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9. CHIEF DISEASES MENTIONED IN THE HIPPOCRATIC COLLECTION.

Diseases were classified by ancient physicians according to their symptoms ; they are now classified according to the micro-organisms which cause them. Accordingly it often happens that no exact equivalent in Greek corresponds to an English medical term and vice versa. The name of a Greek disease denotes merely a syndrome of symptoms.

Perhaps the most remarkable point arising in a discussion of Greek diseases is the apparent absence of most infectious fevers. Plagues, vaguely referred to by the term λοιμός,1 occurred at intervals, but the

[p. lvi] medical writings in the Hippocratic collection are occupied almost entirely with endemic disease and do not describe plagues, not even the great plague at Athens. There is no mention of smallpox or measles ; no certain reference occurs to diphtheria, scarlet fever, bubonic plague or syphilis. It is extremely doubtful whether typhoid was present in Greece, for although it is similar to severe cases of καῦς1ος and φρενῖτις, the latter were certainly in most cases pernicious malaria, which is often so like typhoid that only the microscope can distinguish them. It is expressly stated by pseudo-Aristotle2 that fevers were not infectious, and it is difficult to reconcile this statement with the prevalence of typhoid. The question must be left open, as the evidence is not clear enough to warrant a confident decision.3

Colds, "with and without fever,"4 were common enough in ancient times, but whether influenza prevailed cannot be stated for certain. Its all too frequent result, pneumonia, was indeed well known, but it is puzzling that in the description of epidemic cough at Perinthus,5 the nearest approach to an influenza wave in the Hippocratic collection, it is expressly stated that relapses into pneumonia were rare.6

Consumption (φθίς1ις) is one of the diseases most frequently mentioned in the Corpus, and it is remarkable that in the very passage where we are told

[p. lvii] that fevers are not infectious it is also stated that consumption is so. To consumption are added "ophthalmias," which term will therefore include all contagious inflammations of the eyes.7

The greatest plague of the Greek and of the ancient world generally was malaria, both mild and malignant, both intermittent and remittent.

The intermittents (διαλείποντες πνρετοί) are :--

ἀμφημερινὸς πυρετός (quotidians)

τριταῖος πυρετός (tertians)

τεταρταῖος πυρετός (quartans)8

The remittents (often ς1υνεχεῖς πυρετοί) included :--

καῦς1ος, so called because of the intense heat felt by the patient, a remittent tertian often mentioned in the Corpus.

φρενῖτις, characterized by pain in the hypochondria and by delirium. It generally had a tertian periodicity.

λήθαργος, characterized by irresistible coma. It bore a strong likeness to what is now known as the comatose form of pernicious malaria.

ἡμιτριταῖος, semitertian, was pernicious remittent malaria with tertian periodicity.9

τῦφος or τῖφος, of which five different kinds are mentioned in the Cnidian treatise περὶ τῶν ἐντὸς παθῶν

[p. lviii] (Littré VII. 260 foll.), was in at least two cases a species of remittent malaria.

In connexion with the question of malaria it should be noticed that malarial cachexia, the symptoms of which are anaemia, weakness, dark complexion and enlarged spleen, is often described in the Hippocratic collection. Especially vivid is the description in Airs Waters Places. This is further evidence of the malarious condition of the ancient Greek world.


μελαγχολία

This word is closely connected both with the doctrine of the humours and with the prevalence of malaria. It is fully discussed in Malaria and Greek History, pp. 98-101. Generally it means our "melancholia," but sometimes merely "biliousness." In popular speech μελαγχολία and its cognates sometimes approximate in meaning to "nervous breakdown." Probably the name was given to any condition resembling the prostration, physical and mental, produced by malaria, one form of which (the quartan) was supposed to be caused by "black bile" (μέλαινα χολή).


ἐρυς1ίπελας

See Foes' Oeconomia, p. 148, where quotations are given which enable us to distinguish ἐρυς1ίπελας from φλεγμονή. Both exhibit swelling (ὄγκος) and heat (θερμας1ία), but whereas ἐρυς1ίπελας is superficial and yellowish, φλεγμονή is internal also and red.


διάρροια and δυς1εντερία

The former is local, and causes merely the passing of unhealthy excreta. The latter is accompanied by

[p. lix] fever, and is a dangerous disease, in which the bowel is ulcerated, with the passing of blood. See περὶ παθῶν 23 and 25 (Littré VI. 234, 235), and more especially περὶ διαίτης2 74 (Littré IV. 616) :--

τοῦτο γὰρ (διάρροια) ὀνομάζεται ἕως2 ἂν αν̓τὴ μόνη ς1απεῖς1α τροφὴ ὑποχωρῆ. ὁκόταν δὲ θερμαινομένου τοῦ ς1ώματος κάθαρς1ις δριμέα γένηται, τό τε ἔντερον ξύεται καὶ ἑλκοῦται καὶ διαχωρεῖται αἱματώδεα, τοῦτο δὲ δυς1εντερίη καλεῖται, νός1ος χαλεπὴ καὶ ἐπικίνδυνος.

"Dysentery" would include what is now called by this name and any severe intestinal trouble, perhaps typhoid and paratyphoid if these were diseases of the Greek world, while "diarrhoea" means merely undue laxity of the bowels.


Delirium

The Hippocratic collection is rich in words meaning delirium of various kinds. It is probable, if not certain, that each of them had its own associations and its own shade of meaning, but these are now to a great extent lost. Only the broad outlines of the differences between them can be discerned by the modern reader. The words fall into two main classes :--

(1) Those in which the mental derangement of delirium is the dominant idea ; e.g. παραφέρομαι, παραφρονῶ (the word common in Prognostic), παρανοῶ, παρακρούω (the most common word in Epidemics I. and III.), παρακοπή, ἐκμαίνομαι, μανία.

(2) Those in which stress is laid upon delirious talk; e.g. λῆρος, παράληρος, παραληρῶ, παραλέγω, λόγοι πολλοί.

[p. lx] It is more difficult to say exactly which words in each class signify the greater degree of delirium. Of class (1) ἐκμαίνομαι is obviously the most vigorous word, meaning "wild raving," μανία comes next to it, and παρακοπή is apparently slightly stronger than the others. Of class (2) λῆρος or παράληρος seems to be the strongest, then παραλέγω, and finally λόγοι πολλοί.


Pain

There are two common words for pain in the Corpus, πόνος and ὀδύνη. They seem practically synonymous. Perhaps πόνος is more commonly used of violent pains, and ὀδύνη of dull, gnawing pains, but I think that no reader would care to pronounce a confident opinion on the matter.


Ague

There are two words commonly used to describe the chilly feeling experienced in fevers, especially in malarial fevers. These are (a) ῥῖγος and its derivatives, and (b) φρίχη and its derivatives. The former lays stress upon the chilly feeling, the latter upon the shivering accompanying it. But in this case also it is possible to discriminate too finely; see e.g. in Epidemics III. Case II. (second series), φρικώδης is followed by μετὰ τὸ γενόμενον ῥῖγος, referring apparently to the same occasion.

The reader should note the extreme care with which symptoms are described in the Hippocratic group of treatises. It has been pointed out, for instance, that in Epidemics I. Case I., and Epidemics III. Case XV. (second series), there are possibly

[p. lxi] instances of Cheyne-Stokes breathing. Noticed by the writer of these works, this important symptom was overlooked until the eighteenth century.

1 For the common Greek conception of λοιμός see pseudo-Aristotle Problems I. 7.

2 Problems, VII. 8.

3 See Stéphanos, La Gréce, p 502.

4 See Epidemics IV., Littré V., p. 149.

5 Epidemics VI., Littré, pp. 331-337.

6 Loc. cit., p. 333.

7 Pseudo-Aristotle Problems VII. 8 : διὰ τί ἀπὸ φθίς1εως καὶ ὀφθαλμίας καὶ ψώρας οἱ πλης1ιάζοντες ἁλίς1κονται: ὰπὸ δὲ ὕδρωπος καὶ πυρετῶν καὶ ἀποπληξίας οὐχ ἁλίς1κονται, οὐδὲ τῶν ἄλλων ;

8 See e.g. Epidemics I. XXIV., where quintans, septans and nonans also are mentioned. In the fourth century the existence of these fevers was denied.

9 I have discussed these diseases more fully in my Malaria and Greek History, pp. 63-68.

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