semiotics occupies a very considerable place in the medical works of the Asclepiadae. Two of the most complete and best achieved treatises of the collection - that on Prognostics, and the second book on Predictions, or Prorrhetics - are devoted to this branch of Pathology. Beside, the first book on Predictions and Coan Prenotions, a species of treatises believed to belong anterior to Hippocrates, as well as the book on Dreams, which is appended to the treatise on Regimen, relate entirely to the same subject. Now, all these portions united, form more than
the eighth part of the entire collection, without counting a great number of Semeiotic sentences scattered in other works, and especially among the Aphorisms.
Hippocrates, at the beginning of his work on Prognosis, gives us a very precise idea of the sense that was formerly attached to this word, while, at the same time, he appreciates, in the highest manner, the importance of this branch of Pathology. " The best physician," he says, " is the one who is able to establish a prognosis; penetrating and exposing first of all, at the bed-side, the present, the past, and the future of his patients, and adding what they omit in their statements ; he will gain their confidence ; and being convinced of the superiority of his knowledge, they will not hesitate to commit themselves entirely into his hands. He can treat, also, so much better their present condition, in proportion as he shall be able from it to foresee the future. To restore to health all the sick is impossible ; and although this would be better than being able to predict the successive progress of symptoms, yet, since men must die, some, succumbing before calling a physician, are carried off by the violence of the disease ; others, immediately after having summoned one, surviving only a day or so, expiring before the physician has been able to combat by his art, each of the accidents ; nevertheless, it is important to understand the nature of such affections, and how much they exceed the constitutional forces, and, at the same time, discern if there be any thing to divine in the disease ; this is the great thing yet to learn." In this way the physician will be justly admired, and will practice his art skillfully ; indeed, those who can be cured, he will be much more capable of preserving from peril, in advising them, long before-hand, against certain casualties ; and, on the other hand, in foreseeing and pointing out those who must perish, and those who will recover, he will exempt himself from all blame.(Prognostics, Â§ 1)
We perceive in this passage, that the word prognostics had a much more extended signification among the ancients, than it has among moderns - that it includes, at the same time, prognosis and diagnosis. The second paragraph of the same book, shows in what way the first Hippocratists established their prognosis, and gives an idea of the extreme difference that exists between the Medicine of their times, and that of ours. " In acute diseases," says the author, "'the physician must make the following observations : first, let him examine the countenance of the patient, and see if the physiognomy is similar to that of men in health, but above all, if it is like itself. Such an appearance will be most favorable, but the danger will be greatest in proportion as the expression is unnatural. The features have attained the last degree of alteration, when the nose becomes pointed, the eyes sunken, the temples flattened, the ears cold and contracted, their lobes shrunken ; the skin of the forehead dry, tense, and parched ; the skin of the entire face of a yellow, dark livid, or leaden hue. If from the beginning of a disease the patient's countenance presents these traits, and if other signs do not furnish sufficient explanation, the patient should be asked if he has lost much rest, or has a severe diarrhea, or is suffering from hunger. An affirmative response on either of these points, would cause the peril to he regarded as less imminent ; such a morbid condition, resulting from any of the causes above mentioned, may be arrested in the course of twenty-four hours ; but if the patient does not communicate any of these causes, and if the affliction does not cease in the interval above-mentioned, it may be predicted that death is not far distant.(Prognostics. Â§ 2)" How much time and observation were necessary to unite thus in a single tableau the evidences of decomposition in the human body at the moment of approaching death ; to associate this frightful train of symptoms, sometimes with a slight affection, that may be cured in a day, and again, with a desperate state, whose fatal termination can not be arrested ! liemark, that on these occasions the physician forms his judgment, and makes his prognosis, without occupying himself with the interior organs, which require much more sagacity, and would be, however much attention he might give them, a source of frequent error. Today, a physician, in presence of such an assemblage of symptoms, would seek and find their cause in some visceral lesion ; but this was not possible in the age of Hippocrates, and for a long time after him. Deprived of the light of post-mortem examinations, the physician of that time was forced to make his observations on superficial phenomena, and deduce his prognosis and treatment from them.
He who is in the habit of seeing patients, and knows by experience the inconceivable variety, and inconstancy of morbid symptoms, can alone appreciate the time, labor and patience it required to deduce some general propositions from the observation of phenomena ; to trace, in a word, those rules of semiotics which ancient Medicine has transmitted to us, and some of which still preserve all their original value. If more perfect and more varied means of investigation allow us now to carry our observations still further, we must at least admire the perspicuity of the ancients, who, in many cases, were able to foresee the future events in diseases, with as much certainty as ourselves.
Observe also that the greater part of the rules of semiotics are announced in an absolute manner, and in the form of aphorisms, which indicate the way in which they were established. They must have proceeded in nearly the following manner : when the identical or analogous symptoms were presented a certain number of times in the same order, the fact of their habitual succession was established by a general proposition, often without exception, because experience had not yet made these known to them. But afterwards, in proportion as such exceptions were observed, they were noted, and new aphorisms drawn from them, which sometimes merely limited the first, or even contradicted them. At length the exceptions to the first observations became so multiplied that those axioms lost much of their value. The authors who adopted at a later period that style of writing, were less affirmative and less absolute in their sentences, and therefore inspired less confidence. This change is already seen to take place between the writings of the treatise on Prognosis and the second book of Predictions. The author of the latter, whoever he was, exhibits less self-confidence, and is less positive than his predecessor. He commences even by cautioning the reader against the marvelousness of certain predictions, and cites for examples those that were attributed to the directors of the gymnasice : "As for me," he adds, "I can not divine, but I will describe the symptoms that will enable you to judge which of your patients will recover and which will succumb, and whether they will recover soon, or be long sick." (Second Book of Predictions, by Gardeil. t Ibid)
It appears from some passages in the same book, and from a fragment on dreams, which is a part of the Hippocratic collection, that it was the custom of physicians of that time, to announce the probable issue of the disease at the first or second visit. This custom still prevails in China. It likewise prevails in Turkey, as is attested by my respectable friend, M. le Doctor Brayer, who relates on this subject a curious anecdote, in which he was in some sort obliged to play the part of a diviner. -j- Such an usage indicates the infancy of art, and can only exist as the effect of ignorance and superstition. It supposes that a physician is consulted as an oracle - as a man endowed with superhuman science, and not as a simple mortal, who by reason of study and observation has attained the fixed impression in his mind of the natural progress of a given number of diseases, and groups certain characteristics, by means of which he can in some cases announce their probable issue. Hippocrates blames loudly these physicians, who abandoning the route of truth and rectitude, assume the position of thaumaturgs before their patients, constructing their replies in a vague and ambiguous manner, so that they may be adapted to the most diverse developments ; in short, the usage of all such artifices as are now employed by sorcerers, card-drawers, and somnambulists, to deceive those men that disease, ignorance, or love of the marvelous renders, and always will render, easy to be imposed upon.
From History of Medicine by P.V. Renouard M.D.