. After the swelling has subsided, a bandage is to be 
applied, so as to bring the separated parts close to one another. Any 
piece of flesh which prevents the lips from coming close together, is to be 
removed. Sponges, with leaves above them, as formerly directed, are to 
be placed on the sore. (§ 3.) 
In the next paragraph our author gives minute directions for prepar- 
ing cataplasms, consisting of various ingredients of a desiccative and 
emollient nature, such as mullein, linseed, and the like. These are either 
to be laid on the sore, or with a clean piece of cloth wetted in wine and 
oil, applied next to the sore. (§ 4.) 
In the next paragraph are described several preparations, mostly of a 
desiccative and caustic nature, for the treatment of ulcers. The object 
is sometimes not very accurately defined, but it is impossible not to see, 
in certain cases, that they are prescribed for the purpose of producing a 
superficial slough or scab, in order to imitate one of nature's modes of 
effecting a cure. Of the articles entering into the composition of these 
medicinal preparations, the flowers of copper, myrrh, pomegranate rind, 
and galls are some of the most important. (§ 5.) 
In the sixth paragraph there are two prescriptions for the purpose of 
preventing inflammation, and for cleansing foul ulcers. They are strongly 
discutient and detergent. 
In the seventh there are also some very important prescriptions, evi- 
dently meant to act upon the principle of producing a scab upon the sore: ULCERS. 
291 
of these, one, to which I. would direct attention, consists Of the impure 
sulphate of copper, alum, and elaterium. (See the Annotations.) It is 
said to be very efficacious in removing warts from the genital member. 
The eighth contains some prescriptions for medicines which are rep- 
resented as being sarcotic, or incarnative, that is to say, calculated to 
promote the filling up of hollow sores. They are mostly of a detergent 
and desiccative nature, such as linseed, the fatty part of a fig, horehound, 
and the like. The principle upon which they are applied, is not stated by 
our author. 
In the ninth paragraph is described the composition of a medicinal 
preparation called caricum, consisting of strong escharotic and septic 
articles, such as hellebore, the flakes of copper, arsenic, and cantharides. 
It is evidently meant to be used for the purpose of removing the morbid 
parts of indolent and malignant ulcers, and with this view, it would be 
difficult, even at the present day, to find ingredients more likely to be 
efficacious. 
In the tenth paragraph, likewise, there are given various prescriptions, 
consisting of articles mostly of a corrosive nature, such as misy and chal- 
citis, which, as explained in the Annotations, there is every reason to 
regard as having been mere varieties of the chalcanthos, or impure native 
sulphate of copper. In the text these applications are designated as being 
adapted to fresh wounds, but, as stated in the Annotations, there is 
reason to suppose that there is some mistake about this title. 
In the eleventh is described an application for old ulcers and sections 
of tendons, consisting of melilot, myrtle, and a herb which probably was 
some species of the Tormentilla or Potentilla. 
In the twelfth there are various prescriptions for preparations des- 
ignated as emollient, and the term, although questioned by some of the 
earlier commentators in modern times, seems not so very inappropriate, 
as they all consist, in a great measure, of axunge, oil, ceruse, wax, the 
grease of a goose, and so forth. 
The thirteenth treats of burns; for these are recommended things of a 
cooling and digestive nature without pungency. The roots of the ilex 
boiled in wine or water until of the consistence of a liniment, are partic- 
ularly mentioned. The squill is an ingredient in the composition of 
several of these prescriptions. 
In the fourteenth paragraph is laid down the treatment of oedemata, 
or swellings in the feet, the particular nature of which, however, is not 
sufficiently defined. Scarifications are much recommended in the treat- 
ment of them. 
The treatment of varix by puncture is briefly noticed in the fifteenth 
paragraph. 
The operation of venesection, and the various circumstances relating 
to it, are briefly noticed in the sixteenth. 292 
GENUINE WORKS OF HIPPOCRATES. 
The last paragraph is devoted to the description of the operation of 
cupping. As the contents of the last two paragraphs are foreign to the 
subject on hand, there is some reason for suspecting them to be an 
appendix to the treatise. 
From this brief outline of its contents, it will be readily admitted that 
the work is one of considerable importance, and it appears to me that, 
when fairly regarded, there is nothing in it at all derogatory to the high 
reputation of our author. That it is in some respects defective, and 
contains matters foreign to the professed object of the treatise, must, 
perhaps, be admitted, but the same objections apply to certain other 
treatises which are generally recognized as being genuine. That it con- 
tains much valuable matter will scarcely be questioned by any practical 
surgeon; indeed, one cannot fail to remark with astonishment, how many 
of the general principles upon which ulcers of all descriptions are now 
treated, may be traced out in the present work. In particular, it will be 
remarked that the mode of treating ulcers by the formation of a scab, 
which was much approved of by Hunter and his friend, Sir Everard 
Home, and also that the method of curing indolent ulcers by applications 
which produce sloughing of their callous edges are recommended in this 
treatise. 
Rest, and a spare diet, it will further be remarked, are held by our 
author to be the best remedial means for promoting the cure of an ulcer, 
and he particularizes gangrenous sores as being more especially benefited 
by this plan of treatment. This is a rule of practice about which there 
is great difference of opinion among our surgical authorities at the present 
time, some of them, in gangrene of the toes, contending for the stimu- 
lant, and others for the opposite plan of treatment. It will be seen, then, 
that the latter have Hippocrates on their side, and along with him a whole 
host of ancient authorities.1 While upon this subject I may take the 
opportunity of mentioning that the stimulant plan of treatment is not at 
all of long standing, for, as far as I am aware, all the earlier modern 
authorities in surgery are advocates for the mild plan of cure. I shall 
onlytake time to refer to one of the best authorities of the sixteenth cent- 
ury-Tagault.2 
The views of our author in directing the choice of incarnants, or sar- 
cotic medicines, are not very clear, and yet such as they are, they guided 
the practice of the profession for full two thousand years. For example, 
Galen expounds the principle fully, professing to have adopted it from 
Hippocrates, in the fourth book of his work, " On Therapeutics," and 
gives his most decided adherence to it. The same principles are ex- 
pounded and advocated by Avicenna,3 and Haly Abbas.4 In like manner, 
1 See in particular, Avicenna, I., iv., 28. 
2 Inst. Chirurg. i., 7. 
!L, iv., 28. 
4Pract. iv., 18. ULCERS. 
293 
Tagault contends that an incarnant medicine should consist of articles 
which are moderately desiccative and detergent.1 Very similar views are 
also advocated by Holler, another surgical authority of about the same 
age.2 Like Tagault he holds that the best sarcotics consist of articles which 
are moderately detergent and desiccative. Much the same principles are 
laid down by Marianus Sanctus.3 
ON ULCERS. 
1. We must avoid wetting all sorts of ulcers except with wine,4 unless 
the ulcer be situated in a joint. For, the dry is nearer to the sound, and 
the wet to the unsound, since an ulcer is wet, but a sound part is dry. 
And it is better to leave the part without a bandage unless a cataplasm 
be applied. Neither do certain ulcers admit of cataplasms, and this is the 
case with the recent rather than the old, and with those situated in joints. 
A spare diet and water agree with all ulcers, and with the more recent 
rather than the older; and with an ulcer which either is inflamed or is 
about to be so; and where there is danger of gangrene; and with the 
ulcers an inflammation in joints; and where there is danger of convul- 
sion; and in wounds of the belly; but most especially in fractures of the 
head and thigh, or any other member in which a fracture may have 
occurred.6 In the case of an ulcer, it is not expedient to stand; more 
especially if the ulcer be situated in the leg; but neither, also, is it proper 
to sit or walk.0 But quiet and rest are particularly expedient.7 Recent 
ulcers, both the ulcers themselves and the surrounding parts, will be least 
exposed to inflammation, if one shall bring them to a suppuration as 
expeditiously as possible, and if the matter is not prevented from escaping 
1 De Vulner. i. 
2 De Med. Chirurg., vi., 8. 
3 De Ulcer., iii. 
4 Dr. Hosack mentions the use of wine as a dressing to wounds among the im- 
provements in surgical practice, which the profession might derive from a study 
of Hippocrates. It is, in fact, often used in this way by the French surgeons. 
Galen, adhering to the principle here laid down, extends in so far the application 
of it: he says, the most proper thing to be used is wine, or oxycrate, or the decoc- 
tion of an austere herb; that is to say, thing's possessed of a desiccant power. 
(Meth. Med., iv.) Upon the whole, however, he prefers wine, (iii., 4.) 
6 It will be remarked that our author in this work, as in the preceding one, On 
the Articulations, is a decided advocate for a low diet and very mild treatment in 
the management of recent ulcers. 
6 Galen comments upon this rule of practice in his work, On Trembling. 
1 Celsus renders this sentence as follows: " Optimum etiam medicamentum 
quies est; mover! et ambulare nisi sanis alienum.7' (v.) 294 
GENUINE WORKS OF HIPPOCRATES. 
by the mouth of the sore; or, if one should restrain the suppuration, so 
that only a small and necessary quantity of pus may be formed, and the 
sore may be kept dry by a medicine which does not create irritation.1 For 
the part becomes inflamed when rigor and throbbing supervene; for ulcers 
then get inflamed when suppuration is about to form. A sore suppurates 
when the blood is changed and becomes heated; so that becoming putrid, 
it constitutes the pus of such ulcers.2 When you seem to require a cata- 
plasm, it is not the ulcer itself to which you must apply the cataplasm, 
but to the surrounding parts, so that the pus may escape and the hardened 
parts may become soft. Ulcers formed either from the parts having been 
cut through by a sharp instrument, or excised, admit of medicaments for 
bloody wounds (evaipia), and which will prevent suppuration by being 
desiccant to a certain degree.3 But, when the flesh has been contused 
1 Vidus Vidius understands the last clause of this sentence (papuaia) fit) TreptcKshet) 
in a different sense; he readsand explains these words as follows: "vinculum 
non postulant, jure autem ita Latinum fecimus. Nani -epicKE/oc Graece subliga- 
culum significat, nec quidquam verisimilus nobis visum est, quam Hippocrateni 
loqui de medicamento quod non alligetur." He understands it, then, to mean an 
application which does not require to be kept on the place by a tight bandage. 
The reader will remark that, in this place, our author mentions two opposite 
modes of treating fresh ulcere, namely, either by promoting moderate suppura- 
tion, or by using means to check it. The text, indeed, is in an equivocal state, 
but I can make no mote of it. In the work, On Female Complaints, the author 
lays down the principles for managing the treatment of ulcers as follows: "In 
order to cure ulcers they are to be kept free of inflammation, and cleansed, and 
filled up, and brought to cicatrization; water is to be given for drink, but not 
wine ; little food, and by no means a full diet." (Lib. i.) These rules, in the 
main, it will be remarked, agree with those here laid down, only no mention is 
made of any means being used to promote suppuration; but every person 
acquainted with practice is aware that a healthy suppuration is one of the best 
means of preventing inflammation. 
2 Our author here, as elsewhere, assumes that pus is nothing else but vitiated 
blood. Vidus Vidius holds that this is a fact so evident as not to require any 
proof. It certainly must be admitted to be highly probable, and yet the chemical 
authorities of the day are not agreed on this point. See Simon's Chemistry, vol. 
ii., p. 86; and Berard, Diet, de Med., tom xxvi. The French physiologists seem 
to deny that pus is a direct transformation of the blood. 
3 The class of applications here referred to are described more fully by Celsus 
than by any other ancient author. The object of them all would appear to be to 
effect a cure by the formation of a scab upon the sore. The words of Celsus are : 
" Ex emplastris autem nulla majorem usum prsestant, quam quae cruentis protinus 
vulneribus injiciuntur ; evatpa Graeci vocant. Haec enim reprimunt inflamma- 
tionem, nisi magna vis earn cogit, atque illius quoque impetum minuunt; turn 
glutinant vulnera, quae id patiuntur, cicatricem iisdem inducunt; constant autem 
ex medicamentis non pinguibus, ideoque ahtiraivr] nominantur." He gives pre- 
scriptions for no fewer than twenty-eight ointments of this class. Of these, the 
first consists of verdigris, litharge, alum, dried pitch, dried pine-rosin, with a 
portion of oil and vinegar, (v., 19.) ULCERS. 
295 
and roughly cut by the weapon, it is to be so treated that it may suppurate 
as quickly as possible; for thus the inflammation is less, and.it is neces- 
sary that the pieces of flesh which are bruised and cut should melt away 
by becoming putrid, being converted into pus, and that new flesh should 
then grow up. In every recent ulcer, except in the belly, it is expedient 
to cause blood to flow from it abundantly,1 and as may seem seasonable; 
for thus will the wound and the adjacent parts be less attacked with 
inflammation. And, in like manner, from old ulcers, especially if situated 
in the leg, in a toe or finger, more than in any other part of the body. 
For when the blood flows they become drier and less in size, as being thus 
dried up. It is this (the blood ?) especially which prevents such ulcers 
from healing, by getting into a state of putrefaction and corruption. 
But, it is expedient, after the flow of the blood, to bind over the ulcer a 
thick and soft piece of sponge, rather dry than wet, and to place above 
the sponge some slender leaves. Oil, and all things of an emollient and 
oily nature, disagree with such ulcers, unless they are getting nearly well. 
Neither does oil agree with wounds which have been recently inflicted, 
nor yet do medicines formed with oil or suet, more especially if the ulcer 
stands in need of more cleansing. And, in a word, it is in summer and 
in winter that we are to smear with oil these sores that require such 
medicines.2 
2. Gentle purging of the bowels agrees with most ulcers, and in wounds 
of the head, belly, or joints, where there is danger of gangrene, in such 
as require sutures, in phagedaenic, spreading and in otherwise inveterate 
ulcers.3 And when you want to apply a bandage, no plasters are to be 
used until you have rendered the sore dry, and then indeed you may apply 
them.1 The ulcer is to be frequently cleaned with a sponge, and then a 
dry and clean piece of cloth is to be frequently applied to it, and in this 
way the medicine which it is supposed will agree with it is to be applied, 
either with or without a bandage. The hot season agrees better than 
winter with most ulcers, except those situated in the head and belly; but 
the equinoctial season agrees still better with them. Ulcers which have 
been properly cleansed and dried as they should be, do not usually get 
1 Vidus Vidius remarks on this passage, that the rule of practice here stated 
by Hippocrates, namely, that a discharge of blood from a recent ulcer is highly 
beneficial, had been injudiciously departed from by surgeons in his time, who 
usually made haste to stop the flow of blood as quickly as possible. The same 
remark 4nay apply to the surgical practice of the present age. 
2 What our author here remarks on oil as an application to sores, deserves to 
be seriously considered. I cannot but think that at the present time it is often 
very injudiciously applied to fresh wounds. 
3 Galen approves highly of this practice, the merits of which he discusses fully. 
(Meth. Med., iv., 6.) 
4 The text here is in a very unsatisfactory state. What I have given appears 
to be the most natural sense of the passage. 296 
GENUINE WORKS OF HIPPOCRATES. 
into a fungated state. When a bone has exfoliated, or has been burned, 
or sawed, or removed in any other way, the cicatrices of such ulcers 
become deeper than usual.1 Ulcers which are not cleansed, are not dis- 
posed to unite if brought together, nor do the lips thereof approximate 
of their own accord. When the points adjoining to an ulcer are inflamed, 
the ulcer is not disposed to heal until the inflammation subside, nor when 
the surrounding parts are blackened by mortification, nor when a varix 
occasions an overflow of blood in the part, is the ulcer disposed to heal, 
unless you bring the surrounding parts into a healthy condition.2 
3. Circular ulcers, if somewhat hollow, you must scarify all along their 
edges, or to the extent of half the circle, according to the natural stature 
of the man.3 When erysipelas supervenes upon any sore, you must purge 
the body, in the way most suitable to the ulcer, either upward or down- 
ward.4 When swelling arises around an ulcer, and if the ulcer remain 
free from inflammation, there will be a deposit of matter in process of 
time. And whatever ulcer gets swelled along with inflammation and does 
not subside as the other parts subside which became inflamed and swelled 
at the same time, there is a danger that such an ulcer may not unite. When 
from a fall, or in any other way, a part has been torn or bruised, and the 
parts surrounding the ulcer have become swelled, and, having suppurated, 
matter flows from the swelling by the ulcer, if in such cases a cataplasm 
be required, it should not be applied to the sore itself, but to the sur- 
rounding parts, so that the pus may have free exit, and the indurated 
parts may be softened. But when the parts are softened as the inflamma- 
tion ceases, then the parts which are separated are to be brought toward 
one another, binding on sponges and applying them, beginning from the 
sound parts and advancing to the ulcer by degrees.6 But plenty of leaves 
are to be bound above the sponge. When the parts are prevented from 
coming together by a piece of flesh full of humors, it is to be removed. 
When the ulcer is deep seated in the flesh, it is swelled6 up, both from 
1 Compare Aph. vi., 45. It will readily be understood that there must be a 
depression at any place where the bone has been severely injured so as to ex- 
foliate. 
2 See Galen, Meth. Med., iv., 5. The ordinary causes which prevent an ulcer 
from healing are here stated very distinctly. 
3 See Galen, Meth. Med., iv., 5. The medical litterateurs, Cassius Medicus and 
Alexander Aphodisiensis, in their Problems, discuss the question why circular 
sores are particularly difficult to heal. Every experienced surgeon must be aware 
of the fact, however it may be accounted for. 
4 Galen, iv., 5. Galen remarks on this passage, that whoever reads the pres- 
ent work carefully will find that he always takes the indication from the affec- 
tion, that is to say, that his practice is always rational, instead of being empirical. 
He reverts to this passage again in § 6. 
5 This principle of bandaging is laid down in the work, On the Surgery. 
6 Vidus Vidius instead of " it is swelled up" (yTroKvpoovrai), reads " forms into a 
varix " (vironipoovrai). ULCERS. 
297 
the bandaging and the compression. Such an ulcer should be cut up 
upon a director (specillum) if possible, at the proper time, so as to admit 
a free discharge of the matter, and then the proper treatment is to be 
applied as may be needed. For the most part, in every hollow ulcer 
which can be seen into direct without any swelling being present, if there 
be putrefaction in it, or if the flesh be flabby and putrid, such an ulcer, 
and the parts which surround it, will be seen to be black and somewhat 
livid. And of corroding ulcers, those which are phagedsenic, spread and 
corrode most powerfully, and, in this case, the parts surrounding the sore 
will have a black and sub-livid appearance. 
4. Cataplasms for swellings and inflammation in the surrounding 
parts.1 Boiled mullein,2 the raw leaves of the trefoil,3 and the boiled 
leaves of the epipetrum,4 and the poley,9 and if the ulcer stand in need of 
cleansing, all these things also cleanse; and likewise the leaves of the fig- 
tree, and of the olive, and the horehound, all these are to be boiled; and 
more especially the chaste-tree,6 and the fig, and the olive, and the leaves 
of the pomegranate are to be boiled in like manner. These are to be used 
raw: and the leaves of the mallow pounded with wine, and the leaves of 
rue, and those of the green origany.7 With all these, linseed is to be boiled 
up and mixed by pounding it as a very fine powder. When there is dan- 
ger of erysipelas seizing the ulcers, the leaves of woad8 are to be pounded 
and applied raw in a cataplasm along wiith linseed, or the linseed is to be 
moistened with the juice of strychnos9 or of woad, and applied as a cata- 
plasm. When the ulcer is clean, but both it and the surrounding parts 
1 See Galen, Meth. Med., i v., 5. Galen remarks, that all the articles about to be 
mentioned are possessed of desiccative powers, as may be learned on reference to 
his work, On Simples. 
2 The 0X<fyzof of Hippocrates is generally admitted to have been some species of 
Verbascum; but Dierbach is undecided as to whether it was V. thapsus, sinua- 
tum, or plicatum. See Arzn. des Hippocrat., p. 70. 
3It is impossible to decide with any certainty what species of Trifolium is re- 
ferred to. 
4 The epipetrum here mentioned is referred by Vidus Vidius to some species of 
Sempervivum. Sprengel. in his Hist. Rei Herb., suggests that it may be Sedum 
ochroleucum. Dierbach inclines to the Ocymum monachorum. (Op. laud., p. 
178.) 
6 The Teucrium polium, L. See Paulus A£gineta, Vol. IH., p. 305, Syd. Soc. 
edition. 
6 The Agnus castus, L. Ibid., p. 20. 
7 Probably the Origanum heracleoticum and creticum. See Dierbach, etc., p. 
174; and Paulus ALgineta, Vol. III., p. 284. 
8 Certainly a species of Isatis is here meant, probably the tinctoria. See 
Dierbach, etc., p. 123. 
9 Dierbach inclines to refer it to the Cucubalus bacciferus, but there is great 
uncertainty on this head. See further Paulus JEgineta, Vol. III., p. 359. I 
would incline to the Solanum nigrum, which long held a place in our Mat. Med. 298 
GENUINE WORKS OF HIPPOCRATES. 
are inflamed, lentil is to be boiled in wine and finely triturated, and, being 
mixed with a little oil, it is to be applied as a cataplasm; and the leaves 
of the hip-tree are to be boiled in water and pounded in a fine powder 
and made into a cataplasm; and apply below a thin, clean piece of cloth 
wetted in wine and oil; and when you wish to produce contraction, pre- 
pare the leaves of the hip-tree like the lentil, and the cress; wine and 
finely-powdered linseed are to be mixed together. And this is proper: lin- 
seed, and raw chaste-tree, and Melian alum,1 all these things being macer- 
ated in vinegar. 
5. Having pounded the white unripe grape in a mortar of red bronze, 
and passed it through the strainer, expose it to the sun during the day, 
but remove it during the night, that it may not suffer from the dew; 
rub it constantly during the day, so that it may dry equally, and may 
contract as much virtue as possible from the bronze: let it be exposed to 
the sun for as great a length of time as till it acquire the thickness of 
honey; then put it into a bronze pot with the fresh honey and sweet wine, 
in which turpentine rosin has been previously boiled, boil the resin in the 
wine until it become hard like boiled honey; then take out the resin and 
pour off the wine: there should be the greatest proportion of the juice of 
unripe grape, next of the wine, and third of the honey and myrrh, either 
the liquid (stacte) or otherwise. The finest kind is to be levigated and 
moistened by having a small quantity of the same wine poured on it; and 
then the myrrh is to be boiled by itself, stirring it in the wine; and when 
it appears to have attained the proper degree of thickness, it is to be 
poured into the juice of the unripe grape; and the finest natron2 is to be 
toasted, and gently added to the medicine, along with a smaller quantity 
of the flowers of copper (flos ceris)3 than of the natron. When you have 
mixed these things, boil for not less than three days, on a gentle fire made 
with fuel of the fig-tree or with coals, lest it catch fire. The applications 
should all be free from moisture, and the sores should not be wetted when 
this medicine is applied in the form of liniment. This medicine is to be 
used for old ulcers, and also for recent wounds of the glans penis, and 
ulcers on the head and ears. Another medicine for the same ulcers:- 
The dried gall of an ox, the finest honey, white wine, in which the shav- 
ings of the lotus4 have been boiled, frankincense, of myrrh an equal part, 
of saffron an equal part, the flowers of copper, in like manner of liquids, 
1 The alum of Melos (now Milo), an island of the 2Egean Sea, was always much 
sought after. See Dioscorid., M. M., v., 122. 
2 The native carbonate of soda. See Paulus ALgineta, Vol. III., p. 232. 
3See Paulus ALgixeta, Vol. III., pp. 404-6. 
4 From the terms in which it is frequently mentioned by our author, there can 
be no doubt that it is the lote-tree, that is to say, the Zizyphus lotus, or Celtis 
australis. See Dierbach, etc., p. 92; and Paulus JEgineta, Vol. III., p. 236; and 
the Appendix to the Edinburgh Greek Lexicon under this term. ULCERS. 
299 
the greatest proportion of wine, next of honey, and least of the gall. 
Another:-Wine, a little cedar honey,1 of dried things, the flowers of cop- 
per, myrrh, dried pomegranate rind. Another:-Of the roasted flower of 
copper half a drachm, of myrrh two half-drachms, of saffron three 
drachms, of honey a small quantity, to be boilled with wine. Another:- 
Of frankincense a drachm, of gall a drachm, of saffron three drachms; let 
each of these be dried and finely levigated, then, having mixed, triturate 
in a very strong sun, pouring in the juice of an unripe grape, until it be- 
come of a gelatinous consistence, for three days; then let them be allowed 
to macerate in an austere, dark-colored, fragrant wine, which is gradually 
poured upon them. Another:-Boil the roots of the holm-oak4 in sweet 
white wine; and when it appears to be properly done, having poured off 
two parts of the wine, and of the lees of wine as free of water as possible 
one part; then boil, stirring it, so that it may not be burnt, at a gentle 
fire, until it appear to have attained the proper consistence. Another:- 
The other things are to be the same; but, instead of the wine, use the 
strongest white vinegar, and dip into it wool as greasy as can be procured, 
and then, moistening it with the lees of oil, boil, and pour in the juice of 
the wild fig-tree, and add Melian alum, and natron, and the flowers of 
copper, both toasted. This cleanses the ulcers better than the former, but 
the other is no less desiccant. Another:-Dip the wool in a very little 
water; and then, having added a third part of wine, boil until it attain 
the proper consistence. By these, recent ulcers are most speedily pre- 
vented from getting into a state of suppuration.3 
6. Another:-Sprinkle on it dried wakerobin,4 and add the green bark 
of the fig-tree, pounding it in the juice: do this with or without wine, 
and along with honey. Another:-Boiling the shavings of lotus with vin- 
egar (the vinegar should be white); then mix the lees of oil and raw tar- 
water,6 and use it as a liniment or wash, and bandage above. These things 
in powder prevent recent wounds from suppurating, or they may be used 
for cleansing the sore along with vinegar, or for sponging with wine. 
1 A sweet exudation forming on the juniper-tree in hot countries. See Theo- 
phrast, Fragment.; Galen, de Alim. Facult., hi., and Paulus AEgineta, Vol. I., 
p. 178. 
2 The Quercus ilex. See Paulus AEgineta, Vol. III., p. 311; and Dierbach, 
etc., p. 27. 
3 The sense of this passage is ambiguous; the most probable meaning is, that 
these things check the formation of pus. Considering that the articles are all of 
an astringent nature, this might seem the more probable interpretation; but some 
of the interpreters understand it in the opposite sense. 
4 Probably the Arum maculatum. See Paulus Vol. III., p. 53; and 
Dierbach, etc., p. 106. 
6 It is the same as the liquid pitch of Dioscorides (i., 79), and is mentioned by 
Paulus yEgineta, Vol. III., p. 74. The description of this preparation is rather 
ambiguous. 300 
GENUINE WORKS OF HIPPOCRATES. 
*7. Another:-Sprinkle (on the sore?) lead finely triturated with the 
recrement of copper; and sprinkle on it, also, the shavings of lotus, and 
the scales of copper, and alum, and chalcitis,1 with copper, both alone, 
and with the shavings of lotus. And otherwise, when it is wanted to use 
these in a dry state, do it with the Illyrian spodos2 triturated with the 
shavings, and with the shavings alone. And the flowers of silver alone, 
in the finest powder; and birthwort,3 when scraped and finely pounded, 
may be sprinkled on the part. Another, for bloody sores * myrrh, frank- 
incense, galls, verdigris6 the roasted flower of copper, Egyptian alum 
roasted, vine flowers, grease of wool, plumbago,8 each of these things is to 
be diluted, in equal proportions, with wine like the former. And there 
is another preparation of the same:-The strongest vinegar of a white 
color, honey, Egyptian alum, the finest natron; having toasted these 
things gently, pour in a little gall; this cleanses fungous ulcers, renders 
them hollow, and is not pungent. Another:-The herb with the small 
leaves, which gets the name of Parthenium parviflorum,1 and is used for 
removing thymia8 {warts P) from the glans penis, alum, chalcitis, a little 
crude Melian alum (?);° sprinkle a little dried elaterium,10 and a little dried 
pomegranate rind in like manner. 
8. The herb which has got the name of lagopyrus,11 fills up hollow and 
1 A variety of the native sulphate of copper. See Paulus jEgineta, Vol. III., 
pp. 399-402. I am fully satisfied, after the most mature deliberation and fullest 
investigation of the subject, that the misy, sori, and chalcitis were merely varie- 
ties of the Chalcanthos, and that it was an impure sulphate of copper 
2 Probably an impure oxide of zinc. See Paulus .Egineta, Vol. III., p. 353. 
3Either the Aristolochia longa or rotunda. Ibid., p. 50. 
4 By bloody sores is always to be understood fresh wounds. I cannot but think, 
however, that the text is in a doubtful state. 
6 The ancient myrrh, frankincense, galls, and verdigris, were all the same as 
the modern articles which still retain these names. 
6 On the Molybdama, see Paulus tEgineta, Vol. III., p. 254. 
' Neither Vidus Vidius nor any other of the authorities on the Flora of Hip- 
pocrates ventures to pronounce decidedly what plant this was. See also Galen, 
Exeges.; Foes (h. 1.; Dierbach, Arzn. des Hipp., p. 185. The most probable con- 
jecture appears to be, that it is the Pyrethrum parthenium, W., or feverfew. 
8 See Vidus Vidius, h. 1. He holds it to be a sort of indurated tumor, or 
wart; and of this, I think, there can be little doubt, as it is well known that warts 
form on the genital member. See further, Celsus, v., 28; and Paulus 
Book VI., 58. 
9 There is some difficulty respecting the alum and chalcitis in this passage, as 
may be seen on consulting' Vidus Vidius and Foes. 
10 Although this term be sometimes used rather vaguely in the Hippocratic 
treatises, there seems no reason to doubt that, in this place, it applies to the fecula 
of the Momordica elaterium. See Paulus jEgineta, Vol. HI., p. 102. 
" Nothing can be made of Galen's notice of this plant in his Exegesis, the text 
being obviously corrupt. From the resemblance of the names it may be supposed 
the same as the XaywTrovf of Dioscorides, probably, then, the Trifolium arvense. ULCERS. 
301 
clean ulcers; (when dried it resembles wheat; it has a small leaf like that 
of the olive, and more long;) and the leaf of horehound, with oil. An- 
other:-The internal fatty part, resembling honey, of a fig much dried, 
of water two parts, of linseed not much toasted and finely levigated, one 
part. Another:-Of the dried fig, of the flower of copper levigated a 
little, and the juice of the fig. The preparation from dried fig:-The 
black chamaeleon,1 the dried gall of an ox, the other things the same. Of 
the powders:-Of the slender cress in a raw state, of horehound, of each 
equal parts; of the dried fig, two parts; of linseed, two parts; the juice 
of the fig. When you use any of these medicines, apply above it com- 
presses wetted in vinegar, apply a sponge about the compresses and make 
a little more pressure. If the surrounding parts be in an inflamed state, 
apply to them any medicine which may appear suitable. 
9. If you wish to use a liquid application, the medicine called caricum2 
may be rubbed in, and the bandages may be applied as formerly described 
upon the same principle. The medicine is prepared of the following 
ingredients:-Of black hellebore, of sandarach, of the flakes of copper, of 
lead washed, with much sulphur, arsenic, and cantharides. This may be 
compounded so as may be judged most proper, and it is to be diluted with 
oil of juniper. When enough has been rubbed in, lay aside the medicine, 
and apply boiled wakerobin in a soft state, either rubbing it in dry, or 
moistening it with honey. But if you use the caricum in a dry state, you 
must abstain from these things, and sprinkle the medicine on the sore. 
The powder from hellebore and sandarach alone answers. Another liquid 
medicine:-The herb, the leaf of which resembles the arum (wakerobin) 
in nature, but is white, downy, of the size of the ivy-leaf:3 this herb is 
applied with wine, or the substance which forms upon the branches of 
the ilex, when pounded with wine, is to be applied. Another:-The juice 
of the unripe grape, the strongest vinegar, the flower of copper, natron, 
the juice of the wild fig-tree. Alum, the most finely levigated, is to be 
put into the juice of the wild grape, and it is to be put into a red bronze 
The authorities subsequent to Hippocrates, in treating of medicines possessed of 
sarcotic or incarnant properties, take no notice of this article, nor of any of the 
others recommended by our author in this paragraph. This is singular, when we 
consider how servilely they generally bow to the authority of Hippocrates. Galen 
treats of the nature of incarnant medicines with his wonted acumen and perspi- 
cuity of style (Meth. Med. iii., 2). On the same subject, see further, Paulus ASgi- 
neta, Vol. II., p. 105. 
1 It was the Carthamus corymbosus, L. See Dierbach, etc., p. 135. 
2 The derivation of this term cannot be ascertained, the notice of it in the Ex- 
egesis of Galen being very corrupt. It has evidently nothing to do with nuts, as 
its name might imply. 
3 Vidus Vidius suggests that it is the tussilago, but it cannot be determined 
with much certainty. 302 
GENUINE WORKS OF HIPPOCRATES. 
mortar and stirred in the sun, and removed when it appears to have 
attained its proper consistence. 
10. These are other powders: -Black hellebore, as finely levigated as 
possible, is to be sprinkled on the sore while any humidity remains about 
it, and while it continues to spread. The bandaging is the same as when 
plasters are used. Another, in like manner:-The driest lumps of salt 
are to be put into a copper, or earthen pot, of equal size, as much as 
possible, and not large, and the finest honey, of double the size of the 
salt, as far as can be guessed, is to be poured upon the lumps of salt, then 
the vessel is to be put upon coals and allowed to sit there until the whole 
is consumed. Then, having sponged the ulcer and cleansed it, bandage 
it as before, and compress it a little more. Next day, wherever the medi- 
cine has not been taken in, sprinkle it on, press it down, and bandage. 
But when you wish to remove the medicine, pour in hot vinegar until it 
separate, and again do the same things, sponging it away, if necessary. 
Another corrosive powder:-Of the most finely-levigated misy,2 sprinkle 
upon the moist and gangrenous parts, and a little of the flower of copper, 
not altogether levigated. Another powder equally corrosive:-Having 
sponged the ulcer, burn the most greasy wool upon a shell placed on the 
fire until the whole be consumed; having reduced this to a fine powder, 
and sprinkled it on the sore, apply the bandage in the same manner. 
Another powder for the same ulcers:-The black chamaeleon, when pre- 
pared with the juice of the fig. It is to be prepared roasted, and alkanet3 
1 These powders, in the original, are described as being applications for fresh 
or bloody wounds (evat/za). But, as Vidus Vidius states, there is evidently an 
error of the text, and he proposes to amend it by substituting vep.6fieva in its place. 
The emendation is plausible; but when a passage in an ancient author is mani- 
festly corrupt, it seldom happens that any ingenuity can amend it satisfactorily. 
It seems wiser, then, to reject the epithet altogether. 
2 A substance nearly allied to the chalcitis, probably an impure sulphate of 
copper containing a large admixture of iron. See Paulus ASgineta, Vol. III., 
pp. 234, 402. These substances would appear to have been well known by the 
surgical authorities of the sixteenth and seventeenth centuries, and are recom- 
mended by them for the very purpose here indicated by our author. See in par- 
ticular, Tagault (de Vulner., ii.) He mentions both the misy and chalcitis as be- 
ing- very powerful escharotics. What he says, in another work, regarding the 
nature of the misy, sori, and chalcitis, is so much in accordance with my own 
views as published in the Commentary on Paulus TEgineta (1. c.), that (since it 
may be said that adhuc sub judice lis est) I am induced to give his words in 
this place: "Misy autem et sori chalcitidi genere cognata sunt, ex una, ut ita 
cum Galeno dicam, radice perducta. Itaque tria haec (quae sub vitreoli genere 
comprehenduntur) majoris tantum et minoris ratione differunt." (De Ulceri- 
bus, iii.) 
3 It may either be the Anchusa tinctoria, or Echium creticum. See Dierbach, 
etc., p. 69. ULCERS. 
303 
mixed withit. Or, pimpernel,1 and Egyptian alum2 roasted, and sprinkle 
on them the Orchomenian powder.3 For spreading ulcers:-Alum, both 
the Egyptian roasted, and the Melian; but the part is to be first cleansed 
with roasted natron and sponged; and the species of alum called chalcitis4 
roasted. It is to be roasted until it catch fire. 
11. For old ulcers which occui' on the fore part of the legs; they 
become bloody and black:-Having pounded the flower of the melilot and 
mixed it with honey, use as a plaster. For nerves (tendons f) which have 
been cut asunder:-Having pounded, sifted, and mixed with oil the roots 
of the wild myrtle, bind on the part; and the herb cinquefoil5 (it is white 
and downy, and more raised above the ground than the black cinquefoil), 
having pounded this herb in oil bind it on the part, and then remove it 
on the third day. 
12. Emollients6 (?):-These medicines are to be used in winter rather 
than in summer. Emollient medicines which make the cicatrices fair:- 
Pound the inner mucous part of the squill and pitch, with fresh swine's 
seam, and a little oil, and a little resin, and ceruse. And the grease of a 
goose, fresh swine's seam, 'and squill, and a little oil. The whitest wax, 
fresh clean grease, or squill and white oil, and a little resin. Wax, 
swine's seam (old and fresh), and oil, and verdigris, and squill and resin. 
Let there be two parts of the old grease to the fresh, and of the other 
things, q. s. Having melted the grease that is fresh, pour it into another 
pot; having levigated plumbago finely and sifted it, and mixed them 
together, boil and stir at first; boil until when poured upon the ground 
1 Without doubt the Anagallis arvensis, L. See Paulus JEgineta, Vol. III., 
p. 43; and Dierbach, etc., p. 150. 
2 Galen informs us that the Egyptian alum was the same as the Tpixiru; of the 
Greeks; there can be no doubt, then, that it was the hair salt of Werner, and con- 
tained a large admixture of the sulphate of magnesia and iron. See Paulus 
JEgineta, Vol. III., p. 361. 
3 The Orchomenian powder cannot be determined with any certainty. Vidus 
Vidius and Foes suggest that it was the same as the adarce, for which see Paulus 
2Egineta, Vol. III., p. 22. 
4 The test is probably corrupt. Galen, in his Exegesis, supposes it to refer 
simply to the Chalcitis, for which see above. Others hold that both the chalcitis 
and the alum were ingredients in the composition. See Foes, h. 1. 
5 It cannot be positively determined; but Foes and Dierbach regard it as being 
some species either of the Tormentilia or Potentilla. The former, I need scarcely 
say, was lately restored to the Mat. Med. The Potentilla anserina would answer 
pretty well to our author's description. 
6 Foes suspects that this term is corrupt, and yet when one examines atten- 
tively the composition of the preparations contained in this paragraph, they will 
be found to consist very much of oily ingredients, so that, after all, the term does 
not appear so very objectionable. Galen, moreover, seems to sanction the word, 
only reading palOwSsa instead of paTSanMea, as used in the text here. The reading 
however, is uncertain in some parts of this paragraph, as may be seen on consult- 
ing Vidus Vidius, and Foes. 304 
GENUINE WORKS OF HIPPOCRATES. 
it concretes; then taking it off the fire, pour it all into another vessel, 
with the exception of the stony sediment, and add resin and stir, and mix 
a little oil of juniper, and what has been taken off. In all the emollient 
medicines to which you add the resin, when you remove the medicine 
from the fire, pour in and mix the resin while it is still warm. Another: 
-Old swine's seam, wax, and oil, the dried shavings of the lotus, frank- 
incense, plumbago,-namely, of the frankincense one part, and of the 
other one part, and of the shavings of the lotus one part; but let there be 
two parts of the old grease, one of wax, and of fresh swine's seam one 
part. Another:-Or old swine's seam along with the fresh grease of a 
goat; when cleaned, let it retain as little as possible of its membrane: 
having triturated or pounded it smooth, pour in oil, and sprinkle the lead 
with the spodium and half the shavings of the lotus.1 Another:-Swine's 
seam, spodium, blue chalcitis,2 oil. 
13. For Burns:-You must boil the tender roots of the ilex, and if 
their bark be very thick and green, it must be cut into small parts, and 
having poured in white wine, boil upon a gentle fire, until it appear to 
you to be of the proper consistence, so as to be used for a liniment. And 
it may be prepared in water after the same manner. Another, not cor- 
rosive:-Old swine's seam is to be rubbed in by itself, and it is to be melted 
along with squill, the root of which is to be divided and applied with a 
bandage.3 Next day it is to be fomented; and having melted old swine's 
seam and wax, and mixed with them oil, frankincense, and the shavings 
of lotus and vermilion, this is to be used as a liniment. Having boiled 
the leaves of the wakerobin in wine and oil, apply a bandage. Another:- 
When you have smeared the parts with old swine's seam let the roots of 
asphodel be pounded in wine and triturated, and rubbed in. Another:- 
Having melted old swine's seam, and mixed with resin and bitumen, and 
having spread it on a piece of cloth and warmed it at the fire, apply a 
bandage. When an ulcer has formed on the back from stripes or other- 
wise, let squill, twice boiled, be pounded and spread upon a linen cloth 
and bound on the place. Afterward the grease of a goat, and fresh swine's 
seam, spodium, oil, and frankincense are to be rubbed in. 
1 The text of this prescription appears to be very corrupt. See Vidus Vidius 
and Foes. 
2 By blue chalcitis may either be meant the cyanus, that is to say, " the blue 
copper" of Jameson, or the chalcanthos, that is to say, "blue vitriol." Compare 
the note of Foes with Paulus JEgineta, Vol. III., pp. 201, 402, Syd. Soc. edit. 
2 Without doubt it was the scilla maritima. See Dierbach, and Paulus JEgi- 
neta, Vol. III., p. 343. It will be remarked that our author would appeal' to have 
been fond of using it as a detergent application to burns. Discorides recommends 
it for fissures on the feet (ii., 202). Our author's applications are either emollient, 
consisting of vegetable and animal oils, or detergent and astringent, formed from 
the ilex and squills. For a digest of the ancient modes of treating burns, see 
Paulus JEgineta, Book IV., 11, Syd. Soc. edit. ULCERS. 
305 
14. Swellings which arise on the feet, either spontaneously or other- 
wise, when neither the swellings nor the inflammation subside under the 
use of cataplasms, and although sponges or wool, or anything else be 
bound upon the sound part;1 but the swelling and inflammation return 
of themselves again, an influx of blood into the veins is the cause, when 
not occasioned by a bruise. And the same story applies if this happen in 
any other part of the body. But blood is to be abstracted, especially 
from the veins, which are the seat of the influx, if they be conspicuous; 
but if not, deeper and more numerous scarifications are to be made in the 
swellings; and whatever part you scarify, this is to be done with the 
sharpest and most slender instruments of iron. When you have removed 
the blood, you must not press hard upon the part with the specillum, lest 
you produce contusion. Bathe with vinegar, and do not allow a clot of 
blood to remain between the lips of the wounds, and having spread greasy 
wool with a medicine for bloody wounds, and having carded the woof and 
made it soft, bind it on, having wetted it with wine and oil. And let the 
scarified part be so placed that the determination of the blood may be 
upward and not downward; and do not wet the part at all, and let the 
patient be put upon a restricted diet and drink water. If upon loosing 
the bandages you find the scarifications inflamed, apply a catasplasm of 
the fruit of the chaste-tree and linseed. But if the scarifications become 
ulcerated and break into one another, we must be regulated by circum- 
stances, and otherwise apply whatever else appears to be proper. 
15. When a varix is on the fore part of the leg, and is very superficial, 
or below the flesh, and the leg is black, and seems to stand in need of 
having the blood evacuated from it, such swellings are not, by any means, 
to be cut open; for, generally, large ulcers are the consequence of the 
incisions, owing to the influx from the varix. But the varix itself is to 
be punctured in many places, as circumstances may indicate.2 
16. When you have opened a vein and abstracted blood, and although 
the fillet be loosed the bleeding does not stop, the member, whether the 
arm or leg, is to be put into the reverse position to that from which the 
blood flows; so that the blood may flow backward, and it is to be allowed 
to remain in this position for a greater or less space of time.3 Then bind 
1 The swelling's or oedemata here described, are not very well defined, at least 
they appear so to us, probably from our unacquaintance with the diseases of 
Greece. See further, the Commentary on Paulus .Egineta, Book IV., 27, Syd. 
Soc. edit. 
2 Allusion is made to this mode of treating varix, in the treatise De Medico. 
On the more formidable operation practiced by the ancients for the cure of varix, 
see the Commentary on Paulus Book VI., 82, Syd. Soc. edit. 
3 The last two paragraphs, on venesection and cupping, have little or no con- 
nection with the subject of this treatise. Very likely they are an appendix added 
to the work. Both these operations are more fully treated of in the work De 
Medico. 306 
GENUINE WORKS OF HIPPOCRATES. 
up the part while matters are so, no clots of blood being allowed to remain 
in the opening. Then having applied a double compress, and wetted it 
with wine, apply above it clean wool which has been smeared with oil. 
For, although the flow of blood be violent, it will be stopped in this 
way. If a thrombus be formed in the opening, it will inflame and sup- 
purate. Venesection is to be practiced when the person has dined more 
or less freely and drunk, and when somewhat heated, and rather in hot 
weather than in cold. 
17. When in cupping, the blood continues to flow after the cupping- 
instrument has been removed, and if the flow of blood, or serum be 
copious, the instrument is to be applied again before the part is healed 
up, so as to abstract what is left behind. Otherwise coagula of blood will 
be retained in the incisions, and inflammatory-ulcers will arise from them. 
In all such cases the parts are to be bathed with vinegar, after which they 
are not to be wetted; neither must the person lie upon the scarifications, 
but they are to be anointed with some of the medicines for bloody wounds. 
When the cupping-instrument is to be applied below the knee, or at the 
knee, it should be done, if possible, while the man stands erect.' 
1 The object in directing the cupping-instrument to be applied while the patient 
stands erect would seem to be, as Foes remarks, that the skin will thus be in its 
natural state, and the blood will flow the more freely. Yet, although the direc- 
tion seems to be a very proper one, it is not attended to by modern practitioners 
of the art of cupping. ON FISTTJL2E. ON FISTTJLtE. 
THE ARGUMENT. 
This little tract is evidently a continuation of the work " On Ulcers/' 
and is equally replete with interesting and important matters. As stated 
in the Preliminary Discourse, the ancient authority in support of its 
genuineness is very strong. 
In the first paragraph, the author gives an account of the formation of 
fiustulcs in ano, which he attributes to tubercles, or to injuries inflicted 
on the parts adjoining to the anus, in riding, rowing, or from any such 
act of violence. 
His first advice is, that the surgeon should lose no time m making an 
incision, even before the mattei is fully formed. If the fistula already 
exist, the surgeon is to examine it with a stalk of fresh garlic. Then the 
herb seseli is to be given as a diuretic, and the bowels cleared out by 
means of purgatives. (§2.) 
In the third paragraph is described the first method of treating fistula 
in ano, namely, by introducing into it a tent formed from a strip of linen 
(or cotton), cloth, smeared with the caustic juice of one of the spurges 
(euphorbia); after which a round ball, resembling a modern pessary, is 
directed to be introduced per anum, the object of which, as stated by 
Foes, may have been to expand the sore, so as to allow the caustic to be 
well diffused over it; or, perhaps, it was merely meant to keep the tent 
secured in the fistula. On the sixth day the tent is to be removed, and, 
the ball being filled with alum, it is to be again introduced, and allowed 
to remain for a time. The object of this second introduction of the ball, 
is not to me sufficiently clear; perhaps it was to keep the sides of the 
fistula expanded while in the process of healing. Myrrh is to be applied, 
probably with the intention of cleansing the sore. 
In the fourth paragraph, the apolinose, or operation by the ligature, 
is described in a very minute and circumstantial manner. No one who 
reads the description can mistake the principle of the operation, whatever 
difficulty he may find in understanding certain expressions contained in 
it. The object evidently is to cut open the fistula by gradually tightening 
a thread which has been passed through both its orifices, and at the same 
time to raise up a healthy action in the part. When the fistula is fairly 310 
GENUINE WORKS OF HIPPOCRATES. 
laid open, pieces of sponge, smeared with some gentle escharotic, such as 
the flos aeris, are to be applied with the view of consuming the callous 
flesh, and keeping the fistula expanded until it heal equally. 
In the fifth is described the treatment when the disease consists of 
several sinuses which are not all fairly laid open by the preceding process; 
in which case our author directs the sinus to be syringed with a stimulant 
and escharotic injection, so as to remove all the callous parts. 
In the sixth, a most accurate description is given of an acute attack of 
phlegmon in the neighborhood of the anus, with the treatment thereof 
by hip-baths, cataplasms, suppositories, and various othei- stimulant and 
soothing applications. 
In the seventh, strangury is correctly described upon the principles of 
the humoral pathology. 
In the eighth paragraph, another common and very serious aggrava- 
tion of these complaints is minutely described, and the treatment is care- 
fully laid down. In certain cases, astringent and escharotic applications 
of a powerful nature are to be made. 
In the ninth is described the mode of procedure when great difficulty 
is experienced in accomplishing the reduction of the gut. The treat- 
ment in this case consists in rest and the application of suitable astrin- 
gents. 
In the tenth is explained the treatment of procidentia ani when 
attended with discharge of blood. It consists either of astringent cata- 
plasms, containing wakerobin, wild vine, etc., or narcotics, such as the 
seed of hemlock. 
In the eleventh is described the treatment when inflammation comes 
on. The applications consist of cataplasms, formed principally of astrin- 
gent and sedative articles, such as ivy, mandrake, and the like. 
When the pain is unattended with inflammation, the applications 
recommended are of a stimulant nature, such as natron, alum, roasted 
salts, the green leaves of capers, and the like; but they are to be varied 
according to the nature of the complaint. See the last paragraph. 
From what has now been stated with regard to the contents of this 
treatise, it will be readily allowed, that the author of it had formed a very 
correct idea of the nature of the disease; and that the plans of treatment 
he lays down are all very rational, and bespeak an accurate acquaintance 
with the subject. 
Gruner and Ackerman argue against the genuineness of this treatise, 
from the circumstance of its containing a manifest allusion to the humoral 
pathology in the seventh paragraph. But if this were sufficient reason 
for regarding it as spurious, we ought, on the same grounds, to reject the 
Aphorisms, in which, as we have seen, there are frequent and decided 
allusions to the hypothesis of the humors. And it is to be borne in 
mind, that Galen invariably represents Hippocrates as the founder of the fistula:. 
311 
humoral doctrine.1 Moreover, it is to be remarked, that the doctrine is 
introduced here in quite a practical form, without any of the systematic 
parade which the later authorities display in dealing with it. Ackerman 
further pronounces against its authenticity, on the ground that it is writ- 
ten in a confused style. Now this may be doubted; but if it were true, 
the inference which Ackerman draws from it would not be warrantable, 
as the same objection might be started against the authenticity of the 
works " On Fractures," " On the Articulations," and " The Epidemics," 
none of these treatises being at all remarkable for methodical arrangement. 
ON FISTULJS. 
1. Fistula: are produced by contusions and tubercles, and they are 
also occasioned by rowing, or riding on horseback, when blood accumu- 
lates in the nates near the anus. For, having become putrid, it spreads 
to the soft parts (the breech being of a humid nature, and the flesh in 
which it spreads being soft), until the tubercle break and corrupt below 
at the anus. When this happens, a fistula is formed, having an ichorous 
discharge, and faeces pass by it, with flatus and much abomination. It is 
produced, then, by contusions when any of the parts about the anus are 
bruised by a blow, or a fall, or a wound, or by riding, or rowing, or any 
such cause. For blood is collected, and it, becoming corrupted, suppu- 
rates; and from the suppuration the same accidents happen, as have been 
described in the case of tubercles. 
2. In the first place, then, when you see any such tubercle formed, 
you must cut it open while still unripe, before it suppurate and burst into 
the rectum. But if a fistula be already formed when you undertake the 
case, take a stalk of fresh garlic,2 and having laid the man on his back, 
and separated his thighs on both sides, push down the stalk as far as it 
will go, and thereby measure the depth of the fistula. Then, having 
bruised the root of seseli3 to a very fine powder, and poured in some 
water, let it macerate for four days, and, mixing the water with honey, 
let the patient drink it, fasting, to the amount of three cyathi, and at the 
same time purge away the ascarides. Those who are left without treat- 
ment die. 
1 Comment. I., in Lib. de Nat. Human., tom. v., p. 11, ed. Basil; De Elem. Sec. 
Hippocr., i.; De Nat. Facult., i. 
2 Instead of the stalk of fresh garlic, Paulus tEgineta recommends a hog's 
bristle, or a sound to be used in exploring the fistula (B. VI., 78). 
3 Most probably the Seseli tortuosam. See Dierbach, etc., p. 187, and Paulus 
HSgineta, Vol. III., p. 330. All the ancient authorities hold it to be a powerful 
diuretic, and probably it is here recommended for this purpose. 312 
GENUINE WORKS OF HIPPOCRATES. 
3. In the next place, having moistened the strip of cotton cloth,1 with 
the juice of the great tithymallus,2 and sprinkling on it the flos teris, 
roasted and triturated/ and having made it into a tent equal in length to 
the fistula, and having passed a thread through the ends of the tent and 
again through the stalk, and having placed the patient in a reclining posi- 
tion, and having examined the ulcerated parts of the rectum with a spec- 
ulum, pass the stalk by it, and when it reaches the rectum, take hold of 
it and draw it out until the tent be pushed through, and be brought on a 
level above and below. When it {the tent ?) has been pushed inward, in- 
troduce a ball of horn3 into the rectum (the rectum having been pre- 
viously smeared with Cimolian chalk), and leave it there, and when the 
patient wants to go to stool, let it be taken out and again replaced, and 
let this practice be continued for five days. On the sixth day let it be re- 
moved, and drawing the tent out of the flesh, and afterwards pounding 
alum and filling the ball {pessary) and introducing it into the rectum, 
leave it until the alum melts. Anoint the rectum with myrrh until the 
parts appear to be united.4 
4. Another method of cure:-Taking a very slender thread of raw 
lint,5 and uniting it into five folds of the length of a span, and wrapping 
them round with a horse hair; then having made a director (specillum) 
of tin, with an eye at its extremity, and having passed through it the end 
of raw lint wrapped round as above described, introduce the director into 
the fistula, and, at the same time, introduce the index finger of the left 
hand per anum; and when the director touches the finger, bring it out 
with the finger, bending the extremity of the director and the end of the 
threads in it, and the director is to be withdrawn, but the ends of the 
threads are to be knotted twice or thrice, and the rest of the raw threads 
1,066viov fivoaivov may either signify "cotton cloth," or "linen cloth." For 
although the /Svctctoj of Theophrastus (H. P. iv., 9) be unquestionably the devdpov 
Epio<f)6pov, or cotton tree (Gossypium arboreum), it is now well ascertained that the 
mummy cloth to which Herodotus applies the name (flvococ), (vii., 181), is linen. 
I need scarcely remark that either cotton or linen cloth will serve the purpose of 
forming a tent to be used as directed by our author. 
2 Some species of the Euphorbia, probably the characias. See Dierbach, etc., 
p. 141; and Paulus A£gineta,Vo1. III., p. 374. 
3 Meaning perhaps a small pessary in the modern sense of that term. 
4 The method of treating fistulas by tents, impregnated with some caustic, such 
as the juice of the spurge, is here very circumstantially described, and although 
some parts of the description be somewhat obscure, the general import of it can- 
not be mistaken. Other corrosive substances are recommended by Paulus 
MEgineta, B. iv., 49; and Celsus, vi., 78. 
5 The thread of raw lint (uyolcvov) was evidently a sort of flaxen thread, but in 
what manner it was prepared, and what was its exact texture, I cannot pretend 
to explain satisfactorily. As far as regards the principle of the operation, this, 
however, is not of much consequence; for a cotton, a flaxen, or a silk thread, 
would evidently serve the purpose. FISTULtE. 
313 
is to be twisted round and fastened into a knot. Then the patient is to 
be told that he may go and attend to his matters.1 The rest of the treat- 
ment:-Whenever any part of the thread gets loose owing to the fistula 
becoming putrid, it is to be tightened and twisted every day; and should 
the raw thread rot before the fistula is eaten through, you must attach 
another piece of raw thread to the hair, pass it through, and tie it, for it 
was for this purpose that the hair was rolled round the raw lint, as it is 
not liable to rot. When the fistula has sloughed through, a soft sponge 
is to be cut into very slender pieces and applied, and then the flowers of 
copper, roasted, are to be frequently applied with a director; and the 
sponge smeared with honey is to be introduced with the index finger of 
the left hand, and pushed forward; and another bit of sponge being 
added, it is to be bound on in the same manner as in the operation for 
hemorrhoids. Next day, having loosed the bandages, the fistula is to be 
washed with hot water, and cleansed, as far as possible, with the finger of 
the left hand by means of the sponge, and again the flos aeris is to be ap- 
plied. This is to be done for seven days, for generally the coat of the fis- 
tula takes that time to slough through. The same mode of bandaging is 
to be persevered in afterwards, until the cure be completed. For in this 
way, the fistula being forcibly expanded by the sponge will not fill up and 
heal unequally, but it will all become whole together. During the treat- 
ment, the part should be bathed with plenty of warm water, and the 
patient kept on a spare diet.2 
1 This seems to be our author's meaning, which is thus expressed by Celsus, 
"interduni autem licet negotia agere, ambulare, lavari, cibum capere perinde ac 
sanissimo." 
2 The operation called apolinose, that is to say, by the ligature, is very cele- 
brated. It is described by Paulus in the words of our author, at Book 
vi., 78; and by Celsus in very distinct terms (vii., 4). It is now greatly fallen into 
disuse in this country: but as the operation with the scalpel sometimes, in the 
hands of the most experienced surgeons, is followed by fatal hemorrhage, I do not 
see why the ligature should be discarded in all cases. See the history of the 
operation in Sprengel's History of Medicine, tom. vii., French edition; and at 
Paulus ACgineta, Book VI., 78, Syd. Soc. edit. The operation with the ligature 
is described by Malgaigne in his Operative Surgery, but he represents it as being 
tedious and painful. From our author's description, it would appear that his 
method consisted in introducing a small bundle of threads into the fistula for the 
purpose of raising an increased action of the vessels in the part. In principle, 
then, his plan would seem to have resembled that which is recommended by Lan- 
genbeck in such cases. It is thus described by Chelius: "In still longer continued 
fistulous passages, especially when their walls have become callous, we endeavour 
to excite a proper degree of inflammation of the walls of the passage, usually by 
the introduction of a seton, or a bundle composed of many threads, which is tied 
together externally upon the fistulous passage, and daily drawn tighter. Accord- 
ing to Langenbeck, the introduction of a ligature is, in many cases, preferable to 
incision, which oftentimes is impracticable, without injuring large vessels, and so 
on. By the ligature inflammation is produced, good consistent pus and granula- 314 
GENUINE WORKS OF HIPPOCRATES. 
5. When the fistula does not get eaten through, having first examined 
it with a sound, cut down as far as it passes, and sprinkle with the flos 
aeris, and let it remain for five days. Then pour warm water upon it, 
and above lay flour mixed with water, and bind on it the leaves of beet. 
When the flos aeris comes away, and the fistulous sore becomes clean, cure 
it as before described. But if the fistula be in a part which does not 
admit of this treatment, and if it be deep, syringe it with the flowers of 
copper, and myrrh, and natron, diluted with urine, and introduce a piece 
of lead into the orifice of the fistula so that it may not close. Syringe the 
fistula by means of a quill attached to a bladder, so that the injection may 
distend the fistula. But it does not heal unless it be cut open. 
6. If the anus gets inflamed, and there is pain, fever, a frequent desire 
of going to stool without passing anything, and the anus appears to pro- 
trude, owing to the inflammation, and if at times strangury come on, 
this disease is formed, when phlegm, collected from the whole body, is 
determined to the rectum.1 Warm things are beneficial in this case; for 
these, when applied, can attenuate and dissolve the phlegm, and dilute 
the acrid and salt particles, so that the heat subsides, and the irritation in 
the rectum is removed. Wherefore it is to be treated thus:-The patient 
is to be put into a hip-bath of hot water, and sixty grains of the grana 
gnidia2 are to be pounded and infused in a hemina of wine, with half a 
hemina of oil, and injected. This brings away phlegm and faeces. When 
the patient does not take the hip-bath, boil eggs in dark-colored fragrant 
wine, and apply to the anus, and spread something warm below, either 
a bladder filled with warm water, or linseed toasted and ground, and its 
meal stirred up and mixed equally with dark, fragrant wine, and oil, and 
thus applied very warm as a cataplasm; or, having mixed barley and 
Egyptian alum pulverized, form into an oblong ball (suppository?) and 
warming it gently at the fire, make it into a cataplasm, foment, form it 
into shape with the fingers, and then making it quite tepid, introduce it 
into the anus. The external parts are to be anointed with cerate, and a 
cataplasm of boiled garlic, with dark wine diluted, is to be applied. But 
if you remove these things, let him take the hip-bath of hot water, and 
having mixed together the juice of strychnos, the grease of a goose, swine's 
tions are produced, etc. As these symptoms come on, the ligature is to be gradu- 
ally drawn tighter." (English edition by South, vol. i., p. 93.) The operation 
with a single thread was strongly recommended lately by Luke of the London 
Hospital. See Lancet, vol. i., 1845, new series. It is also advocated by Mr. 
Bransby Cooper, Med. Gaz., 1093. 
1 In this paragraph our author evidently describes a case of phlegmon, which 
usually precedes fistula in ano. See Pott, and Cooper's Surgical Dictionary, 
under this head, where very similar descriptions are given. 
2 The fruit of the Dajjhne gnidium. See Paulus AEgineta, Vol. III., 179. 
The grains are recommended in this case to form a stimulant injection. FISTULJE. 
315 
seam, chrysocolla,1 resin, and white wax, and then having melted in the 
same and mixed together, anoint with these things, and while the inflam- 
mation lasts, use the cataplasm of boiled garlic. And if by these means 
he be freed from the pain, it is enough; but if not, give him the white 
meconium (Euphorbia peplus f), or, if not it, any other phlegmagogue 
medicine. While the inflammation lasts, the diet should be light. 
7. The strangury comes on in this way:-The bladder being heated 
from the rectum, phlegm is attracted by the heat, and by the phlegm 
(inflammation the strangury is occasioned. If, then, as is frequently 
the case, it cease with the disease, well; but, if not, give any of the medi- 
cines for strangury.2 
8. If procidentia ani take place, having fomented the part with a soft 
sponge, and anointed it with a snail,8 bind the man's hands together, and 
suspend him for a short time, and the gut will return. But if it still 
prolapse, and will not remain up, fasten a girdle round his loins and attach 
a shawl behind, and having pushed up the anus, apply to it a soft sponge, 
moistened with hot water in which the shavings of lotus have been boiled; 
pour of this decoction upon the anus by squeezing the sponge, then, 
bringing the shawl below between the legs, fasten it at the navel. But if 
he wish to evacuate the bowels, let him do so upon a very narrow night- 
stool. Or, if the patient be a child, let him be placed on the feet of a 
woman, with his back reclined to her knees,4 and when the bowels are 
evacuated, let the legs be extended. In this way the anus will be the 
least disposed to fall out. When a watery and ichorous discharge flows 
from the rectum, wash it out with burnt lees of wine,6 and water from 
myrtle, and having dried maiden-hair,8 pound and sift it, and apply as a 
cataplasm. But if there be a discharge of blood, having washed with the 
same, and pounded chalcitis, and the shavings of cypress,7 or of juniper, or 
of stone-pine,8 or of turpentine, the latter in equal proportions with the 
chalcitis, apply as a cataplasm. Anoint the external parts with thick 
cerate. ' 
1 Probably an impure carbonate of copper. See Paulus 2Egineta, Vol. III., 
416. 
2 On the complication of phlegmon of the rectum with strangury, see further, 
Aph. v., 58, vii., 13; Int. Affect, xli., 6. 3 No doubt the Helix pomatia. 
4 This singular substitute for a nursery night-table I have never seen mentioned 
by any other author, as far as I can recollect. The object of the contrivance here 
mentioned evidently is to prevent the child from straining hard, so as to bring- 
down the gut. 
5 This, no doubt, was an impure caustic potass. See Paulus AEgineta, Vol. 
III., 185, and II,, 265. 
6 The Adiantum capillus Veneris. See Paulus JEgineta, B. III., 22; and 
Dierbach, etc., 86. 
1 The Cupressus sempervirens, Vet. iii., 204, Dierbach, etc., 218. 
8Namely, the Finns pinea, L. See Paulus AEgineta, Vol. III., 302; and 
Dierbach, etc., p. 215. 316 
GENUINE WORKS OF HIPPOCRATES. 
9. When the gut protrudes and will not remain in its place, scrape 
the finest and most compact silphium (assafcetida ?) into small pieces and 
apply as a cataplasm, and apply a sternutatory medicine to the nose and 
provoke sneezing, and having moistened pomegranate rind with hot water, 
and having powdered alum in white wine, pour it on the gut, then apply 
rags, bind the thighs together for three days, and let the patient fast, 
only he may drink sweet wine. If even thus matters do not proceed 
properly, having mixed vermilion with honey, anoint. 
10. If procidentia ani be attended with a discharge of blood, pare off 
the rind of the root of wakerobin, then pound and mix flour with it, and 
apply it warm as a cataplasm. Another:-Having scraped off the rind of 
the most tender roots of the wild vine, which some call psilothrion, boil in 
a dark austere wine undiluted; then having pounded, apply as a tepid 
cataplasm; but mix also flour and stir it up with white wine and oil in a 
tepid state. Another:-Having pounded the seed of hemlock, pour on 
it a fragrant white wine, and then apply in a tepid state as a cataplasm. 
11. But if it be inflamed, having boiled in water the root of the ivy, 
finely powdered, and mixing the finest flour, and stirring it up with white 
wine, apply as a cataplasm, and mix up some fat with these things. 
Another:-Take the root of the mandrake, especially the green (fresh) 
root, but otherwise the dried, and having cleaned the green root and cut 
it down, boil in diluted wine, and apply as a cataplasm; but the dry may 
be pounded and applied as a cataplasm in like manner. Another:-Hav- 
ing bruised the inner part of a ripe cucumber to a soft state, apply as a 
cataplasm.1 
12. If there be pain without inflammation, having roasted red natron, 
and pounded it to a fine powder, and added alum and roasted salts,2 finely 
triturated, mix together in equal proportions; then having mixed it up 
with the best pitch and spread upon a rag, apply, and bind. Another:- 
Having pounded the green leaves of capers, put into a bag and bind on 
the part; and when it appears to burn, take it away and apply it after- 
ward; or, if you have not the leaves of capers, pound the rind of its roots, 
and having mixed it up with dark-colored wine, bind on the part in the 
same manner. This is a good application also for pains of the spleen. Of 
these poultices, those which are cooling, stop the discharge; those which 
are emollient and heating, discuss; and those which are attractive, dry up 
and attenuate. This disease is formed when bile and phlegm become 
seated in the parts. When the anus is inflamed, it should be anointed 
with the ointment, the ingredients of which are resin, oil, wax, plumbago, 
and suet, these being all melted and applied quite hot as a catapalasm. 
1 One cannot help being struck with the admirable judgment with which the 
ingredients in these cataplasms are selected. What articles so likely to soothe ir- 
ritation and allay pain, as hemlock, mandragora, cucumber, and the like ? 
2 The process of roasting salts is minutely described by Dioscorides (v., 125). ON HEMORRHOIDS. ON HEMORRHOIDS. 
THE ARGUMENT. 
That this little work is a continuation of the preceding one " On 
J?istulse," is admitted by all the authorities, ancient and modern. 
In the first paragraph is described the formation of hemorrhoids from 
bile or phlegm, which are determined to the rectum and inflame the blood 
in the veins, so that they become gorged, and the gut swells, and when the 
parts are injured by the passage of hard faeces, the vessels squirt out blood. 
In the second, the author boldly declares that such operations as those 
of cutting, sewing, binding, and applying septics to the anus, although 
formidable in name, are by no means so much so in reality, as might be 
suspected. He then describes in very lucid terms the method of applying 
the actual cautery to the hemorrhoids. He directs the patient to be 
properly secured, and the piles having been made to protrude, are to be 
burnt by means of red-hot irons. The after-treatment is then distinctly 
laid down, first by cataplasms and by means of a soft sponge, secured 
with a shawl. 
In the third, the operation of excising the hemorrhoids is described 
along with the subsequent management by means of astringent applica- 
tions and a piece of sponge. 
In the fourth, the condyloma is described, and the mode of operating 
upon it when it protrudes is most minutely described. He directs that 
the tumor should be torn away with the finger, and the decoction of 
galls applied to the place. 
In the fifth is described the proper mode of procedure when the tumor 
is far up the rectum. The great principle of treatment which he lays 
down is to remove it by the roots, in which case, he says, there is no risk 
of bleeding, whereas, if it be separated elsewhere, there will be a dangerous 
discharge of blood. 
In the sixth is described the process of burning the hemorrhoid, first by 
means of an iron conducted within a canula, or if neither excision nor 
the actual cautery be practicable, with caustics, by means of which, he 
says, the pile will separate like a piece of burnt hide. The ingredients 
in his applications are sulphate of copper, alum, and the like. 
In the last paragraph is given the treatment of what was described by 320 
GENUINE WORKS OF HIPPOCRATES. 
the ancients as hemorrhoids of the female parts of generation. It consists 
in fomenting them with certain things of a soothing and stimulant nature. 
What gives this treatise the most interest is the description contained 
in it of the method of curing hemorrhoids by the actual and potential 
cauteries. Neither of these methods are much known in this country, 
but both are often practiced in France. The caustic most frequently used 
is the Vienna paste, which, I believe, is a preparation from the potassa 
fusa. It is applied by means of a forceps, porte-caustique. I have often 
applied successfully the simple caustic potass. The French surgeons also 
operate with the actual cautery. See the English edition of Malgaigne's 
Operative Surgery, p. 445. 
ON HEMORRHOIDS. 
1. The disease of the hemorrhoids is formed in this way: if bile or 
phlegm be determined to the veins in the rectum, it heats the blood in the 
veins; and these veins becoming heated attract blood from the nearest 
veins, and being gorged the inside of the gut swells outwardly, and the 
heads of the veins are raised up, and being at the same time bruised by 
the feces passing out, and injured by the blood collected in them, they 
squirt out blood, most frequently along with the feces, but sometimes 
without feces. It is to be cured thus: 
2. In the first place it should be known in what sort of a place they 
are formed. For cutting, excising, sewing, binding, applying putrefacient 
means to the anus,-all these appear to be very formidable things, and 
yet, after all, they are not attended with mischief. 1 recommend seven 
or eight small pieces of iron to be prepared, a fathom in size, in thickness 
like a thick specillum, and bent at the extremity, and a broad piece should 
be on the extremity, like a small obolus.1 Having on the preceding day 
first purged the man with medicine, on the day of the operation apply the 
cautery. Having laid him on his back, and placed a pillow below the 
breech, force out the anus as much as possible with the fingers, and make 
the irons red-hot, and burn the pile until it be dried up, and so as that 
11 would direct the attention of my surgical readers to the form of the ancient 
cautery or burning iron; it resembles a small coin, that is to say, it was a disk. I 
have often thought that modern practitioners in surgery erred in making their 
cauteries globular, instead of making them flat disks like the ancient. Several 
of the burning- irons delineated by Scultet are of this shape. See, in particular, 
Tab. xxxviii., f. 4. Lecautere mummulaire of the French surgeons is formed ex- 
actly upon the model of the ancient cautery here noticed by Hippocrates. See 
Malgaigne, Med. Operat., p. 22. He describes it as being "un disque de douze 
lignes de diametre sur quatre d'epaisseur." HEMORRHOIDS. 
321 
no part may be left behind. And burn so as to leave none of the hemor- 
rhoids unburnt, for you should burn them all up.1 You will recognize 
the hemorrhoids without difficulty, for they project on the inside of the 
gut like dark-colored grapes, and when the anus is forced out they spirt 
blood. When the cautery is applied the patient's head and hands should 
be held so that he may not stir, but he himself should cry out, for this 
will make the rectum project the more. When you have performed the 
burning, boil lentils and tares, finely triturated in water, and apply as a 
cataplasm for five or six days. But on the seventh, cut a soft sponge into 
a very slender slice, its width should be about six inches square. Then a 
thin smooth piece of cloth, of the same size as the sponge, is to be smeared 
with honey and applied; and with the index finger of the left hand the 
middle of the sponge is to be pushed as far up as possible; and afterward 
wool is to be placed upon the sponge so that it may remain in the anus. 
And having girded the patient about the loins and fastened a shawl to the 
girdle, bring up this band from behind between the legs and attach it to 
the girdle at the navel. Then let the medicine which I formerly said is 
calculated to render the skin thick and strong, be bound on. These things 
should be kept on for not less than twenty days. The patient should once 
a day take a draught from flour or millet, or bran, and drink water. 
When the patient goes to stool the part should be washed with hot 
water. Every third day he should take the bath.2 
3. Another method of cure:-Having got the anus to protrude as 
much as possible, foment with hot water, and then cut off the extremities 
of the hemorrhoids. But this medicine should be prepared beforehand, 
as an application to the wound:-Having put urine into a bronze vessel, 
sprinkle upon the urine the flower of bronze calcined and finely triturated; 
then, when it is moistened, shake the vessel and dry in the sun. When 
it becomes dry, let it be scraped down and levigated, and apply with the 
finger to the part, and having oiled compresses, apply them, and bind a 
sponge above/ 
4. Another method:-There grows upon the bleeding condyloma,4 a 
1 This is contrary to the advice given at Aph. vi., 12, and is the only passage 
in this small tract which would lead me to question its genuineness. Celsus (ii., 
7) and Paulus TEgineta (B. VI., 79) follow the rule laid down in the Aphor. (1. c.) 
Aetius, on the other hand, is an advocate for the practice here recommended. 
(Tetr, iv., 2, 5.) 
2 The treatment of hemorrhoids by the cautery is not described by Celsus, 
Paulus, or Albucasis, and is condemned by Andreas a Cruce. 
31 need scarcely remark that the operation of excising hemorrhoids has been re- 
vived of late years, but that it is not devoid of danger. Sir Astley Cooper relates 
cases in which it was followed by fatal hemorrhage. The application recommen- 
ded by our author is probably intended, in a great measure, for restraining the 
bleeding. 
4 This is a term still in use. See Liston's Pract. Surg. The treatment of con- 
dyloma ani is minutely given by Celsus, vi., 18, and vii., 30. 
Vol. II.-21. 322 
GENUINE WORKS OF HIPPOCRATES. 
protuberance like the fruit of the mulberry, and if the condyloma be far 
without, an envelope of flesh is adherent to it. Having placed the man 
over two round stones1 upon his knees, examine, for you will find the parts 
near the anus between the buttocks inflated, and blood proceeding from 
within. If, then, the condyloma below the cover be of a soft nature, 
bring it away with the finger, for there is no more difficulty in this than 
in skinning a sheep, to pass the fingei' between the hide and the flesh. 
And this should be accomplished without the patient's knowledge, while 
he is kept in conversation. When the condyloma is taken off, streaks of 
blood necessarily flow from the whole of the torn part. It must be 
speedily washed with a decoction of galls, in a dry wine, and the bleeding 
vein will disappear along with the condyloma, and its cover will be re- 
placed. The older it is, the more easy the cure. 
5. But if the condyloma be higher up, you must examine it with the 
speculum, and you should take care not to be deceived by the speculum; 
for when expanded, it renders the condyloma level with the surrounding 
parts, but when contracted, it shows the tumor right again. It is to be 
removed by smearing it with black hellebore on the finger. Then, on 
the third day, wash it out with a dry wine. You need not be surprised that 
there is no discharge of blood when you remove the condyloma, for 
neither, if you cut off the hands or legs at the articulations will there be 
any flow of blood; but if you cut them off above or below the joints, you 
will find there hollow veins which pour out blood, and you will have diffi- 
culty in stopping the bleeding. In the same manner, the bleeding vein in 
the anus, if you cut it above or below the point of separation of the con- 
dyloma, will pour forth blood; but if you take away the condyloma at its 
junction (with the natural parts f) there will be no flow of blood.2 If 
matters then be thus put to rights, it will be well; but otherwise burn it, 
taking care not to touch the place with the iron, but bringing it close so 
as to dry it up, and apply the flos aeris in the urine. 
6. Another method of curing hemorrhoids:-You must prepare a cau- 
tery like the arundo phragmites,3 and an iron that exactly fits is to be 
1 Or mortars, meaning those used in houses for pounding corn. See Hesychius, 
and Foes in his annotations on this place. 
2 The directions given by Celsus are to the same effect: " At tubercula, quae 
appellantur, ubi induruerunt, luec ratione curantur. Alvus ante 
omnia ducetur; turn vulsella tuberculum apprehensum juxta radices exciditur." 
(vii., 30, 2.) 
31 have no doubt that this is the reed described by Dioscorides, i., 114. The 
meaning of our author, I suppose, is, that the canula used in burning internal 
hemorrhoids should resemble the stalk of the Arundo phragmites. I think it re- 
markable that the ingenious mode of procedure here described should not be 
noticed by any of the subsequent authorities on operative surgery. The use of 
the canula, however, in the application of the cautery for the purpose of stopping 
bleeding- arteries, is not unknown at the present day. See South's edition of HEMORRHOIDS. 
323 
adapted to it; then the tube being introduced into the anus, the iron, red 
hot, is to be passed down it, and frequently drawn out, so that the part may 
bear the more heat, and no sore may result from the heating, and the dried 
veins may heal up. But if you are neither disposed to burn nor excise, 
having first fomented with plenty of hot water and turned out the anus, 
levigate myrrh, and having burnt galls and Egyptian alum, in the propor- 
tion of one and a half to the other things, and as much of melanteria;1 
these things are all to be used in a dry state. The hemorrhoid will sep- 
arate under the use of these medicines, like a piece of burnt hide. You 
are to proceed thus until the whole are removed, and a half part of burnt 
chalcitis does the same thing. But if you wish to effect the cure by sup- 
positories, take the shell of the cuttie fish, a third part of plumbago, 
bitumen, alum, a little of the flos aeris, galls, a little verdigris; having 
poured a small quantity of boiled honey on these, and formed an oblong 
suppository, apply until you remove them.2 
7. An hemorrhoid in a woman may be thus cured. Having fomented 
with plenty of hot water, boil in the water certain of the fragrant medi- 
cines, add pounded tamarisk, roasted litharge and galls, and pour on them 
white wine, and oil, and the grease of a goose, pounding all together. 
Give to use after fomenting. In fomenting the anus is to be made to 
protrude as much as possible.3 
Chelius, etc., vol. i., p. 315; and Malgaigne's Operative Surgery, p. 16, English 
edition. The cautery with the canula is well delineated by Scultet, Arm. Chirurg., 
t. xvi. 
1 Probably " the ferruginous arseniate of copper." See Paulus AEgineta, Vol. 
III., p. 244, Syd. Soc. edit. It is proper to mention, that there is a mistake there 
in stating that this substance is not mentioned by Hippocrates. 
2 This method of removing internal piles by means of caustics and septics, is 
described by Celsus, Aetius, and Paulus. Of the ingredients which they contain, 
the most powerful is arsenic. I have more than once removed hemorrhoids by 
means of the potassa fusa, and condylomata by preparations of arsenic. 
3 On this subject, see the authorities quoted in the Commentary on Paulus 
ASgineta, Book VI., 71, Syd. Soc. edit. ON THE SACRED DISEASE. 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 produc- 
tions 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 cer- 
tain 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 in- 
comprehensible; 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 abil- 
ity 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 con- 
sequently they would be superior to the gods themselves. He further 
contends, that if magical arts could effect what they are represented as 328 
GENUINE WORKS OF HIPPOCRATES. 
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. 
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 resem- 
blance 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 exha- 
lents. 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 calcu- 
lated 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 at- 
tacks of apoplexy, owing to the scantiness of the blood in their veins, 
which is coagulated by the cold defluxion. THE SACRED DISEASE. 
329 
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 twen- 
tieth 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 a 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 prev- 
alence 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 decla- 
ration, 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 de- 
ranged in cases of insanity. These maniacal affections he holds to be con- 
nected 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 feel- 
ing 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 330 
GENUINE WORKS OF HIPPOCRATES. 
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 per- 
ceive that the work is highly interesting, and of a very original nature. 
The argument here directed against the vulgar belief that epilepsy is de- 
rived 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 opera- 
tions 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.2 But, as we have stated in the Preliminary Discourse, the 
-1 Noif opg Kai vovq aKover r a/7a Kutjid Kai TV(f>2.a. (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 Mos- 
heim 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, THE SACRED DISEASE. 
331 
author of one of the Hippocratic treatises, would seem to have confounded 
mind with heat, and the same idea runs through the present work, where 
it certainly appears that Hippocrates (or whoever was the author of 
the work) expresses himself as if he held the opinion that breath and 
soul are the same thing.1 This, I say, would seem to be the doctrine 
which our author holds, but, as we stated before, his ideas on abstruse 
points of philosophy are not always so well defined as could have been 
wished; in short, he had not learned, like his immediate successor, Aris- 
totle, to distinguish accurately between the immaterial principle and its 
primary instrument. Nor is this to be wondered at, when we reflect that 
a similar confusion of ideas prevails with many writers of the present day 
who maintain that some electrical or magnetical substance is the principle 
of life in all animals, and do not perceive the necessity of admitting an 
immaterial principle, as the conductor of its operations. Altogether, it 
is impossible not to remark a most striking coincidence between the tenets 
of the ancient philosophers regarding a pneuma, and those of certain 
modern mesmerists respecting a magnetical principle existing in the 
microcosm. 
With regard to the cause of epilepsy, it will be remarked that our 
author assigns its seat to the brain, and holds that the materies morbi is 
a cold phlegm or pit tilt a, secreted in that organ, which passing down into 
the blood-vessels, and encountering the pneuma, or principle of life, 
produces those dreadful convulsions to which epileptics are subject. I 
may be permitted to state, that this doctrine of our author's, respecting 
a cold pituitous humor or phlegm secreted in the brain, is decidedly 
adopted by Aristotle, who probably received this, as he did most of his 
physiological opinions, from Hippocrates.2 Lucretius, the Epicurean 
De Generatione. A tenet, which has been always reckoned peculiar to him, is 
that the spirit is analogous to the substance of which the stars are composed, by 
which he probably meant ether, that is to say, light or heat, This would appear 
to have been a doctrine very generally maintained in ancient times; it forms part 
of the popular philosophy of the Augustan age, as expounded by Virgil in the 
Sixth 1. 724. The poet here describes the pneuma as being " aurai 
simplicis ignem;" and in the Georgies he calls it " sethereos haustus." (iv., 220.) 
The best modern exposition of the ancient doctrines regarding the pneuma, is that 
by Abraham Kaau, in his work, Respiratio Dicta Hippocrati, which is replete with 
acute and profound views on many points connected with philosophy and physi- 
ology. The reader will also find much delightful information on the higher phi- 
losophy of the ancients in Berkeley's Siris, a most profound and original work. The 
doctrine of the pneuma thus broached by Hippocrates gave rise, several centuries 
afterwards, to a very important sect called the Pneumatic. On it, see in particular 
the French edition of Sprengell's Hist, of Med., tom. ii., p. 69; and the Preliminary 
Disquisition to Boerhaave's edition of Aretseus. 
1 Moses would seem to identify breath and the vital principle. See Genesis, 
ii., 7. 
2 De Partibus Animal., ii., 7. 332 
GENUINE WORKS OF HIPPOCRATES. 
poet, also, although he rejects the mental philosophy of the Platonists and 
Peripatetics, espouses an hypothesis quite similar to' our author's, in order 
to account for the phenomena of epilepsy. The description is so striking, 
that I subjoin a literal translation of it, by Mason Good: 
" Oft too some wretch, before our startled sight, 
Struck as with lightning, by some keen disease, 
Drops sudden:-by the dread attack o'erpowered 
He foams, he groans, he trembles, and he faints; 
Now rigid, now convulsed, his laboring lungs 
Heave quick, and quivers each exhausted limb. 
Spread through the frame, so deep the dire disease 
Perturbs his spirit; as the briny main ■ 
Foams through each wave beneath the tempest's ire. 
He groans since every member smarts with pain, 
And from his inmost breast, with wontless toil, 
Confused and harsh, articulation springs. 
He raves since soul and spirit1 are alike 
Disturbed throughout, and severed each from each 
As urged above distracted by the bane. 
But when, at length, the morbid cause declines, 
And the fermenting humors from the heart 
Flow back-with staggering foot the man first treads, 
Led gradual on to intellect aud strength." 
(De Rerum Natura, iii., 1. 486-504.) 
I may just mention further, that this doctrine of a pneuma, or animal 
spirits, was adopted by all the Arabian authorities, of which I shall only 
take time to refer to Avicenna, iii., 1, 4. It has also been held under a 
variety of shapes, by some of the first names in ancient and modern 
philosophy, as is correctly stated in the following interesting extract: 
11 Hippocrates, Galen, and Vieussens, thought that the spirits are formed 
of an aerial principle. Van Ilelmont, Willis, and Stenon assimilated them 
to light. Newton said that they consist of part of that very elastic ele- 
ment upon which the reflection and rarefaction of the solar rays depend. 
Descartes regarded them as an igneous principle; Boerhaave thought that 
they approach to the nature of water. Saussure and De Ilaen confound 
them with electric matter." (Dumas, Physiol., iv., 73.) At present, 
however, as hinted above, the form which the hypothesis has assumed is 
that of animal magnetism, which, it is well known, has many intelligent 
supporters, of whom I shall only mention one, my intelligent countryman, 
Mr. Colquhoun, the author of Isis Revelata. 
The other part of our author's hypothesis, I mean the connection of 
the disease with a pituitous secretion from the brain, however much some 
1 The poet applies the term animus to the mind or soul; and anima to the 
pneuma or spirit. Celsus renders the pneuma of Hippocrates by spiritus. See 
Praefatio. THE SACRED DISEASE. 
333 
may be disposed thoughtlessly to deride it, received a most remarkable 
confirmation from the observations of the celebrated anatomists, the 
Wenzels. The following account of their opinions I extract from Dr. 
Copland's Dictionary of Practical Medicine: "The Wenzels in their 
numerous dissections, directed attention to the state of the pituitary and 
pineal glands. These able pathologists found the pituitary glands and 
infundibulum variously altered in color, consistence, size, and structure, 
in nearly all the cases of epilepsy they examined. . . Alterations in 
the sphenoid bone and pituitary gland have been found also by Geeding, 
Newman, Sims, and myself." (See under Epilepsy, § 48. ') 
Before concluding, I have a few additional remarks to make on the 
question whether or not the present treatise be the production of Hippoc- 
rates himself. I am aware that many learned critics, such as Gruner and 
Ackerman, looking to the difference of style and matter between it, and 
the genuine works of Hippocrates, such as the Prognostics and Aphorisms, 
have not hesitated to decide that it must be the production of an entirely 
different mind. But why should it appear incredible that the great 
master of Grecian medicine should have devoted his leisure hours to the 
study of the transcendental philosophy then in so high repute, and that 
he should have displayed the versatility of his genius in the manner he 
handles the new subject of his research? I have stated in the short 
biography I have given of him at the commencement of this work, that 
he was familiarly acquainted with Democritus of Abdera, and it is well 
known that he visited Athens at the time when Socrates had diverted the 
minds of his countrymen from verbal disputations to the cultivation of a 
sound and masculine philosophy. When we reflect how narrow the field 
of intellectual research then was, compared with what it has now become, 
it need not appear at all remarkable that the enlarged mind of our author 
should have ventured to grapple with all those great questions in physical 
and mental philosophy, which the sages of his time were attempting to 
solve. Galen, in fact, on many occasions, pronounces Hippocrates to 
have been a great philosopher, as well as a great physician; and that there 
is no incompatibility in the two characters is apparent from examples of 
very recent date. My lamented friend, Dr. Abercrombie, not only wrote 
elaborate works on Pathology and the Practice of Medicine, but also pub- 
lished treatises on Moral and Intellectual Philosophy. Haller was not 
only a great physician and physiologist, but also a highly popular poet. 
Why then should it appear incredible that Hippocrates should have dis- 
played as wide a grasp of mind as a Haller or an Abercrombie ? I know 
that the opinion is now pretty generally propagated, that a medical man 
ought to be exclusively occupied with professional pursuits, and have no 
1 See further, Syder's edition of Sir Astley Cooper's Lectures, p. 20 334 
GENUINE WORKS OF HIPPOCRATES. 
leisure to devote to the cultivation of elegant literature, and it is not 
unusual to hear of a physician's being run down by the craftsmen of our 
art, as a person who, it is inferred, must be deficient in a practical 
acquaintance with medicine, because it is admitted that he has made 
respectable acquirements in the liberal sciences, and in philosophy. Such 
members of the medical profession (or, I should rather say, craft), though 
they can find no time to devote to Homer or Aristotle, to Milton or Kant, 
find plenty of leisure to frequent all the haunts of fashionable resort, and 
as Galen somewhere says of his professional contemporaries, when the 
rich and the noble do not want them in the sick chamber, they are always 
ready to attend them in the ball or the banquet room. But is such a 
waste of intellectual existence indispensably necessary, in order to attain 
success in the practice of our profession ? And might not a man become 
a useful and respectable member of it, by discharging the duties of his 
profession actively when called upon, and then retiring to the study of the 
liberal arts and sciences ? I shall conclude this Argument and my present 
task, by quoting the memorable words in which Cicero apologizes for his 
having spent a certain portion of his time in the cultivation of elegant 
literature, and of philosophy, leaving the reader to apply the same in the 
case of Hippocrates, and, I may be permitted to add, in that of the humble 
Editor of the present volume, who trusts he shall not be set down as an 
idle and unprofitable practitioner of the Art, because he has found leisure 
amidst the turmoil and distraction of a professional life, to cqmmunicate to 
his countrymen the important opinions contained in the genuine remains 
of The Coan Sage:-" Ego vero fateor me his studiis esse deditum; ceteros 
pudeat, siqui ita se literis abdiderunt, ut nihil possint ex his neque ad 
communem ferre fructum, neque in adspectum, lucemque proferre. 
Quare quis tandem me reprehendat, aut quis mihi jure succenseat si, 
quantum ceteris ad suas res obeundas, quantum ad festos dies ludorum 
celebrandos, quantum ad alias voluptates, et ad ipsam requiem animi et 
corporis conceditur temporum; quantum alii tribuunt tempestivis convi- 
viis; quantum denique aleae, quantum pilae, tantum mihi egomet ad ham 
studia recolenda sumsero ? " 1 
ON THE SACRED DISEASE. 
It is thus with regard to the disease called Sacred: it appears to me to 
be nowise more divine nor more sacred than other diseases, but has a 
natural cause from which it originates like other affections. Men regard 
its nature and cause as divine from ignorance and wonder, because it is 
1 Pro Archia Poeta. THE SACRED DISEASE. 
335 
not at all like to other diseases. And this notion of its divinity is kept up 
by their inability to comprehend it, and the simplicity of the mode by 
which it is cured, for men are freed from it by purifications and incanta- 
tions. But if it is reckoned divine because it is wonderful, instead of one 
there are many diseases which would be sacred; for, as I will show, there 
are others no less wonderful and prodigious, which nobody imagines to be 
sacred. The quotidian, tertian, and quartan fevers, seem to me no less 
sacred and divine in their origin than this disease, although they are not 
reckoned so wonderful. And I see men become mad and demented from 
no manifest cause, and at the same time doing many things out of place; 
and I have known many persons in sleep groaning and crying out, some in 
a state of suffocation, some jumping up and fleeing out of doors, and 
deprived of their reason until they awaken, and afterward becoming well 
and rational as before, although they be pale and weak; and this will 
happen not once but frequently.1 And there are many and various things 
of the like kind, which it would be tedious to state particularly. And 
they who first referred this disease to the gods, appear to me to have been 
just such persons as the conjurors, purificators, mountebanks, and charla- 
tans now are, who give themselves out for being excessively religious, and 
as knowing more than other people. Such persons,, then, using the 
divinity as a pretext and screen of their own inability to afford any assist- 
ance, have given out that the disease is sacred, adding suitable reasons for 
this opinion, they have instituted a mode of treatment which is safe for 
themselves, namely, by applying purifications and incantations, and en- 
forcing abstinence from baths and many articles of food which are un- 
wholesome to men in diseases. Of sea substances, the sur-mullet,2 the 
blacktail,3 the mullet,4 and the eel; for these are the fishes most to be 
guarded against. And of fleshes, those of the goat, the stag, the sow, and 
the dog: for these are the kinds of flesh which are aptest to disorder the 
bowels. Of fowls, the cock, the turtle,5 and the bustard,6 and such others 
as are reckoned to be particularly strong. And of potherbs, mint, garlic, 
and onions' for what is acrid does not agree with a weak person. And 
they forbid to have a black robe, because black is expressive of death; and 
to sleep on a goat's skin, or to wear it, and to put one foot upon another, 
or one hand upon another; for all these things are held to be hinderances 
to the cure. All these they enjoin with reference to its divinity, as if 
1 Our author in this place evidently alludes to nightmare and somnambulism. 
2 Namely, the Mullus barbatus. See under Tptyiby, in the Appendix to Dunbar's 
Greek Lexicon. 
3 Namely, the Spams melanurus. See under pe/avovpoQ, in the above cited 
work. 
4 Namely, the Mugil cephalus. See under icecrrpevc, as above. 
6 Namely, the Columba turtur. See under rpvyuv, as above. 
6 Namely, the Otis tarda. See under wrtf, as above. 336 
GENUINE WORKS OF HIPPOCRATES. 
possessed of more knowledge, and announcing beforehand other pretents, 
so that if the person should recover, theirs would be the honor and credit; 
and if he should die, they would have a certain defense, as if the gods, 
and not they, were to blame, seeing they had administered nothing either 
to eat or drink as medicines, nor had overheated him with baths, so as to 
prove the cause of what had happened. But I am of opinion that (if this 
were true) none of the Libyans, who live in the interior, would be free from 
this disease, since they all sleep on goats' skins, and live upon goats' flesh; 
neither have they couch, robe, nor shoe that is not made of goat's skin, 
for they have no other herds but goats and oxen. But if these things, 
when administered in food, aggravate the disease, and if it be cured by 
abstinence from them, then is God not the cause at all; nor will purifica- 
tions be of any avail, but it is the food which is beneficial and prejudicial, 
and the influence of the divinity vanishes. Thus, then, they who attempt 
to cure these diseases in this way, appear to me neither to reckon them 
sacred nor divine. For when they are removed by such purifications, 
and this method of cure, what is to prevent them from being brought upon 
men and induced by other devices similar to these ?1 So that the cause 
is no longer divine, but human. For whoever is able, by purifications 
and conjurations, to drive away such an affection, will be able, by other 
practices, to excite it; and, according to this view, its divine nature is 
entirely done away with. By such sayings and doings, they profess to be 
possessed of superior knowledge, and deceive mankind by enjoining lus- 
trations and purifications upon them, while their discourse turns upon the 
divinity and the godhead.2 And yet it would appear to me that their dis- 
course savors not of piety, as they suppose, but rather of impiety, and as 
if there were no gods, and that what they hold to be holy and divine, were 
impious and unholy. This I will now explain. For, if they profess to 
know how to bring down the moon, and darken the sun, and induce 
storms and fine weather, and rains and droughts, and make the sea and 
land unproductive, and so forth, whether they arrogate this power as be- 
11 cannot but think that the proper reading is, kntyiyveadat,, and not aTvoyiyvecdai. 
Agreeably to this reading, the meaning is more clear. 
2 The term in the original (Jai/ztfawv) is of dubious meaning. In the works of 
earlier Greek authors, it and dalp-uv are generally put in a good sense; but in 
Christian times they are almost always taken in a bad sense, and applied to evil 
spirits. Hence demoniacs were held to be persons possessed with evil spirits or 
devils. In this light, I need scarcely remark, they are universally represented in 
the New Testament. That the persons there described as being- possessed with 
impure spirits were the same as the demoniacs of the Greeks, and that they were 
epileptics and maniacs, cannot admit of the very slightest doubt. It will be seen 
below that our author understands the popular belief to be, that the bodies of such 
persons were possessed by demons, who, he argues, must be good beings and not 
bad. The earlier Christians, however, held that all the gods of the heathens were 
demons in a bad sense, that is to say, devils. THE SACRED DISEASE. 
337 
ing derived from mysteries or any other knowledge or consideration, they 
appear to me to practice impiety, and either to fancy that there are no 
gods, or, if there are, that they have no ability to ward off any of the 
greatest evils. How, then, are they not enemies to the gods? For if a 
man by magical arts and sacrifices will bring down the moon,1 and darken 
the sun, and induce storms, or fine weather, I should not believe that 
there was anything divine, but human, in these things, provided the 
power of the divine were overpowered by human knowledge and subjected 
to it. But perhaps it will be said, these things are not so, but, men being 
in want of the means of life, invent many and various things, and devise 
many contrivances for all other things, and for this disease, in every phase 
of the disease, assigning the cause to a god. Nor do they remember the 
same things once, but frequently.2 ZFor, if they imitate a goat, or grind 
then' teeth, or if their right side be convulsed, they say that the mother 
of the gods is the cause. But if they speak in a sharper and more intense 
tone, they resemble this state to a horse, and say that Posidon 
is the cause. Or if any excrement be passed, which is often the case, 
owing to the violence of the disease, the appellation of Enodius {Hecate P) 
is adhibited; or, if it be passed in smaller and denser masses, like bird's, 
it is said to be from Apollo Nomius. But if foam be emitted by the 
mouth, and the patient kick with his feet, Ares {Mars) gets the blame. 
But terrors which happen during the night, and fevers, and delirium, and 
jumpings out of bed, and frightful apparitions, and fleeing away,-all 
these they hold to be the plots of Hecate, and the invasions of the Heroes, 
and use purifications and incantations, and, as appears to me, make the 
divinity to be most wicked and most impious. For they purify those 
laboring under this disease, with the same sorts of blood and the other 
means that are used in the case of those who are stained with crimes, and 
of malefactors, or who have been enchanted by men, or who have done 
any wicked act; who ought to do the very reverse, namely, sacrifice and. 
pray, and, bringing gifts to the temples, supplicate the gods. But now 
they do none of these things, but purify; and some of the purifications: 
they conceal in the earth, and some they throw into the sea, and some: 
they carry to the mountains where no one can touch or tread upon them. 
But these they ought to take to the temples and present to the god, if a 
1 This was supposed to be a very common, exploit of the ancient witches, 
Hence Virgil says, 
" Carmina vel caalo possunt deducere lunam." 
And Tibullus, in like manner: 
" Hanc ego de caslo ducentem sidera vidi." (El. i., 2.) 
And in similar terms Horace says, 
" et polo 
Deripere lunam vocibus possum meis." (Epod. xvii.) 
2 The text appears to be corrupt; at least the meaning is very equivocal. 
Vol. IL-22. 338 
GENUINE WORKS OF HIPPOCRATES. 
god be the cause of the disease. Neither truly do I count it a worthy 
opinion to hold that the body of man is polluted by god, the most impure 
by the most holy; for were it defiled, or did it suffer from any other thing, 
it would be like to be purified and sanctified rather than polluted by god. 
For it is the divinity which purifies and sanctifies the greatest of offenses 
and the most wicked, and which proves our protection from them. And 
we mark out the boundaries of the temples and the groves of the 
gods, so that no one may pass them unless he be pure, and when we enter 
them we are sprinkled with holy water, not as being polluted, but as lay- 
ing aside any other pollution which we formerly had. And thus it ap- 
pears to me to hold, with regard to purifications. But this disease seems 
to me to be nowise more divine than others; but it has its nature such as 
other diseases have, and a cause whence it originates, and its nature and 
cause are divine only just as much as all others are, and it is curable no 
less than the others, unless when, from length of time, it is confirmed, 
and has become stronger than the remedies applied. Its origin is heredi- 
tary, like that of other diseases.1 For if a phlegmatic person be born of 
a phlegmatic, and a bilious of a bilious, and a phthisical of a phthisical, 
and one having spleen disease, of another having disease of the spleen, what 
is to hinder it from happening that where the father and mother were 
subject to this disease, certain of their offspring should be so affected also ? 
As the semen comes from all parts of the body, healthy particles will come 
from healthy parts, and unhealthy from unhealthy parts.2 And another 
great proof that it is in nothing more divine than other diseases is, that it 
occurs in those who are of a phlegmatic constitution, but does not attack 
the bilious. Yet, if it were more divine than the others, this disease 
ought to befall all alike, and make no distinction between the bilious and 
phlegmatic. But in them, the brain is the cause of this affection, as it is 
of other very great diseases, and in what manner and from what cause it 
is formed, I will now plainly declare. The brain of man, as in all other 
animals, is double, and a thin membrane (meninx) divides it through the 
middle, and therefore the pain is not always in the same part of the head; 
for sometimes it is situated on either side, and sometimes the whole is 
affected; and veins run toward it from all parts of the body, many of 
which are small, but two are thick,-the one from the liver, and the 
other from the spleen. And it is thus with regard to the one from the 
liver: a portion of it runs downward through the parts on the right side, 
near the kidneys and the psoas muscle, to the inner part of the thigh, and 
extends to the foot. It is called vena cava. The other runs upward by 
1 That epilepsy is often hereditary, is admitted by our best authorities in 
modern times, as Zacutus Lusitanus (Prax. ad Mir., i., 36), Stahl (de Haered. 
Dispos. ad Var. Affect.), Boerhaave (Aphor. 1075), M. Esquirol, and Dr. Copland 
(Dictionary of Practical Medicine, under Epilepsy, p. 789). 
2 See, in like manner, On Airs, Waters, etc., § 15. THE SACRED DISEASE. 
339 
the right veins and the lungs, and divides into branches for the heart and 
the right arm. The remaining part of it rises upward across the clavicle 
to the right side of the neck, and is superficial so as to be seen; near the 
ear it is concealed, and there it divides; its thickest, largest, and most 
hollow part ends in the brain; another small vein goes to the right ear, 
another to the right eye, and another to the nostril. Such are the distri- 
butions of the hepatic vein. And a vein from the spleen is distributed on 
the left side, upward and downward, like that from the liver, but more 
slender and feeble. By these veins we draw in much spirit (gas for they 
are the spiracles of our bodies inhaling air to themselves and distributing 
it to the rest of the body, and to the smaller veins, and they cool and 
afterwards exhale it. For the breath (pneumo) cannot be stationary, but 
it passes upward and downward, for if stopped and intercepted, the part 
where it is stopped becomes powerless. In proof of this, when, in sitting 
or lying, the small veins are compressed, so that the breath (pneuma) 
from the larger vein does not pass into them, the part is immediately 
seized with numbness; and it is so likewise with regard to the other veins. 
This disease, then, affects phlegmatic persons, but not bilious. It begins 
to be formed while the foetus is still in utero. For the brain, like the 
other organs, is depurated and grows before birth. If, then, in this pur- 
gation it be properly and moderately depurated, and neither more nor less 
than what is proper be secreted from it, the head is thus in the most 
healthy condition. If the secretion (melting) from the whole brain be 
greater than natural, the person, when he grows up, will have his head dis- 
eased, and full of noises, and will neither be able to endure the sun nor 
cold. Or, if the melting take place from any one part, either from the 
eye or ear, or if a vein has become slender, that part will be deranged in 
proportion to the melting. Or, if the depuration do not take place, but it 
(the secretion ?) accumulates in the brain, it necessarily becomes phleg- 
matic. And such children as have an eruption of ulcers on the head, on 
the ears, and along the rest of the body, with copious discharges of saliva 
and mucus,-these, in after life, enjoy best health; for in this way the 
phlegm which ought to have been purged off in the womb, is discharged 
and cleared away, and persons so purged, for the most part, are not sub- 
ject to attacks of this disease. But such as have had their skin free from 
eruptions, and have had no discharge of saliva or mucus, nor have under- 
gone the proper purgation in the womb, these persons run the risk of 
being seized with this disease. But if the defluxion be determined to the 
heart, the person is seized with palpitation and asthma, the chest becomes 
diseased, and some also have curvature of the spine. For when a deflux- 
ion of cold phlegm takes place on the lungs and heart, the blood is chilled, 
and the veins, being violently chilled, palpitate in the lungs and heart, 
and the heart palpitates, so that from this necessity asthma and orthopnoea 
supervene. For it does not receive the spirits (pneuma) until the de- 340 
GENUINE WORKS OF HIPPOCRATES. 
fluxion of phlegm be mastered, and being heated is distributed to the 
veins, then it ceases from its palpitation and difficulty of breathing, and 
this takes place as soon as it obtains an abundant supply; and this will be 
more slowly, provided the defluxion be more abundant, or if it be less, 
more quickly. And if the defluxions be more condensed, the epileptic 
attacks will be more frequent, but otherwise if it be rarer. Such are the 
symptoms when the defluxion is upon the lungs and heart; but if it be 
upon the bowels, the person is attacked with diarrhoea. And if, being 
shut out from all these outlets, its defluxion be determined to the veins I 
have formerly mentioned, the patient loses his speech, and chokes, and 
foam issues by the mouth, the teeth are fixed, the hands are contracted, 
the eyes distorted, he becomes insensible, and in some cases the bowels 
are evacuated. And these symptoms occur sometimes on the left side, 
sometimes on the right, and sometimes in both. The cause of every one 
of these symptoms I will now explain. The man becomes speechless when 
the phlegm, suddenly descending into the veins, shuts out the air, and 
does not admit it either to the brain or to the vena cava, or to the ventri- 
cles, but interrupts the inspiration. For when a person draws in air by 
the mouth and nostrils, the breath (pneumo) goes first to the brain, then 
the greater part of it to the internal cavity, and part to the lungs, and 
part to the veins, and from them it is distributed to the other parts of the 
body along the veins; and whatever passes to the stomach cools, and does, 
nothing more; and so also with regard to the lungs. But the air which 
enters the Feins is of use (to the body) by entering the brain and its ven- 
tricles, and thus it imparts sensibility and motion to all the members, so 
that when the veins are excluded from the air by the phlegm and do not 
receive it, the man loses his speech and intellect, and the hands become 
powerless, and are contracted, the blood stopping and not being diffused, 
as it was wont; and the eyes are distorted ow'ing to the veins being excluded 
from the air; and they palpitate; and froth from the lungs issues by the 
mouth. For when the breath (pneumo) does not find entrance to him, 
he foams and sputters like a dying person. And the bowels are evacuated 
in consequence of the violent suffocation; and the suffocation is produced 
when the liver and stomach ascend to the diaphragm, and the mouth of 
the stomach is shut up; this takes place when the breath (pneumo) does 
not enter by the mouth, as it is wont. The patient kicks with his feet 
when the air is shut up in the lungs and cannot find an outlet, owing to 
the phlegm; and rushing by the blood upward and downward, it 
occasions convulsions and pain, and therefore he kicks with his feet. All 
these symptoms he endures when the cold phlegm passes into the warm 
blood, for it congeals and stops the blood.1 And if the defluxion be 
1 See Lucretius, De Rerum Nat. iii., 1. 486; and the translation of the same as 
given in the Argument. THE SACRED DISEASE. 
341 
copious and. thick, it immediately proves fatal to him, for by its cold, it 
prevails over the blood and congeals it; or, if it be less, it in the first place 
obtains the mastery, and stops the respiration; and then in the course of 
time, when it is diffused along the veins and mixed with much warm 
blood, it is thus overpowered, the veins receive the air, and the patient 
recovers his senses. And of little children which are seized with this dis- 
ease, the greater part die, provided the defluxion be copious and humid, 
for the veins being slender cannot admit the phlegm, owing to its thick- 
ness and abundance; but the blood is cooled and congealed, and the child 
immediately dies. But if the phlegm be in small quantity, and make a 
defluxion into both the veins, or to those on either-side, the children sur- 
vive, but exhibit notable marks of the disorder; for either the mouth is 
drawn aside, or an eye, the neck, or a hand, wherever a vein being filled 
with phlegm loses its tone, and is attenuated, and the part of the body 
connected with this vein is necessarily rendered weaker and defective. 
But for the most it affords relief for a longer interval; for the child is no 
longer seized with these attacks, if once it has contracted this impress of 
the disease, in consequence of which the other, veins are necessarily 
affected, and to a certain degree attenuated, so as just to admit the air, 
but no longer to permit the influx of phlegm. However, the parts are 
proportionally enfeebled whenever the veins are in an unhealthy state. 
When in striplings 1 the defluxion is small and to the right side, they re- 
cover without leaving any marks of the disease, but there is danger of its 
becoming habitual, and even increasing if not treated by suitable reme- 
dies. Thus, oi- very nearly so, is the case when it attacks children. But 
when it attacks persons of a more advanced age, it neither proves fatal, 
nor produces distortions. For their veins are hollow (large ?), and filled 
with hot blood; and therefore the phlegm can neither prevail nor cool the 
blood, so as to coagulate it, but it is quickly overpowered and mixed with 
the blood, and thus the veins receive the air, and sensibility remains; and, 
owing to their strength, the aforesaid symptoms are less likely to seize them. 
But when this disease attacks very old people, it therefore proves fatal, 
or induces paraplegia, because the veins are empty, and the blood scanty, 
thin, and watery.2 When, therefore, the defluxion is copious, and the 
season winter, it proves fatal; for it chokes up the exhalents, and coagu- 
lates the blood if the defluxion be to both sides; but if to either, it merely 
induces paraplegia. For the blood being thin, cold, and scanty, cannot 
prevail over the phlegm, but being itself overpowered, it is coagulated, so 
that those parts in which the blood is corrupted, lose their strength. The 
defluxion takes place rather on the right side than on the left, because the 
1 Meaning persons about puberty, and until 25 years of age. See Aph. v., 7. 
2 The connection between epilepsy and apoplexy is indisputable, and has been 
often adverted to in modern times. See Copland's Dictionary, under Epilepsy, 
§§ 16, 40. 342 
GENUINE WORKS OF HIPPOCRATES. 
veins there are more capacious and numerous than on the left side, for on 
the one side they spring from the liver, and on the other from the spleen. 
The defluxion and melting down take place most especially in the case of 
children in whom the head is heated either' by the sun or by fire, or if 
the brain suddenly contract a rigor, and then the phlegm is excreted. 
For it is melted down by the heat and diffusion of the brain, but it is ex- 
creted by the congealing and contracting of it, and thus a defluxion takes 
place. And in some this is the cause of the disease, and in others, when 
the south wind quickly succeeds to northern breezes, it suddenly unbinds 
and relaxes the brain, which is contracted and weak, so that there is an 
inundation of phlegm,- and thus the defluxion takes place. The defluxion 
also takes place in consequence of fear, from any hidden cause, if we are 
frightened at any person's calling aloud, or while crying, when one cannot 
quickly recover one's breath, such as often happens to children. When 
any of these things occur, the body immediately shivers, the person 
becoming speechless cannot draw his breath, but the breath (pneumo) 
stops, the brain is contracted, the blood stands still, and thus the excre- 
tion and defluxion of the phlegm take place. In children, these are the 
causes of the attack at first. But to old persons winter is most inimical. 
For when the head and brain have been heated at a great fire, and then 
the person is brought into cold and has a rigor, or when from cold he 
comes into warmth, and sits at the fire, he is apt to suffer in the same 
way, and thus he is seized in the manner described above. And there is 
much danger of the same thing occurring, if in spring his head be exposed 
to the sun, but less so in summer, as the changes are not sudden. When 
a person has passed the twentieth year of his life, this disease is not apt 
to seize him, unless it has become habitual from childhood, or at least 
this is rarely or never the case. For the veins are filled with blood, and 
the brain consistent and firm, so that it does not run down into the veins, 
or if it do, it does not overpower the blood, which is copious and hot. 
But when it has gained strength from one's childhood,and become habitual, 
such a person usually suffers attacks, and is seized with them in changes 
of the winds, especially in south winds, and it is difficult of removal. For 
the brain becomes more humid than natural, and is inundated with phlegm, 
so that the defluxions become more frequent, and the phlegm can no 
longer be excreted, nor the brain be dried up, but it becomes wet and 
humid. This you may ascertain in particular, from beasts of the flock 
which are seized with this disease, and more especially goats, for they are 
most frequently attacked with it. If you will cut open the head, you will 
find the brain humid, full of sweat, and having a bad smell.1 And in 
1 It is well known that this is also the case with sheep, and that they are sub- 
ject to the disease called the sturdy, which is indisputably a sort of epilepsy. 
Many shepherds have told me that they have perforated the skull so as to evacu- 
ate the water in the brain. The operation, however, is not often successful. The 
materies morbi, I believe, is a hydatid. THE SACRED DISEASE. 
343 
this way truly you may see that it is not god that injures the body, but 
disease. And so it is with man. For when the disease has prevailed for 
a length of time, it is no longer curable, as the brain is corroded by the 
phlegm, and melted, and what is melted down becomes water, and sur- 
rounds the brain externally, and overflows it; wherefore they are more 
frequently and readily seized with the disease. And therefore the disease 
is protracted, because the influx is thin, owing to its quantity, and is immedi- 
ately overpowered by the blood and heated all through. But such per- 
sons as are habituated to the disease, know beforehand when they are 
about to be seized and flee from men; if their own house be at hand, 
they run home, but if not, to a deserted place, where as few persons as 
possible will see them falling, and they immediately cover themselves up. 
This they do from shame of the affection, and not from fear of the di- 
vinity, as many suppose. And little children at first fall down wherever 
they may happen to be, from inexperience. But when they have been 
often seized, and feel its approach beforehand, they flee to their mothers, 
or to any other person they are acquainted with, from terror and dread of 
the affection, for being still infants they do not know yet what it is to be 
ashamed. And for these reasons, I say, they are attacked during changes 
of the winds, and especially south winds, then also with north winds, and 
afterwards also with the others. These are the strongest winds, and the 
most opposed to one another, both - as to direction and power. For, the 
north wind condenses the air, and separates from it whatever is muddy 
and nebulous, and renders it clearer and brighter, and so in like manner 
also, all the winds which arise from the sea and other waters; for they ex- 
tract the humidity and nebulosity from all objects, and from men them- 
selves, and therefore it (the north wind) is the most wholesome of the 
winds. But the effects of the south are the very reverse.1 For in the 
first place it begins by melting and diffusing the condensed air, and there- 
fore it does not blow strong at first, but is gentle at the commencement, 
because it is not able at once to overcome the dense and compacted air, 
which yet in a while it dissolves. It produces the same effects upon the 
land, the sea, the rivers, the fountains, the wells, and on every production 
which contains humidity, and this, there is in all things, some more, some 
less. For all these feel the effects of this wind, and from clear they be- 
come cloudy, from cold, hot; from dry, moist; and whatever earthen 
vessels are placed upon the ground, filled with wine or any other fluid, 
are affected with the south wind, and undergo a change. And the sun, 
the moon, and the stars it renders blunter in appearance than they natu- 
1 The classical scholar will here recollect the character of the auster given by 
Horace: 
" frustra per autumnum nocentem 
Corporibus mutuemus austrum." 
This wind, I suppose, there can be no doubt, was the sirocco. 344 
GENUINE WORKS OF HIPPOCRATES. 
rally are. When, then, it possesses such powers over things so great and 
strong, and the body is made to feel and undergo changes in the changes 
of the winds, it necessarily follows that the brain should be dissolved and 
overpowered with moisture, and that the veins should become more re- 
laxed by the south winds, and that by the north the healthiest portion of 
the brain should become contracted, while the most morbid and humid is 
secreted, and overflows externally, and that catarrhs should thus take 
place in the changes of these winds. Thus is this disease formed and pre- 
vails from those things which enter into and go out of the body, and it is 
not more difficult to understand or to cure than the others, neither is it 
more divine than other diseases. And men ought to know that from 
nothing else but thence (from the brain') come joys, delights, laughter and 
sports, and sorrows, griefs, despondency, and lamentations. And by this, 
in an especial manner, we acquire wisdom and knowledge, and see and 
hear, and know what are foul and what are fair, what are bad and what 
are good, what are sweet, and what unsavory; some we discriminate by 
habit, and some we perceive by their utility. By this we distinguish 
objects of relish and disrelish, according to the seasons; and the same 
things do not always please us. And by the same organ we become mad 
and delirious, and fears and terrors assail us, some by night, and some by 
day, and dreams and untimely wanderings, and cares that are not suitable, 
and ignorance of present circumstances, desuetude, and unskilfulness. 
All these things we endure from the brain, when it is not healthy, but 
is more hot, more cold, more moist, or more dry than natural, or when it 
suffers any other preternatural and unusual affection. And we become 
mad from humidity (of the brain). For when it is more moist than 
natural, it is necessarily put into motion, and the affection being moved,1 
neither the sight nor hearing can be at rest, and the tongue speaks in 
accordance with the sight and hearing. As long as the brain is at rest, 
the man enjoys his reason, but the depravement of the brain arises from 
phlegm and bile, either of which you may recognize in this manner: 
Those who are mad from phlegm are quiet, and do not cry out nor make 
a noise; but those from bile are vociferous, malignant, and will not be 
quiet, but are always doing something improper.2 If the madness be con- 
stant, these are the causes thereof. But if terrors and fears assail, they are 
connected with derangement of the brain, and derangement is owing to its 
being heated. And it is heated by bile when it is determined to the brain 
along the blood-vessels running from the trunk; and fear is present until 
1 If the text be not in fault, we must here understand by " affection " the affect- 
ed part, or organ; that is to say, the abstract is put for the concrete. This is con- 
stantly done by our author's contemporary, Pindar, but one would scarcely expect 
so bold a trope in a prose writer. 
2 The connection between epilepsy and mania is undoubted. See Copland's 
Dictionary, under Epilepsy. THE SACRED DISEASE. 
345 
it return again to the veins and trunk, when it ceases. He is grieved and 
troubled when the brain is unseasonably cooled and contracted beyond its 
wont. This it suffers from phlegm, and from the same affection the 
patient becomes oblivious. He calls out and screams at night when the 
brain is suddenly heated. The bilious endure this. But the phlegmatic 
are not heated, except when much blood goes to the brain, and creates an 
ebullition. Much blood passes along the aforesaid veins. But when the 
man happens to see a frightful dream and is in fear as if awake, then his 
face is in a greater glow, and the eyes are red when the patient is in fear. 
And the understanding meditates doing some mischief, and thus it is 
affected in sleep. But if, when awakened, he returns to himself, and the 
blood is again distributed along the aforesaid veins, it ceases. In these 
ways I am of opinion that the brain exercises the greatest power in the 
man. This is the interpreter to us of those things which emanate from 
the air, when it (the brain) happens to be in a sound state. But the air 
supplies sense to it. And the eyes, the ears, the tongue and the feet, 
administer such things as the brain cogitates. For inasmuch as it is sup- 
plied with air, does it impart sense to the body. It is the brain which is 
the messenger to the understanding. For when the man draws the 
breath (pneuma) into himself, it passes first to the brain, and thus the air 
is distributed to the rest of the body, leaving in the brain its acme, and 
whatever has sense and understanding. For if it passed first to the body 
and last to the brain, then having left in the flesh and veins the judg- 
ment, 1 when it reached the brain it would be hot, and not at all pure, but 
mixed with the humidity from the fleshy parts and the blood, so as to be 
no longei' pure. Wherefore., I say, that it is the brain which interprets 
the understanding. But the diaphragm has obtained its name (cppeves) 
from accident and usage, and not from reality or nature, for I know no 
power which it possesses, either as to sense or understanding, except that 
when the man is affected with unexpected joy or sorrow, it throbs and 
produces palpitations, owing to its thinness, and as having no belly to re- 
ceive anything good or bad that may present themselves to it, but it is 
thrown into commotion by both these, from its natural weakness. It 
then perceives beforehand none of those things which occur in the body, 
but has received its name vaguely and without any proper reason, like 
the parts about the heart, which are called auricles, but which contribute 
nothing towards hearing. Some say that we think with the heart, and 
that this is the part which is grieved, and experiences care.2 But it is 
1 AiayviMjit;. The term is very obscure; indeed I cannot but think the text must 
be corrupt. If it stand, it must be understood to mean the peculiar or discrim- 
inating power oi' property of the pneuma. 
2 This opinion was decidedly maintained by Chrysippus, but he flourished more 
than 200 years after our author. Who, among the more ancient philosophers in 
particular lie alludes to, it is difficult to determine with precision. Plato, in imita- 346 
GENUINE WORKS OF HIPPOCRATES. 
not so; only it contracts like the diaphragm, and still more so for the same 
causes. For veins from all parts of the body run to it, and it has valves, 
so as to perceive if any pain or pleasurable emotion befall the man. For 
when grieved the body necessarily shudders, and is contracted, and from 
excessive joy it is affected in like manner. Wherefore the heart and the 
diaphragm are particularly sensitive, they have nothing to do, however,with 
the operations of the understanding, but of all these the brain is the cause. 
Since, then, the brain, as being the primary seat of sense and of the spirits, 
perceives whatever occurs in the body, if any change more powerful than 
usual take place in the air, owing to the seasons, the brain becomes 
changed by the state of the air. For, on this account, the brain first 
perceives, because, I say, all the most acute, most powerful, and most 
deadly diseases, and those which are most difficult to be understood by the 
inexperienced, fall upon the brain. And the disease called the Sacred arises 
from causes as the others, namely, those things which enter and quit the 
body, such as cold, the sun, and the winds, which are ever changing and 
are never at rest. And these thing are divine, so that there is no neces- 
sity for making a distinction, and holding this disease to be more divine 
than the others, but all are divine, and all human. And each has its own 
peculiar nature and power, and none is of an ambiguous nature, or irre- 
mediable. And the most of them are curable by the same means as those 
by which they were produced. For any other thing is food to one, and 
injurious to another. Thus, then, the physician should understand and 
distinguish the season of each, so that at one time he may attend to the1 
nourishment and increase, and at another to abstraction and diminution. 
And in this disease as in all others, he must strive not to feed the disease, 
but endeavor to wear it out by administering whatever is most opposed 
to each disease, and not that which favors and is allied to it. For by 
that which is allied to it, it gains vigor and increase, but it wears out 
and disappears under the use of that which is opposed to it. But who- 
ever is acquainted with such a change in men, and can render a man humid 
and dry, hot and cold by regimen, could also cure this disease, if he re- 
cognizes the proper season for administering his remedies, without mind- 
ing purifications, spells, and all other illiberal practices of a like kind. 
tion of Homer, Euripides, Tyrtseus, and others of the Greek poets, held that the 
heart is the organ or seat of the passions; but the brain, of the understanding. 
See On the Republic, pluries. This philosophical question is discussed at great 
length by Galen, in the Second and Third Books of his work, On the Tenets of 
Hippocrates and Plato. EXPLANATION OF THE PLATES TO VOL. II. 
PLATE IV. 
Fig. 1. The Scamnum Hippocratis, or Bench of Hippocrates, as repre- 
sented by Andreas a Cruce. (Officina Chirurgica. Venetiis, 
1596). 
2. The same, as represented by M. Littre. 
A. A board, 6 cubits long, 2 broad, and 12 inches thick; not 13, 
as incorrectly stated by M. Littre. 
B. The feet of the Axles, which are short. 
CO. Axle-trees. 
dd. Grooves three inches deep, three broad, separated from one 
another by four inches. 
e. A small post, or pillar, fastened in the middle of the machine 
in a quadrangular hole. 
F. Pillars a foot long. 
G. A cross-beam laid on the pillars ff, which can be placed at 
different heights by means of holes in the pillars. 
PLATE V. 
Fig. 1. Representation of the mode of reducing dislocation of the thigh 
outwards, as given by M. Littre. (CEuv. d'Hipp., tom. iv., 
p. 305.) 
A mistake in the figure given by M. Littre is here corrected. It applies to 
Articulations, § 74. 
A. A lever applied to the nates of the luxated side, and acting 
from without inwards, in order to bring the head of the bone 
into its cavity. 
b. Another lever, held by an assistant, put into one of the grooves 
of the machine, and intended to act against lever A. 
c. Groove in which the end of the lever a takes its point of support. 
D. The luxated member. 
ee. Extension and counter-extension. 
2. Representation of the ancient mode of performing succusion, as 
given by Vidus Vidius in the Venetian edition of Galen's 
works. (Cl. vi., p. 271.) 
It applies to Articulations, § 43. 348 
EXPLANATION OF PLATES. 
PLATE VI. 
Fig. 1. The Circular Band, named Rotunda sincera cequalis. From the 
Venetian edition of Galen, (vi., p. 205.) 
2 and 3. The form of bandage named Ascia sincera incequalis {Ibid. 
p. 206.) 
4 and 5. The form of bandage named Sima sincera incequalis. 
{Ibid.) 
These bandages relate to the work, On the Surgery. 
PLATE VII. 
Fig. 1. The bandage named Monoculus. 
2. The bandage named Rhombus. 
3. The bandage named Semirhombus. 
These figures apply to the work, On the Surgery. 
PLATE VIII. 
Fig. 1. Elastic rods used as splints in fracture of the leg. Figure as 
given by Littre. {CEuv. d'Hippocrat., iii., p. 519.) 
2. The same, as given by Vidus Vidius in the Venetian edition of 
Galen. 
These two figures apply to the description given in § 30 of Fractures. 
3 and 4. Apparatus for the cure of Club-foot, as given by Aracaeus. 
(See p. 560 of this work.) The Boot, probably, was used in 
lieu of the Chian sandals of Hippocrates, p. 634. PLATE I V. 
1 
C 
B 
F 
G 
E 
K 
» 
r 
D 
II 
Q 
IB 
A 
2 PLATE V. 
IB 
\d 
E 
E 
1 
2 PLATE VI. 
1 
2 
3 PLATE VII. 
1 
2 
3 PLATE VIII. 
I 
2 
3 
4 INDEX TO THE TWO VOLUMES. 
Abercrombie, Dr., his work on the 
Brain referred to, i, 287; his double 
character as a metaphysician and 
physician instanced as a parallel to 
that of Hippocrates, ii, 333. 
Abernethy, his rule in regard to tre- 
panning the skull, i, 360, 361. 
Abortion, ancient modes of producing, 
ii, 280. 
Abruption, definition of the term, ii, 18; 
of the extremity of the humerus 
defined and described by the Editor, 
ii, 31-32; briefly noticed by Hip- 
pocrates, ii, 71; of the acromion, 
described and explained, ii, 97, 
98. 
Ackerman, a very learned authority 
on the authenticity of the different 
Hippocratic treatises, i, 29; his list 
of the genuine works, i, 29. 
Acromion, on the dislocation at the, 
ii, 166. 
Acute diseases, what were so named 
by Hippocrates, i, 235. 
Affections, characters of the Hippocrat- 
ic treatise on, i, 70, 71; on inter- 
nal, the characters of, i, 71, 72; 
probably emanated from the Cni- 
dian school of medicine, i, 73. 
Affusion, of hot water on the head use- 
ful in all fevers but the bilious, 
ii, 266; of cold water in tetanus, 
ii, 237; and swellings and pains of 
the joints, ii, 197. 
Air, treatise on, probably not genuine, 
i, 60, 61; opinions of the ancient 
philosophers regarding atmos- 
pheric, i, 118, 119; held by them to 
support the earth, i, 61. 
Airs, Waters, and Places, genuineness 
of this work, i, 46; argument to 
and translation of, i, 147, 184. 
Alexander the Great, description of 
the fever which proved fatal to 
him, i, 260, 261. 
Aliment, the Hippocratic treatise on, 
analysed, i, 95, 96. 
Allopathy, or the doctrine of the con- 
traries, i, 60, 63. 
Alvine discharges, prognostics founded 
upon, i, 203, 215. 
Amazons, the ancient myth respecting 
them considered, i, 155, 156; Hip- 
pocrates neither affirms nor de- 
nies the truth of it, ii, 128, 129. 
Ambe, reduction of dislocations by the, 
ii, 89, 90. 
Amputation of the extremities in cases 
of gangrene, i, 334. 
Analepsis, or the suspending the arm 
in a sling, ii, 35. 
Analogy between the bones of the 
upper and lower extremities, ii, 53, 
54. 
Anatomy, whether or not the Ascle- 
piadae cultivated human and com- 
parative, i, 6; Hippocrates cer- 
tainly not unacquainted with hu- 
man, ii, 81; Aristotle, his ac- 
quaintance with human, ii, 81; re- 
marks of Beclard on the knowl- 
edge of, possessed by Hippocra- 
tes, ii, 84; further proofs of Hip- 
pocrates' acquaintance with, ii, 
86, 119. 
Andral confirms the ancient doctrines 
on crises, i, 206; his observations 
on the critical days, i, 206. 350 
INDEX. 
Ankle-joint, on the accidents which be- 
fall the bones of the, ii, 33-35. See 
under Dislocations. 
Anthrax or Carbuncle, a dangerous 
complication of fever, i, 332; ob- 
servations on, i, 79. 
Aphorisms, Books of, universally held 
to be genuine, i, 42; English trans- 
lations of, i, 43; great excellence 
and high reputation of the work, 
ii, 183; object of, ii, 184; divisions 
of by ancient authorities, ii, 185; 
argument to, ii, 184-192; transla- 
tion of, ii, 192-273. 
Apolinose, description of the operation, 
ii, 312, 313. 
Apollonius Citiensis, his Commen- 
taries on Hippocrates referred to, 
ii, 69, 87, 102, 103; his mistaken 
notion respecting dislocation at the 
hip-joint, ii, 146. 
Apoplexy, prognosis in cases of, ii, 
209; age most subject to, ii, 259. 
Appendix to Regimen in Acute Dis- 
eases, i, 254, 279. 
Arantius, his Commentary on Hip- 
pocrates' work on Injuries of the 
Head, i, 376-385; misspelt Aselli- 
us, i, 375, 376. 
Aristophanes, the comic poet, mis- 
represents meterology, i, 157. 
Aristotle, the way in which he pub- 
lished his works, i, 20; the casu- 
alties which befel his library after 
his death, i, 34; date of his death, 
i, 35; the character of his esoteric 
works, i, 149; his opinions on the 
subject of meterology, i, 157; bor- 
rows freely from Hippocrates on 
physiological subjects, i, 181. 
Art, the Hippocratic treatise on, not 
genuine, i, 65; the medical art pro- 
nounced to be long when contrasted 
with the shortness of human life, 
ii, 192. 
Articulations, on the genuineness of 
the Hippocratic treatise bearing 
this title, i, 47; argument to the 
work, ii, 75-85; translation, ii, 85; 
some sections of the work perfect 
masterpieces in surgical literature, 
ii, 76. 
Ascia, a peculiar form of bandage, ii, 
10. 
Asclepia, or Temples of Health, in 
Greece, i, 4-7; remedial measures 
practiced in them, i, 4-6; those of 
Cos, Cnidos, and Rhodes particu- 
larly celebrated in the age of Hip- 
pocrates, i, 7. 
Asclepiadse, or Priest-physicians, ac- 
count of, i, 4; publicly consulted 
by States during the prevalence of 
fatal epidemics, i, 11; conclusions 
respecting their system of prac- 
tice, i, 188, 189. 
Asellius, see under Arantius. 
Asiatics, characters of the, i, 169-174; 
causes of their pusillanimity, i, 173, 
174. 
Astragalus, see Dislocations at the 
Ankle-joint. 
Astronomy, see Meteorology. 
his characters of the differ- 
erent kinds of waters, i, 165. 
Athletae, important facts regarding the 
regimen to which they were sub- 
jected, ii, 193. 
Atrophied limbs, how to be treated, 
11, 19. 
Aulus Gellius, his authority on the 
date of Hippocrates' death un- 
justly overlooked, i, 9. 
Autumn, diseases most prevalent in, 
ii, 216; generally reckoned a very 
unhealthy season, ii, 212. 
Axis in peritrochio, and the other 
mechanical powers, ii, 63. 
Bacon, Lord, agreed with the ancient 
philosophers regarding the nature 
of matter and the elements, i, 121. 
Bandages, general directions respect- 
ing, ii, 10-13; purposes to be ful- 
filled by ii, 11; on the forms called 
epidesmis and hypodesmis, ii, 12, 
39; remarks on the Hippocratic 
mode of applying them, by Mal- 
gaigne and the Editor, ii, 26; 
symptoms indicative of their be- 
ing properly applied, ii, 40; mode 
of applying, ii, 10, 13. 
Bath, on the use of the, in acute dis- 
eases, i, 252, 253. INDEX. 
351 
Beclard, his description of the parts 
connected with the elbow-joint, 
ii, 84. 
Bell, Sir Charles, his description of 
fracture of the trochlea, ii, 32. 
Belly or venter, ambiguous use of the 
term, ii, 119. 
Berard, his important observations on 
partial dislocation of the jaw-bone, 
in illustration of Hippocrates' 
doctrines on this subject, ii, 106. 
Bile, prognostics founded on vomitings 
of, i, 203, ii, 222, 223. 
Births, seven months' and eight 
months', the Hippocratic treatises 
on them probably not genuine, 
i, 78. 
Bleeding, rules for, in acute diseases, 
i, 262, 276; carried ad deliquium 
animi in fevers, i, 269 (see Deli- 
quium); in injuries of the head, i, 
369, 370. 
Bones of the skull, description of the, 
i, 370, 379; their characters in 
children, i, 385; protrusion of fract- 
ured bones in compound fractures, 
how to be remedied, ii, 63, 67; in 
the arm and thigh generally fatal, 
ii, 65, 66. 
Bread, remarks on the invention of, i, 
134; characters of the different 
kinds mentioned by Hippocrates, 
i, 139. 
Broussais, his hypothetical system at 
variance with the principles of the 
Hippocratic medicine, i, 130. 
Buboes, a fatal symptom in all fevers 
except the ephemeral, ii, 229. 
Burning-irons of the ancients, their 
form, ii, 321. 
Burns, on the treatment of, as laid 
down by Hippocrates, ii, 304. 
Caddis, on the use of, in fractures of 
the nose, ii, 111, 163. 
Chelius Aurelianus, his strictures on 
Hippocrates, i, 258. See Sora- 
NUS. 
Calculus, ancient theory regarding the 
formation of, i, 166; relieved by 
diluents, i, 166. See Stone. 
Canals or gutters, how used by the 
ancients in the treatment of fract- 
ures, ii, 15, 51, 55. 
Cancer, rules laid down by Hippocra- 
tes for the treatment of, ii, 256. 
Cantharis, its administration in medi- 
cine, i, 276; the mylabris cichorii 
or Fusselina, i, 276. 
Carbuncle, opinions regarding the nat- 
ure of, i, 80. See Anthrax. 
Causus or ardent fever, on the nature 
of, i, 260, 264, 288, 302, 334. 
Cautery, application of the, in the vi- 
cinity of joints, i, 177; to the shoul- 
der, particularly described, ii, 94, 
95; different forms of, for the cure 
of hemorrhoids, ii, 321; held to be 
the highest of the medicinal pow- 
ers, ii, 273. 
Celsus states that Hippocrates sepa- 
rated medicine from philosophy, 
i, 4; Schulze's ingenious explana- 
tion of the meaning of this state- 
ment, i, 130; his practice in inju- 
ries of the skull, i, 365; further 
quoted, ii, 140, 146 et pluries. 
Characters, explanation of those which 
occur in the cases related by Hip- 
pocrates, i, 320-322. 
Cheese, its dietetical qualities, i, 272. 
Chelius, his opinions referred to, ii, 77, 
82; his remarks on the Hippo- 
cratic mode of treating fracture of 
the jaw, ii, 108. 
Chian slippers, used in the cure of club- 
foot, ii, 139. 
Cholera, on the nature and treatment 
of dry, i, 257, 273. 
Cicero, his interpretation of one of 
the Aphorisms of Hippocrates, ii, 
194; his eulogium on the cultiva- 
tion of elegant literature, ii, 334. 
Clark, Sir James, referred to as an 
authority on phthisis, i, 338, 339; 
confirms the statement of Hippoc- 
rates as to the period of life most 
subject to phthisis, ii, 235. 
Clavicle, see Fractures. 
Clifton, the character of his transla- 
tion of the Prognostics, i, 41. 
Club-foot, remarks on Hippocrates' 
description of, ii, 78; rules laid 
down by Hippocrates appreciated 352 
INDEX. 
by ArCtEUS, ii, 79; observations 
on, by Dr. Little, ii, 79; minute 
description of the process of treat- 
ment in children, ii, 138; brief 
statement of the general methods 
of treatment, ii, 173. 
Cnidian sentences, on the probable na- 
ture of their contents, i, 234, 235; 
Cnidian system of medicine found- 
ed on diagnosis, i, 235. 
Coar, his translation of the Aphorisms 
criticised, i, 44. 
Cold applications, use of, in injuries of 
the head, i, 370. 
Coldness of the extremities, prognosis 
founded upon, i, 201. 
Coma vigil, a description of, i, 335. 
Commentators on Hippocrates, a 
complete list of, i, 21-24. 
Compresses, how to be applied in fract- 
ures, ii, 13. 
Conception, how produced in certain 
circumstances, i, 162; on the char- 
acters of false, i, 221; how to judge 
when it will readily take place, i, 
223. 
Concussion of the brain induces loss of 
speech, ii, 269. 
Condyloma, on the nature and treat- 
ment of, ii, 322. 
Congestion of the brain, symptoms of, 
as described by Hippocrates, i, 
263. 
Constitution of the seasons described 
by Hippocrates, i, 284, 288; Const. 
I, i, 293; Const. II, i, 296, Const. 
HI, i, 301; pestilential, i, 332. 
Contagion, no mention of, in the works 
of Hippocrates, i, 292, 293; on the 
contagiousness of consumption, i, 
293. 
Continued fevers, on the nature of, i, 
295. 
Contusions of the skull, on the nature 
and treatment of, i, 358; the prac- 
tice of Mr. Pott and other modern 
authorities compared with that of 
Hippocrates, i, 364; held by Hip- 
pocrates to be more dangerous 
than depressed fractures, i, 385. 
Convulsions, the double nature of, ii, 
256; apt to attack the side of the 
body opposite that which is in- 
jured, i, 386; children subject to, i, 
298. 
Cooper, Sir Astley, his opinions re- 
ferred to, ii, 32 et pluries. 
Cooper, Mr. Bransby, his surgical 
opinions compared with those of 
Hippocrates, ii, 32 et pluries. 
Coray, his character of the style of 
Hippocrates, i, 18; his translation 
of the work " On Airs, &c." i, 47; 
his divisions of it, i, 149; figure of 
the Greek winds as given by, i, 
153. 
Cotton or linen cloth used in the form 
of a tent for the cure of fistulas, ii, 
311. 
Counter fissure or contre-coup, i, 358, 
359, 374; opinions of Mr. Guthrie 
and others regarding, i, 374, 375. 
Coups de soleil, notices of, by the an- 
cients, i, 158. 
Cranium, description of, by Hippoc- 
rates, i, 370, 371. 
Crasis, theory of, whether Alcmjeon 
or Hippocrates was the founder 
of it, i, 130; explanation of it by 
Hippocrates, i, 142. 
Crises, the Hippocratic treatise on, not 
genuine, i, 102; the ancient opinions 
regarding, confirmed by Andral, 
i, 206. 
Critical days, the Hippocratic treatise 
on, though not genuine, contains 
much valuable matter, i, 102;. 
prognosis founded upon, i, 208; 
Hippocrates, according to Galen, 
the first author who treated of 
them, i, 209. 
Croup, whether the ancients have des- 
cribed the disease, i, 54. 
Ctesias, the historian and physician, 
i, 12, 13; his mistaken notion re- 
garding dislocations at the hip- 
joint, ii, 145. 
Cullen, his hypothetical system at 
variance with the principles of 
Hippocrates, i, 130. 
Cupping, on the operation of, ii, 306. 
Custom, the effects of, on the body,, 
i, 246. 
Cyceon, on the nature of, i, 245. INDEX. 
353 
Cynanche, most comprehensive de- 
scription of, given by Hippocra- 
tes, i, 263. 
Deafness, whether a favorable or un- 
favorable symptom in fevers, i, 
325. 
Decorum, Hippocratic treatise on, cer- 
tainly not genuine, i, 100; import- 
ance attached to the observance of 
by the ancient physicians, ii, 8. 
Defluxions, cause of, according to Hip- 
pocrates, i, 142. 
Dejections, on the characters of, ii, 271. 
Delirium, its connections with phthisis, 
i, 295; prognosis in, ii, 261; sketch 
of delirium tremens, i, 268. 
Democritus, intercourse between him 
and Hippocrates, i, 13; the sup- 
posed author of the work " On 
Herbs," i, 97; and " On Dissection," 
i, 101; further referred to, i, 105, 
117. 
Demoniacs, what diseases they were 
affected with, ii, 327, 336. 
Dentition, the Hippocratic treatise on, 
though not genuine, possessed of 
considerable value, i, 101; diseases 
connected with, ii, 217. 
Depletion, and repletion, the evil effects 
of, described, i, 138. 
Deposits or abscesses in diseases, their 
characters, i, 207, 208, 211. 
Depressed fractures, nature and treat- 
ment of, i, 361-363. 
Desault, his explanation of the ancient 
modes of reducing dislocations 
referred to, ii, 87. 
Dialects, remarks on those of the 
Greek language, i, 27. 
Diaphysis, explanation of the term, ii 
48. 
Diarrhoea, prognostics founded on, i, 
219; a fatal symptom in phthisis, 
ii, 236; danger in pregnant women, 
ii, 241; various remarks on, ii, 252. 
Diastasis or separation of the bones of 
the skull at a suture, i, 373, 379; 
general definition of the term, ii, 
18, 103. 
Diet in health, character of the treat- 
23 
ise on, i, 52; ancient grades of, 
ii, 42; regulations respecting, ii, 
193-198. 
Dietetics, how cultivated at first, i, 134 
et seq. ; further notice of, i, 67. 
Dinner, a meal not generally partaken 
of by the ancients, i, 157. 
Dionysius of Halicarnassus cited, 
i, 18, 19. 
Diseases, the Four Books on, most 
probably not genuine, i, 73; ab- 
stract of their contents, i, 73-77; 
probably emanated from the Cni- 
dian School, i, 77; enumeration of 
the diseases held to be particularly 
fatal, i, 74. 
Dislocations, general remarks on the 
nature and treatment of, ii, 177;- 
at the knee, disquisition on the 
nature of, by the Editor, ii, 27-30; 
rarity of the accident, ii, 29, 30; in- 
teresting case of, ii, 27; account 
of, by Hippocrates, ii, 67, 68, 171; 
compound, remarks on the treat- 
ment of, ii, 141; comparison be- 
tween those at the elbow and knee, 
ii, 153;-at Chopart's tarsal joint, 
ii, 35, 45;-of the astragalus, ii, 45, 
46, 155,156,172,173;-at the ankle- 
joint, ii, 48, 49, 173;-treatment of 
compound, ii, 139-141;-at tjie 
elbow, minute description of, ii, 67- 
71; subject resumed, ii, 102-104; 
again treated of, ii, 165-167; com- 
pound treatment of, ii, 142; at the 
hip-joint, wonderful completeness 
of the description of, given by 
Hippocrates, ii, 78, 128; congeni- 
tal and from disease, ii, 128, 260; 
four forms most minutely de- 
scribed, ii, 125, 147; remarks on by 
Apollonius Citiensis, ii, 146; in 
cattle, ii, 91; at the wrists, remarks 
by the Editor upon, ii, 81; descrip- 
tion of, by Hippocrates, ii, 103, 
104, 167; congenital, ii, 104-168; 
compound, remarks of the Editor 
upon, ii, 81; treatment by Hippoc- 
rates, ii, 141,173;-at the shoulder- 
joint, ii, 85 et seq., 165, 166; gen- 
eral remarks on the modes of 
reducing, ii, 87; these modes of 354 
INDEX. 
reduction described, ii, 87 et seq. ; 
remarks on the disposition to, ii, 
93; operation for correcting the 
disposition to, ii, 93-96; congenital, 
remarks on, ii, 96, 97;-of the 
fingers, ii, 104; on the reduction of, 
ii, 152, 168;-of the toes, treatment 
of, ii, 142;-of the jaw bone, ii, 105- 
109, 165;-of the vertebrae, ii, 114- 
124, 174, 177; divisions of, ii, 114; 
reduction of, by a machine, ii, 121, 
122; unsuccessful experiment to 
reduce, ii, 122; remarks on con- 
genital, ii,' 131; remarks of M. 
Littre upon spontaneous disloca- 
tion, i, 80; of the upper vertebra, 
ii, 224, 225: ready means of reduc- 
ing, ii, 151, 152; general regimen 
after reduction, ii, 153. 
Dissection, Hippocratic treatise on, not 
genuine, i, 101; Hippocrates had 
no repugnance to, ii, 119. See 
Anatomy. 
Distortions of the countenance, prog- 
nosis founded upon, i, 222. 
Divjne diseases, the opinions of Hip 
pocrates regarding, i, 178; fur- 
ther remarks upon, i, 195, ii, 327. 
Douche, on the use of, in fevers, i, 233, 
252. 
Dreams, character of the Hippocratic 
work on, i, 67, 68; ancient writers 
on, and the character of their 
works, i, 69, 70. 
Drink, on the administration of, in 
fevers, i, 240. 
Dropsies, prognosis founded upon, in 
acute diseases, i, 200, 216; on the 
nature and varieties of, i, 274; 
ulcers connected with, difficult to 
cure, ii, 250; cured by a spontane- 
ous discharge of water from the 
bowels, ii, 251. 
Dry cholera, on the nature of, i, 273. 
See Cholera. 
Dupuytren, Baron, his work on surgi 
cal operations quoted, ii, 32, 68, et 
pluries. 
Dysentery, on the prevalence of in 
spring, i, 166; prognosis founded 
upon, i, 219; on the treatment of, 
i, 270; symptoms of, ii, 223; treat- 
ment of symptomatic, ii, 145; 
prognosis in, ii, 249; when epi- 
demic according to Hippocrates, 
i, 167. 
Dysuria, a favorable termination of 
fever, i, 300. 
Ears, fractures of, common among the 
ancient Athletae, ii, 113, 114. See 
further under Fractures. 
Ecchymosis, how to be treated, ii, 17. 
Eclectic, a misprint for Eleatic, i, 115. 
Ecthymata, meaning of the term, not 
well defined, i, 336. 
Effeminacy of the Scythians, different 
opinions regarding, i, 154, 155. 
Egyptians, their resemblance to the 
Scythians, i, 174, 175. 
Elbow, disquisition on the nature of 
the accidents which occur at the 
joint, ii, 30-33; description of the 
mode of bandaging in injuries 
thereof, ii, 71. 
Eleatic philosophers, their opinions 
akin to those of Pythagoras, i, 
130. 
Elements, the ancient opinions regard- 
ing their nature, generally misun- 
derstood, i, 107; the real opinions 
of the ancient philosophers stated 
by the Editor, i, 117 et seq. ; coun- 
tenanced by Lord Bacon, i, 121- 
by Sir Isaac Newton, i, 122-by 
Dr. L. Oken, i, 123-by Mr. Har- 
ris, i, 122. 
Empedocles, his speculations, as ap- 
plied to medicine, i, 143. 
Empyema, the opinions of the ancient 
authorities regarding, i, 75, 204- 
207; probably often confounded 
with acute phthisis, i, 204, 205; 
prescription for, i, 277; treatment 
of, i, 73; a termination of pleurisy, 
ii, 235; additional statements re- 
specting, ii, 236, 253; results when 
treated with the cautery or knife, 
ii, 266. 
Empirics, Hippocrates not to be con- 
sidered as belonging to the sect of, 
i, 15, ii, 117. 
Epicureans, their opinions with regard 
to the elements, i, 117. INDEX. 
355 
Epicurus took his system of Physics 
from Democritus, i, 117. 
Epidemic, term, how used by the an- 
cients, i, 273; nature of the Books 
of Epidemics, i, 284; argument to, 
i, 283, 293, translation of the 1st 
and 3d Books, i, 293-350; argu- 
ment to 3rd Book, i, 318; nature 
of the epidemic fevers described by 
Hippocrates, i, 292; Books 1st and 
3rd generally admitted to be gen- 
uine, i, 45; English translations by 
Floyer and Farr, i, 45; character 
of the 2d, 4th, 5th, 6th, and 7th, i, 
78-84; great excellence of the 
whole work, i, 85. 
Epidesmis, see Bandages. 
Epilepsy, prognosis in, ii, 235; an 
hereditary disease, ii, 338. 
Epinyctis, a disease of the skin, i, 158, 
217. 
Epiphysis, import of the term, as ap- 
plied by Hippocrates, ii, 33,48,161. 
Epistles, the Hippocratic, although 
perhaps not genuine, of very high 
antiquity, i, 104; most probably 
turn upon real events in the life of 
Hippocrates, i, 13, 104; were 
probably composed by the Sophists 
as exercises in composition, i, 104; 
analysis of them, i, 103-105. 
Equitation, its effects on the genital 
organs differently represented, i, 
180. 
Ermerins, Dr., his ingenious work on 
the Prognostics of Hippocrates, 
i, 57, 187, 191. 
Erotian, one of the greatest authori- 
ties on the works of Hippocrates, 
i, 24. 
Erysipelas, case of malignant, i, 314; 
history of an epidemical, i, 332, 334; 
on the use of cold applications in, 
ii, 238; of the womb, ii, 242; deter- 
minations of, inwardly or outward- 
ly, ii, 254; connected with diseased 
bone, ii, 262. 
Eunuchs, not subject to gout, ii, 254. 
Europeans, their peculiar characters, 
i, 180 et seq. 
Exanthemata, on the nature of broad, 
ii, 250. 
Excalcitration, explanation of the term, 
ii, 153, 154. 
Excrement, prognostics founded on the 
characters of, i, 201. 
Exfoliation of bones, how to be treated, 
ii, 60. 
Extravasation of blood, how treated in 
injuries of the head, i, 363, 365. 
Extremities, analogy of the upper and 
lower, ii, 53, 54. 
Eyes, prognostics founded upon the, 
i, 219; prescription for diseases of 
the, i, 277, 278; various remedial 
means in pains of the, ii, 255. 
Facies Hippocratica, the characters of 
it given, i, 197. 
Fasces, prognostic characters of the, i, 
201. 
Fasting, its effects in drying bodies, ii, 
269. 
Febris algida, on the nature of, i, 288, 
290. 
Feminine disease, on the nature of, i, 
154,155. 
Fevers, different kinds of, i, 307, 337; 
puerperal, interesting case of, i, 
311, 312; pestilential, remarks on 
the nature of, i, 318; nocturnal, 
nature of, i, 308, 337; various aphor- 
isms relating to, ii, 270. 
Fire, held anciently to be a great dis- 
infectant, i, 10; ancient opinions 
on the nature of, explained, i, 119; 
confounded with mind by certain 
of the authorities, i, 119. 
Fistulas, genuineness of the treatise 
bearing this title, i, 57; argument 
to, ii, 309; translation of, ii, 311; 
how to be treated, ii, 311; in ano, 
how formed, ii, 314. 
Fleshes, or Principles, the Hippocratic 
treatise on, not genuine, i, 96, 97. 
Flourens, extract from, on the anal- 
ogy of the upper and lower ex- 
tremities, ii, 54. 
Fluor albus, account of, i, 92. 
Foes, his merits as an editor of the 
Works of Hippocrates, i, 26. 
Foetus, the Hippocratic treatise on the 
excision of, not genuine, i, 101. 356 
INDEX. 
Fomentations, on the application of, 
to the side in pleurisy, i, 240. 
Foot, description of the bones of the, 
ii, 45. 
Fractures, on the genuineness of the 
Hippocratic treatise bearing this 
title, i, 47; argument to the work, 
ii, 23-35; translation of, ii, 35-72; of 
the skull, divisions of, i, 358; char- 
acters of, i, 377; mode of treating, 
ii, 14, 15;-of the arm, method of 
treating, ii, 35-38, 43, 44;-of the 
forearm, treatment of, ii, 16, 23, 
38;-of the leg, ii, 50, 51;-of the 
fibula, ii, 53;-of the tibia, ii, 53;- 
of the thigh, ii, 54-55;-of the jaw, 
ii, 110; remarks of Chelius on the 
same, ii, 110; compound, ii, 56, 61, 
96; an injudicious method of treat- 
ing fractures described, ii, 57, 59; 
method of treating with wool, ii, 
62;-of the olecranon, account of, 
ii, 71;-of the trochlea of the hu- 
merus, see Abruption;-of the cla- 
vicle, account of, ii. 98-101;-of the 
nose, minutely described, ii, 109, 
112, 163; compound, ii, 112;-of 
the ears, ii, 112, 114, 164; common 
among the ancient athletae, ii, 114; 
-of the vertebrae, less dangerous 
than severe contusions, ii, 123;-of 
the ribs, less dangerous than se- 
vere contusions, ii, 124. 
Free institutions and the opposite, their 
different effects on the human 
mind, i, 173, 174. 
Friction, its uses in surgery, ii, 16. 
Fruits of the season, or Summer fruits, 
characters of, i, 170. 
Fumigation of the uterus, in amenor- 
rhoea, ii, 239, 240, 245. 
Galen, his account of the Asclepiadae, 
i, 6; mentions frequently the pub- 
lic services of Hippocrates during 
the prevalence of the Athenian 
plague, i, 11; his character of the 
style of Hippocrates, i, 18; his 
commentaries on Hippocrates, i, 
22; his ideas on respiration akin to 
those of Cuvier, i, 117; his opin- 
ions regarding the nature and 
merits of the work On Regimen in 
Acute Diseases, i, 229, 232; further 
quoted, i, 20, 21 et pluries. 
Galiancones, see Weasel-armed. 
Gangrene, of the extremities compli- 
cated with fever, i, 333; prognosis 
founded on the symptoms of, i, 201; 
traumatic, on the treatment of, ii, 
143, 144,173; how gangrenous sores 
are to be treated, ii, 295. 
Garlic, the dietetical characters of, i, 
272. 
Glands* the Hippocratic treatise on, 
very interesting, but probably not 
genuine, i, 98; further remarks on 
the subject, ii. 95. 
Globus hystericus, noticed in one of 
the Hippocratic treatises, i, 64. 
Gout, various prognostics in, i, 217, 
ii, 254, 255. 
Greenhill, Dr., his arrangement of 
the treatises in the Hippocratic 
collection, i, 37, 38; his critical re- 
marks on the Aphorisms, i, 42. 
Grimm, his character as a writer on the 
genuineness of the Hippocratic 
treatises, i, 30. 
Grote, Mr., his opinions regarding the 
mythical genealogies of the an- 
cients, i, 155; on the myths of the 
Greeks, i, 8; on the myth of the 
Amazons, i, 155. 
Gruner, his great merits as a writer 
on the authenticity of the Hippo- 
cratic treatises, i, 27; his classifica- 
tion of them, i, 28. 
Gymnastics, Hippocrates instructed 
in the application of them in medi- 
cine by Herodicus, i, 9, 134; on 
their introduction into the practice 
of medicine, i, 9; cautions to be 
used in founding prognostics on, i, 
215. 
Haemoptysis, connection of with phthi- 
sis, i, 83, 295, ii, 262; sometimes re- 
moved by menstruation, ii, 240. 
Haller, his classification of the Hip- 
pocratic treatises, i, 27; unjustly 
taxes Hippocrates with falsly stat- 117 DEX. 
357 
ing that dysentery occurs in spring, 
i, 167; a highly popular poet, ii, 333. 
Harris, Mr., in his Philosophical Ar- 
rangements, espouses the doctrines 
of the ancients on matter and the 
elements, i, 121, 122. 
Head, different forms of, according to 
Hippocrates, i, 370, 371. 
Headache, prognosis founded on, i, 209; 
induced by various causes, i, 274. 
Heart, the Hippocratic treatise on the, 
of much merit, but probably not 
genuine, i, 94, 95. 
Heat, identified with mind, i, 102; in- 
nate, ancient doctrines regarding, 
ii, 197; the medicinal effects of 
heat and cold, ii, 237, 238. 
Hebdomads, Hippocratic treatise on, 
exists only in Latin, i, 97. 
Hedra, or indentation of the skull, on 
the characters of, i, 357-360, 375; 
explanation of the term, and usage 
of it, i, 373, 375. 
Heel, attention to be paid to its posi- 
tion in the treatment of fractures 
of the leg, ii, 56. 
Heliodorus describes the diastasis of 
the cranial bones, i, 373. 
Hellebore, Hippocratic treatise on the 
administration of, not genuine, i, 
103; cases in which it was adminis- 
tered, i, 271; its use in tetanus, ii, 
66; rules for the administration of, 
ii, 221. 
Hepatitis, terminating in abscess, i, 
199. 
Hereditary diseases, difficult to re- 
move, i, 215. 
Hernia cerebri, obscurely treated of by 
Hippocrates, i, 384. 
Herodicus, the master of Hippocra- 
tes, i, 9, 134; his dangerous sys- 
tem of regimen in acute diseases, 
i, 228. 
Herophilus, the earliest commentator 
on Hippocrates, i, 21; the first per- 
son who studied the characters of 
the pulse, i. 293; referred to, ii, 
270. 
Heurnius, or Hoorne, a modern com- 
mentator on Hippocrates, quoted 
i, 144, ii, 250 et alibi. 
Hiccup, danger of, in dropsy, ii, 256, 
260, 267. 
Hippace, a species of cheese used by 
the Scythians, i, 175. 
Hippocrates, biography of, i, 9-13; 
the principles upon which his sys- 
tem of medical practice was 
founded, i, 14-17; remarkably free 
from superstition and quackery, i, 
15, 16; a bold operator in surgery, 
i, 17, 18; the genealogy of, i, 19; 
further particulars regarding the 
family of, i, 19; published part of 
his works separately in his lifetime, 
i, 20, 21; characters of the style of, 
i, 18, 19; candidly confesses his 
own mistakes, and different opin- 
ions on his conduct in so doing, i, 
81, ii, 122; instance of his remark- 
able talent for original observa- 
tion, i, 343; certainly had some ac- 
quaintance with human anatomy, 
ii, 83, 86 (see Anatomy); recom- 
mends the study of incurable dis- 
eases as an assistance to progno- 
sis and diagnosis, ii, 134; his pru- 
dent regard for the safety of the 
physician, ii, 144; had the reputa- 
tion of being a great philosopher 
as well as a great physician, ii, 333; 
said to be incapable either of de- 
ceiving or of being deceived, i, 
353. 
Hippocratic treatises, various distribu- 
tions of, i, 20-40; the editor's con- 
clusions as to the authenticity of the 
particular treatises, i, 105, 106. 
Homer, a line incorrectly referred to, 
ii, 92. 
Homoeopathy, the principles of, to be 
found in the Hippocratic works, i, 
64. 
Horace, plan upon which he published 
his works, i, 20; his lines descript- 
ive of the dog-days, i, 301. 
Hosack, the American physician, con- 
curs with Hippocrates in prais- 
ing wine as an application to 
ulcers, ii, 293. 
Hot and cold, hypothetical systems 
founded on these principles, i, 140; 
the modes of applying- hot applica- 358 
INDEX. 
tions recommended by Hippocra- 
tes, i, 240, 241. 
Humidity of constitution, on the char- 
acters of, i, 176, 177. 
Humors, the Hippocratic treatise on, 
reviewed, i, 85, 87; Galen holds 
Hippocrates to be the author of 
the Theory of the Humors, i, 52, 
57. 
Humpback, when complicated with 
asthma, fatal, ii, 258. 
Hunger the debilitating effects of, ii, 
202; relieved by drinking wine, ii, 
203. 
Hydatids of the womb, account of, i, 
162. 
Hydromel, its use in acute diseases, i, 
247, 248. 
Hydrops uteri, description of, i, 162. 
Hypochondriac region, prognosis 
founded on the different states of 
the, i, 198, 199, ii, 231. 
Hypoglottis, description of, i, 76. 
Hypothesis in medicine strongly con- 
demned by Hippocrates, i, 132, 
140 et alibi. 
Hyssop, used anciently as an emetic, 
i, 52. 
Hysterics, prognostics in, ii, 241. 
latrium, on the nature of this establish- 
ment, i, 50, 99; resembled the sur- 
gery of modern physicians in the 
days of Pott, ii, 3; identified with 
the surgery by Galen, ii, 4. 
Ice and snow, the medicinal properties 
of, ii, 238, 239. 
Ileus, on the treatment of, i, 70; com- 
plicated with strangury, fatal in 
seven days, ii, 257. 
Immoderate sleep, and insomnolency, 
both bad symptoms, ii, 200. 
Impotence of the Scythians, supposed 
cause of the, i, 179. 
Incarnant or Sarcotic Medicines, on the 
nature of, ii, 292, 301. 
Incisions in the temples generally held 
to be very dangerous, i, 381. 
Influenza, or Epidemic Cough, de- 
scribed in the Hippocratic treat- 
ises, i, 83. 
Injuries of the head, on the genuine- 
ness of the treatise bearing this 
title, i, 49; argument to the treat- 
ise, i, 353-370; translation of the 
same, i, 370, 388; general view of 
the subject, i, 366-368; dressing 
applicable in the treatment of, i, 
380; when complicated with disease 
of the bone, i, 283. 
Ink, the ancient different from the 
modern, i, 383. 
Instruments of reduction, or Mochli- 
cus, genuineness of the treatise 
bearing this title, i, 48. 
Intermittent fevers, supposed to prove 
a protection from phthisis, i, 295. 
Intoxication, dangerous symptoms 
from, ii, 235. 
Invalids, regimen applicable to, ii, 198. 
Ischiatic diseases, prognosis founded 
on, i, 223. 
Italian physicians have been unjustly 
blamed for being sparing of vene- 
section in a hot climate, and in 
warm weather, ii, 193. 
Jaundice, history of, complicated with 
fevers, i, 302, 323, 324; compared 
with a recent epidemic prevalent 
in Scotland, i, 324; prognosis 
founded upon, i, 246, ii, 229; com- 
plicated with scirrhus of the liver, 
ii, 257. 
Jaw, see Fractures and Dislocations. 
Joints, general description of the, ii, 
151. 
Kant, the opinions of, on the origin of 
Grecian philosophy referred to, i, 
3; further quoted and noticed, i, 
192, ii, 333. 
Kedmata, on the nature of the disease, 
i, 178,179. 
Kidneys, diseases of the, i, 72; deter- 
mination to the, a favorable termi- 
nation in certain fevers, i, 299; dis- 
eases of the, difficult to cure in old 
persons, ii, 250. 
Knee-joint, description of the, ii, 68; 
general view of the dislocations at 
the, ii, 27-30, see Dislocations. INDEX. 
359 
Lassitude, spontaneous, an indication 
of disease, ii, 200. 
Laurie, Dr., his rule with regard to 
trepanning in iniuries of the head, 
i, 361, 362. 
"Law," the tract on the, hesitatingly 
acknowledged as genuine, i, 49; 
argument to, ii, 283; translation of 
the work, ii, 283. 
Le Clerc, his merits as an authority 
on the Hippocratic treatises, i, 29. 
Leg, description of the bones of the, 
ii, 48. 
Lemos, the earliest modern writer on 
the authenticity of the Hippocratic 
treatises, i, 24. 
Leprosy and Lichen, prognosis founded 
upon, i, 223. 
Leucophlegmasia, description of, i, 161. 
Lientery, prognosis founded on the 
symptoms of, i, 219, ii, 249. 
Link and Petersen, the authors of a 
very ingenious but rather equivo- 
cal hypothesis regarding the genu- 
ineness of the Hippocratic treat- 
ises, i, 31, 32. 
Liquids, on the use of, in medicine, i, 
86-89; Hippocratic treatise bearing 
this title, i, 89. 
Liston, Mr., his opinions quoted in il- 
lustration of certain passages in 
the works of Hippocrates, ii, 27, 
31, et pluries. 
Lithotomy, not practiced by the fol- 
lowers of Hippocrates, ii, 280; in 
Scotland used to be performed by 
non-professional men, ii, 278. 
Little, Dr., interesting remarks by, on 
the account of club-foot, given by 
Hippocrates, ii, 80. 
Littre, M., his very high merit as an 
authority on the genuineness of 
the Hippocratic treatises, i, 32; 
style diffuse, and sometimes rather 
prolix, i, 33; his position with re- 
gard to the Hippocratic collection, 
i, 34; probably not correct in ques- 
tioning the established character 
of the style of Hippocrates, i, 18; 
doubtful if he makes out his posi- 
tion as to the date at which the 
Hippocratic collection was made, 
i, 34; his arrangement of the treat- 
ises, i, 35-37; his characters of the 
treatise "On Airs, Waters," etc., 
i, 149; his remarks on empyema 
considered, i, 204, 205; further 
quoted, i, 131, et pluries. 
Liver, results of the treatment in ab- 
scess of the, ii, 266; on collections 
of water in, ii, 268. 
Longinus, his affecting description of 
the state of servitude, i, 149, 150. 
Louis, M., referred to as an authority 
in phthisis, i, 338, 339. 
Macrocephali, account of this people, 
i, 170, 171. 
Machine or instrument for the treat- 
ment of a fractured leg, ii, 61. 
Mania, treatment of, by man dragora, 
i, 64. 
Manipulation, importance of, to the 
surgeon, ii, 9. 
Marsh effluvia, whether Hippocrates 
was acquainted with their effects 
in inducing fevers, i, 291. 
Matter, ancient opinions regarding the 
nature of, i, 117, 118; the nature of 
the. primary, explained, i, 117 et 
pluries; striking instances of its 
transmutations in the animal 
frame, i, 120-122; the ancient opin- 
ions on it confirmed by Lord Bacon 
and other modern authorities, i, 
122. 
Maza, description of, i, 134, 382. 
Mechanical powers, on those known to 
Hippocrates, ii, 62. 
Meconium, different applications of the 
term, i, 278. 
Medicine, origin of Grecian, uncertain, 
i, 3; not derived from the East as 
was once supposed, i, 3, 4; culti- 
vated by the Asclepiadie and by 
the philosophers, i, 4; remarks on, 
i, 14; the rise of, satisfactorily ac- 
counted for by Hippocrates, i, 
129, 133-135; on the authenticity 
of the Hippocratic treatise bearing 
the title of "Ancient Medicine," i, 
41; translation of, i, 127-146. 
Melancholy, case of, i, 347. 360 
INDEX. 
Medicines, iron, and fire, the gradation 
of their medicinal powers, ii, 273. 
Mercuriali, a learned writer on the 
Hippocratic treatises, i, 24; his 
classification of them, i, 25, 26. 
Meteorology of the ancients nearly 
identical with astronomy, i, 157; 
opinions held by Aristophanes 
and Aristotle on the subject, i, 
157. 
Meteorism, account of, in diseases, i, 
199. 
Midwifery, much cultivated by medical 
men in early times, i, 92. 
Milk, its dietetical and medicinal prop- 
erties, ii, 246. 
Mind, explanation of the, term as used 
by the ancient philosophers, ii, 
330; a Hippocratic writer con- 
founds it with heat, i, 119. 
Mochlicus, genuineness of the treatise 
bearing the name, i, 49; argument 
to the work, ii, 159-161; transla- 
tion of, ii, 161-179. 
Modiolus of Celsus, a circular saw like 
the modern trephine, i, 369, 387. 
Moffat, his translation of the Prog- 
nostics, i, 41. 
Morbus coxarius, attended with dislo- 
cation of the bone, ii, 132, 260. 
Movement of the hands, prognosis 
founded on, i, 197. 
Mumps. See Parotitis. 
Muscle of the arm, namely the biceps, 
ii, 43. 
Nature, held by Hippocrates to be a 
restorative principle, i, 16; editor's 
remarks on the ancient doctrines 
regarding, i, 84; Nature of Man, 
the Hippocratic treatise bearing 
this title probably not genuine, i, 
52; Nature of the Infant, the Hip- 
pocratic treatise with this title con- 
sidered, i, 89; On the Female Nat- 
ure, this Hippocratic treatise made 
up from the work on Female Com- 
plaints, i, 94; Nature of the Bones, 
this Hippocratic treatise not gen- 
uine, i, 101, 102. 
Nerves, distribution of the, by Erasis- 
tratus, ii, 118; description of the 
vertebral, by Hippocrates, ii, 117, 
118. 
Newton, Sir Isaac, countenances the 
ancient opinions on the elements, 
i, 122. 
Nightmare described by Hippocrates, 
ii, 335. 
Nonon intermittents, remarks on, i, 
307. 
Nose, on the subsidence of the, from 
disease, ii, 177; on fractures there- 
of. See Fractures. 
Nyctalopia, the characters of, i, 222. 
Oath, genuineness of the little tract 
with this title, i, 49; argument to, 
ii, 277; translation of, ii, 277. 
Oken, Dr. Lorenz, adopts the ancient 
arrangement of the elementary 
substances, i, 123. 
Olecranon, remarks on the term as ap- 
plied by Hippocrates, ii, 163; on 
fractures of the, ii, 71. 
Old persons, questions whether they 
can bear fasting well or ill, ii, 196; 
their general state of health, ii, 208; 
their catarrhs not readily concoc- 
ted, ii, 208; diseases to which they 
are peculiarly subject, ii, 218. 
Omentum, on protrusion of the, ii, 260. 
Oneirocritica, ancient authorities on 
the, i, 69, 70. See Dreams. 
Operator, enumeration of particulars 
relating to the, ii, 8. 
Ophthalmy, description of the epidem- 
ical, by Hippocrates, i, 297; de- 
scription of the purulent, i, 335. 
Organic structures, their effects in pro- 
ducing disease, i, 144. 
Osteology, on Hippocrates' acquaint- 
ance with, i, 353; brief system of, 
ii, 161-163. 
Oxen generally supposed to be liable 
to dislocations of the hip-joint in 
spring, ii, 91. 
Oxyglyky, explanation of the term, ii, 
47. 
Oxymel, on the administration of, in 
acute diseases, i, 250. INDEX. 
361 
Pains of the ear, prognosis founded on, 
i, 209. 
Pains of the eyes, how remedied, ii, 267. 
Palladius, a commentator on Hippoc- 
rates, referred to, ii, 37, 39, 40, 41. 
Paracentesis thoracis, account of the 
operation of, i, 72. 
Paralysis held generally to affect the 
side opposite that which has sus- 
tained an injury, i, 386. 
Parap] egiakhe same as apoplexy, i, 302. 
Pare adopts Hippocrates' description 
of the forms of the head, i, 356; ad- 
vocates bleeding in injuries of the 
head, on the authority of Hip- 
pocrates, i, 369; the first who used 
pulleys in reducing dislocations, 
ii, 87. 
Parotitis, ancient description of, by 
Hippocrates, i, 294. 
Pathici of the ancients, account of the, 
i, 155. 
Periodeutae, or travelling physicians, 
reference to the, ii, 284. 
Periods of life, the diseases peculiar to 
each, ii, 216-218. 
Peripatetics, their opinions with re- 
gard to the elements, i, 113. 
Pestle, ancient mode of reducing1 dis- 
locations by means of the, ii, 39. 
Petronas, his strange regimen in 
fevers, i, 237. 
Phasis, account of the country and its 
inhabitants, i, 172. 
Phlegm, on the collection of about the 
stomach, ii, 268. 
Phrenitis of the ancients was a fe- 
brile affection, i, 297, 304; history of 
an acute case of, i, 342; other strik- 
ing cases of, i, 348-349. 
Phthisis treated of as a febrile disease, 
by Hippocrates, i, 285; held to be 
contagious, by Isorates, i, 293; 
history of, by Hippocrates, i, 294, 
337; whether intermittent fevers 
afford any protection from, i, 296; 
period of life at which Hippocra- 
tes held it to be most common, 
ii, 235; Sir J. Clark confirms the 
opinion of Hippocrates on this 
subject, ii, 235; various prognostics 
in, ii, 236. 
Physical or Natural philosophy of the 
ancients much misunderstood and 
misrepresented, i, 107; reason for 
giving an exposition of it, i, 107. 
Physician, on the, this Hippocratic 
treatise generally rejected as spu- 
rious, i, 99; duties of, distinctly an- 
nounced, i, 339; subjects to be 
known by the, ii, 7; 
Piles or Hemorrhoids, Hippocratic 
treatise on, probably genuine, i, 
113; a natural cure of certain dis- 
eases, ii, 250. 
Pituita. See Phlegm. 
Placenta prasvia, the dangers attend- 
ing, stated, i, 93; retention of, de- 
scribed, i, 93; how to be remedied, 
ii, 243. 
Plasters for fresh wounds, ii, 294-295. 
Plato, his mode of publishing his 
works, i, 21; his opinion with re- 
gard to divine diseases, i, 59, 178. 
Pleurisy, excellent plan of treating, 
laid down by Hippocrates, i, 233, 
241. 
Pneuma, Breath, or Spirits, ancient 
opinions on the nature of, ex- 
plained, ii, 329-333. 
Pneumonia, on the treatment of, i, 270; 
question whether the recent inno- 
vations in the treatment of, be im- 
provements, i, 232, 233. 
Polybus, the son-in-law of Hippocra- 
tes, i, 19, 34, 51. 
Position in bed, prognostic founded 
upon, i, 197; of a fractured limb, ii, 
6/ 61; of a fractured arm, ii, 36-38; 
the half-bent, in fractures of the 
thigh disapproved of, ii, 55. 
Precepts, the Hippocratic treatise with 
this name not held as genuine, i, 
100. 
Pregnancy, prognostics referring to, ii, 
240-247. 
Presentation of an injured limb, the 
act of, explained, ii, 9, 15. 
Procidentia ani, on the treatment of, 
ii, 315, 316. 
Prognosis, nature of the Hippocratic, 
i, 194, 195. 
Prognostics, book of, generally held to 
be genuine, i, 41; translation of, by 362 
INDEX. 
Moffat, character of, i, 42; by Low, 
i, 42; by Clifton, i, 42; translation 
of, with argument, i, 185-213; the 
work founded on the Coan Preno- 
tions, i, 18 et seq. ; nature of the 
Hippocratic treatise on, i, 192-194. 
Prorrhetics, character of the first book 
of, i, 53; of the second book of, i, 
55; abstract of the latter, i, 214-222. 
Proteus, the ancient fable of, applied 
to the First Matter, by Eustathius 
and Lord Bacon, i, 131. 
Ptisan, on the preparation of, and its 
uses in medicine, i, 237-240. 
Publication of works, ancient mode of, 
as illustrated in the cases of 
Horace, Martial, Cicero, Plato, 
Aristotle, and Hippocrates, i, 
20, 21. 
Pulse, or Legumina, their characters 
in dietetics, i, 272. 
Pulse, the arterial, not attended to by 
Hippocrates, i, 292; first studied 
by Herophilus, i, 293. 
Pulleys first used in reducing fractures, 
by Pare, ii, 87. 
Purgative medicines, the Hippocratic 
treatise well written, though prob- 
ably not genuine, i, 103; observa- 
tions on the ancient mode of pre- 
scribing, i, 241; their debilitating 
effects, ii, 207, 208; to be avoided 
in hot weather, ii, 219. 
Purgings, general directions regarding, 
ii, 218, 223; rules for the applica- 
tion of, i, 276, ii, 142, 199, 219; ef- 
fects of, in pregnancy, ii, 218; in- 
duce thirst, ii, 222. 
Pythagoreans, their opinions with re- 
gard to the elements, i, 107-109. 
Quain, Mr. Richard, agrees with Hip- 
pocrates as to the usual situation 
of the head of the femur in the 
fourth form of dislocation at the 
hip-joint, ii, 78; interesting case of 
this accident related by, ii, 132. 
Quartans supposed to free the system 
from the disposition to other dis- 
eases, ii, 248. 
Quesnay, opinions of, on the contre- 
coup, i, 375. 
Quinsy, on the formation and treat- 
ment of i, 262, 263; cured by the 
occurrence of internal swelling, ii, 
256, 267. 
Quintan intermittents, remarks on, i, 
307. 
Rales in the chest described by Hippoc- 
rates, i, 75, 85, 270. 
Regimen, effects of changes in, i, 271; 
departures from, dangerous, i, 271; 
the three Books on, probably not 
genuine, i, 65; nature of their con- 
tents, i, 66, 67; the treatise On 
Regimen in Acute Diseases gener- 
ally admitted to be genuine, ii, 72; 
Galen's strictures on the system 
of treatment there laid down, i, 
228. 
Remittent fevers, remarks of modern 
authorities on, i, 302. See further 
under Causes. 
Research, importance of to professional 
men, ii, 81. 
Resection of bones, observations on, ii, 
82; practice of Hippocrates and 
certain modern authorities, ii, 142, 
143. 
Revulsion, Hippocrates the establisher 
of this therapeutical rule of prac- 
tice, i, 17, 52. 
Ruffus Ephesius, important fragment 
of, published by Mai, i, 318, 319. 
Sabinus, the Commentator, an absurd 
opinion of his on a passage of Hip- 
pocrates, i, 325. 
Sacred disease, Hippocratic treatise on 
the, probably genuine, i, 58, 59; 
argument to, ii, 327, 334; transla- 
tion of, ii, 334, to the end. 
Satyriasmus, account of, ii, 216. 
Sauromatse or Sarmatae, a description 
of the, i, 174. 
Saws, used in trepanning the head, i, 
387. 
Scaliger, on the Oneirocritica of the 
ancients, i, 69; further referred to, 
i, 353. 
Scamnum Hippocratis, referred to, ii, 
78; minutely described, i, 147. See 
Plates. INDEX. 
363 
Schulze probably influenced by the 
prejudices of his age in tracing the 
origin of medicine to the East, i, 3; 
in judging of the authenticity of 
the Hippocratic treatises generally, 
follows Mercuriali and Le Clerc, 
i, 29; his list of the Asclepia, i, 4. 
Scoliosis, usage of the term by Hippoc- 
rates, ii, 119. 
Scurvy, descriptions of, by ancient au- 
thors, i, 161, 222. 
Scythians, a description of their char- 
acters, i, 174-179. 
Seasons, their influence on the health, 
ii, 211, 216. 
Selvages of cloth, used' in the treat- 
ment of fractures, ii, 14. 
Semeiology, the prognostics a branch 
of, i, 192. 
Semi-tertian fever, description of, by 
Hippocrates, i, 298. 
Semen, the Hippocratic treatise on the, 
not genuine, i, 89; Aristotle's 
theory on the, i, 90; generally held 
by the ancients to be the first germ 
of the foetus, i, 171. 
Septics, on the treatment of hemor- 
rhoids by, ii, 324. 
Sewers, the want of, in ancient times 
aggravated pestilential diseases, 
i, 11; public, first constructed by 
the Romans, i, 11. 
Silphium, when unseasonably adminis- 
tered apt to produce Dry Cholera, 
i, 275. 
Slavery, the debasing effects of, de- 
scribed by Longinus, i, 151. 
Sleep, prognosis founded on, in dis- 
eases, i, 201; aphorisms founded 
on, ii, 200. 
Smegma, a detergent application, i, 
252. 
Smith, Dr. R. W., his important obser- 
vations on congenital dislocations, 
ii, 96, 104. 
Sneezing, how it arises, ii, 268. 
Socrates, on his character as a phil- 
osopher, i, 16, ii, 323; holds that 
courage is identical with knowl- 
edge, i, 152. 
Somnambulism, described by Hippoc- 
rates, ii, 335. 
Soranus, his biography of Hippocra- 
tes, i, 8. 
Soranus, the Methodist, his strictures 
on the Hippocratic treatise on Reg- 
imen in Acute Diseases, i, 258. 
Spasm or Convulsion, the dangers of, 
in various conditions and circum- 
stances, ii, 234. 
Spatula, on the ancient, ii, 110. 
Specillum, the ancient, resembled the 
modern probe, i, 387. 
Sphacelus of the Brain, on the nature 
of, i, 55, 168; prognostics in, ii, 267. 
Spleen, on enlargement of the, ii, 258. 
Splints, use of, in the treatment of frac- 
tures, ii, 14; disquisition on the 
nature of those used by the an- 
• cients, ii, 40, 41. 
Sprengel, Kurt, unfair to Schulze, 
in not acknowledging his obligation 
to him, i, 4; his merits as an au- 
thority on the Hippocratic treati- 
ses, i, 31; further referred to, i, 187 
et pluries; Conrad, his translation 
of the Aphorisms of Hippocrates 
noticed, i, 44. 
Spring reckoned a fatal season to con- 
sumptive patients, i, 339; the 
proper season for bleeding and 
purging, ii, 258, 267; diseases pecu- 
liar to, ii, 215. 
Sputa, characters of the, in prognos- 
tics, i, 203, 216, ii, 270. 
Stoics, their doctrines on the elements, 
i, 115-117. 
Stone or Calculus, observations by Hip- 
pocrates on the formation of, i, 
165-167; comparative immunity of 
females from, i, 166. 
Strangury, how to be cured, ii, 267. 
Structures or Structural arrangements, 
their effects on diseases, i, 144. 
See Organic. 
Styptic, how prepared, i, 276. 
Subluxations at the knee, account of, 
ii, 67; of the lower jaw, ii, 106. 
Succussion on a ladder, description of 
the process, ii, 116. 
Suidas, his biography of Hippocrates, 
i, 8. 
Summer, diseases most prevalent in, ii, 
216. 364 
INDEX. 
Superfoetation, the Hippocratic treatise 
on, not genuine, i, 93, 94. 
Superventions, explanation of the term, 
ii, 190. 
Surgery, authenticity of the treatise 
on, i, 49, 50; argument to the work, 
ii, 3-7; translation of, ii, 7; the 
subjects connected with, defined, 
ii, 7. See latrium. 
Sutures of the skull, description of, by 
Aristotle, i, 354; by Celsus, i, 
354; by Pliny, i, 354; by Ruffus 
. Ephesius, i, 354; by Galen, i, 354; 
great difference of opinion respect- 
ing the description of them given 
by Hippocrates, i, 354, 356; con- 
jectural opinion of the Editor on 
thi§ subject, i, 357, 358. • 
Sweats, prognosis founded on, i, 198, 
ii, 226; further defined, ii, 200, 272. 
Swelling on the feet, how to be treated, 
ii, 305. 
Sydenham, the great modern authority 
on epidemics, i, 283; how he pro- 
ceeded in the treatment of epidem- 
ics, i, 287; further referred to on 
this subject, i, 212; his fondness 
for the administration of ptisans, 
i, 233. 
Syrmaism, description of the process, 
ii, 113. ' 
Tabes dorsalis, account of, i, 63, 75. 
Tagault, his treatment of gangrenous 
sores, ii, 292; his opinions with re- 
gard to misy and chalcitis, ii, 302. 
Tents, on the treatment of fistulas by, 
ii, 312. 
Tetanus, on the treatment of, i, 270; 
prognosis in, ii, 235. 
Thermal waters, account of, i, 162. 
Thirst, how to be managed, ii, 239. 
Thread, on the treatment of fistulas by, 
ii, 314 et seq. See Apolinose. 
Thucydides, remarks on his descrip- 
tion of the Plague of Athens, i, 10, 
104, 320, 333; the characters of 
his style, according to Dionysius 
of Halicarnassus, i, 18. 
Thymia or Warts about the genital or- 
gans, ii, 300. 
Trallian, his rule for the administra- 
tion of wine in fevers, i, 256. 
Treatment, why generally omitted in 
the reports of Cases contained in 
the Books of Epidemics, i, 286, 287. 
Trepanning, description of the ancient 
mode of performing, i, 367; not 
usually performed at the sutures, 
either by the ancient or modern 
authorities on surgery, i, 380; a 
mode of performing it peculiar to 
Hippocrates, i, 387; practiced on 
the preventive principle by Dr. 
Laurie, in fractures attended with 
depression, i, 361; practiced by 
Hippocrates in cases attended 
with extravasation of blood, i, 363, 
385. 
Trephine, used by the ancient sur- 
geons, i, 368, 387. 
Trichiasis, operation for the cure of, 
i, 276, 277. 
Tzetzes, his biography of Hippocra- 
tes, i, 8; his mythical genealogy 
of the same, i, 19. 
Trochlea of the Humerus. See Abrup- 
tion. 
Tubercles, in the urethra, how re- 
moved, ii, 268; how to judge 
whether they be of a local or gen- 
eral nature, ii, 202. 
Tweedie, Dr., his opinions on the ad- 
ministration of wine in fevers con- 
sidered, i, 255, 256. 
Ulceration of the throat, prognosis 
founded upon, i, 210; of the womb, 
prognosis founded upon, i, 220. 
Ulcers, genuineness of the treatise 
bearing this title, i, 56, 57; argu- 
ment to the treatise on, ii, 289; 
translation of the treatise, ii, 293; 
circular, why difficult to heal, ii, 
296; gangrenous, how treated by 
Tagault, ii, 236; prognosis found- 
ed upon, i, 218. 
Urine, ancient doctrines respecting, 
unjustly disregarded, i, 80; progno- 
sis founded upon, i, 202, 215; im- 
portant observations upon, in feb- 
rile diseases, i, 266, 304; interesting INDEX. 
365 
case illustrative of its characters, i, 
315; sediments in, ii, 264; albumin- 
ous or frothy, ii, 264; comparison 
of healthy with unhealthy, ii, 271; 
general characters of, in diseases, 
ii, 231, 232; further remarks on, i, 
336, 337, 343, 345, ii, 231, 232; its 
characters in cases of delirium, i, 
346; in other acute diseases, ii, 230. 
Uterine hemorrhage, excellent treat- 
ment of, i, 64, 92. 
Uterus, dropsy of, i, 161, 162; fumiga- 
tion of the, in amenorrhoea and 
other diseases i, 91, ii, 239. 
Varices, why held by Hippocrates a 
natural cure* of curvature of the 
spine, ii, 114; treatment of, by 
puncture, ii, 291, 305. 
Variola, not described by the Greek 
authorities, as has been supposed, 
i, 320. 
Veins, the Hippocratic treatise on the, 
probably an excerpt from another 
work, i, 98. 
Venesection, rules for, in acute dis- 
eases, i, 261; Galen's opinions as 
to the cause why no mention is 
made of its having been performed 
in most of the Cases of Epidemics 
related by Hippocrates, i, 323, 329; 
remarks on the performance of the 
operation, ii, 306; cures dysuria, ii, 
252. 
Verduc, his translation of a passage of 
Hippocrates, ii, 11; further cited, 
ii, 12, 17, 44 et pluries. 
Vertebrae, minute description of, ii, 
117,118; the great vertebra, mean- 
ing the vertebra dentata, ii, 115, 
meaning* the fifth lumbar, ii, 
118, the seventh cervical, ii, 
119; on curvature and displace- 
ment of, ii, 114 et seq. 
Vesalius, his remarks, with regard to 
the sutures of the skull, i, 353; fur- 
ther reference to, i, 356. 
Vidus Vidius, his opinion with regard 
to the treatise on Ulcers, i, 56; fur- 
ther quoted, i, 57 et pluries; his 
definition of the hedra, i, 373; on 
the treatment of wounds, ii, 295. 
Vision, on the, Hippocratic treatise 
with this title not genuine, i, 101. 
Voice, impairment of the, in phthisis, 
i, 334. 
Vomitings, prognosis founded upon, i, 
203; rules respecting the remedial 
use of, ii, 219, 220. 
Water, ancient opinions on the nature 
of, i, 117; on the administration of, 
in acute diseases, i, 250; hot and 
cold, the uses of, i, 88, 89; in surg- 
ical practice, i, 376. 
Waters, characters of the different 
kinds of, i, 161-166; characters of 
thermal, i, 162. 
Watson, Bishop of Llandaff, misrepre- 
sents the ancient doctrines on the 
elements, i, 107. 
Wax or Cerate, use of, in the ancient 
method of treating fractures, ii, 14, 
38. 
Weasel-armed or Weasel-elbowed per- 
sons, ii, 96, 165. See Dislocations. 
Wenzels, their opinions regarding the 
nature of the pituitary gland, ii, 
355. 
Winds, their different effects on the 
health, ii, 212; figure of the Greek, 
as given by Coray, i, 151. 
Wine, on the administration of, in 
fevers, i, 247, 248; important rules 
on this head by Hippocrates and 
by a modern authority, Dr. Stokes, 
i, 256; directions to the same effect 
by Dr. Tweedie, i, 255, 256; by 
Trallian in phrenitis, i, 256; used 
as a dressing to ulcers, ii, 293. 
Women, on the Diseases of, analysis 
of this Hippocratic treatise, i, 90- 
93; on Sterile, this Hippocratic 
treatise reviewed, i, 93; on the 
Complaints of Young, this Hippo- 
cratic treatise reviewed, i, 93, 94; 
how to judge whether or not they 
are pregnant, i, 219. 
Wounds of important parts, prognosis 
founded on, i, 218; of certain or- 
gans mortal, ii, 252. 366 
INDEX. 
Xenophon, cited in reference to Cte- 
SIAS, i, 13; further quoted regard- 
ing medical authors, i, 40; quoted 
in reference to an opinion of Soc- 
rates, i, 152. 
Zeno, the Eleatic (misprinted Eclectic), 
different from Zeno the Stoic, i, 115. 
Zuinger, his opinion regarding the 
treatise on the Law, ii, 283, 284; 
further quoted, i, 85 et pluries.