Nosography is the eye of therapeutics. In proportion as the first is lucid, methodical, and complete, the second is sure and rational. The possession of the most efficacious curative agents is of no avail to us if we can not distinguish the cases in which their use is advantageous, from those in which they would be injurious. In fact the more the means that the therapist dispensers have of power and energy, the more
they become dangerous in the hands of the ignorant. That which distinguishes the sage and enlightened practitioner from the blind and headlong routinist, is the knowledge of indications. Now this knowledge is & only acquired by the comparison of the morbid phenomena that are before him, with those that he has before observed, and with the most faithful nosological descriptions of others.
In many passages of the Hippocratic works, diseases are termed sporadic, epidemic, and endemic, a useful and well founded distinction, of which the practitioner should never lose sight while the same affection changes in gravity and requires different treatment, accordingly as it exists under one or other of the above forms.
The same writers also divide diseases into acute and chronic, but they do not seem to attach a near and precise idea to this separation - they only indicate it, and in their pathological works they mingle indifferently, and confound these two classes of morbid affections ; in general they observe no order. In one of them alone they are distinguished from each other by a more methodic arrangement, and that is the work on Affections, a summary abridgment of nosography, the most complete of the collection. In it the diseases are classified according to their localities, beginning at the head and going down to the feet. Thus phrenitis, that was supposed to be a disease of the diaphragm, is described immediately after pneumonia; and what is remarkable, fevers follow phrenitis, because supposed to have their seat in the superior viscera of the abdomen.
The following is the list of the Hippocratic books devoted wholly or in part to internal nosology :
1 The treatise on the Regimen in acute diseases, from the 29th to the 44th paragraph, inclusive.
2. The treatise on the Regions in man, from the 16th paragraph to the end.
3. A small monograph on Epilepsy, which was called the sacred disease.
4. A treatise on Diseases, in four volumes.
5. A treatise on Affections.
6. On Internal Affections.
7. A fragment on Diseases of Girls, relating particularly to histeria.
8. A book on the Nature of Woman.
9. A treatise on Diseases of Women, in two volumes.
10. A monograph on Sterility.
All these books and fragments united, are far from constituting a complete nosography of internal diseases. In the first place the greater part of chronic affections are only designated by their names. Some are not even named, and a very small number are described. The omission of all that class of diseases, so important, is owing to the fact that they were generally regarded as inconveniences which did not merit the attention of physicians. We have already quoted and refuted the opinion of Plato, who blames Herodicus for striving to prolong the existence of valetudinarians by the aid of gymnastics. Here is a passage from another author, cotemporaneous with that philosopher, who agrees very nearly with him: "Leprosy, pruritis, teter, white spots on the skin, baldness, etc , it is said, proceed from the pituite ; on this account remedies are employed to evacuate this humor ; but they are rather deformities than diseases."
In the second place, though the attention of the Asclepiadae was principally directed to acute diseases, the descriptions which they have transmitted to us, are, for the most part, so defective, that it would be difficult, if not impossible, to report a single one of them that offers a tableau at all complete or well arranged, of any morbid species whatever.
I conclude from this, that the remains of medical antiquity have now little interest in a didactic point of view ; but though they are completely sterile for the student and young practitioner, they will always interest, to the last degree, the erudite man and the philosopher, to whom these delus are one, as stakes that indicate the route followed in antiquity by science, and serving to measure the stages through which she has passed.
On this account, my readers will not be displeased, I presume to find here two descriptions of diseases, chosen from amongst those which have appeared the best defined in the Hippocratic collection.
On Peripneumonia (Traite dos Maladies, liv. 3e, Â§ 17, trad, de Gardeil)
"Peripneumonia shows itself in the following manner: a great fever is developed; the respiration is hot and frequent; the patient does not know how to contain himself ; he is feeble and totters. The pain is felt at the shoulders, above and in front of the chest, as far as the breasts. He grows worse - sometimes delirium supervenes. There is a species of peripneumonia where the pain is only felt when the patient begins to cough. These are more dangerous and longer continued. At first the expectoration is small and frothy ; the tongue is yellow, and becomes darker. When it is black from the commencement, the disease is more rapidly developed ; it is slower in its progress when the blackening of the tongue comes on later ; afterwards it becomes rough and cracks, the finger adhering to it when applied. The changes in the state of the tongue announce those of the disease, the same as in pleurisy. Peripneumonia continues at least fourteen days, or twenty-one at farthest.
" During this time the cough is severe, and the lungs are depleted by the cough. At first, the expectoration is frothy and copious ; about the seventh or eighth day, when the fever is in full force, if the peripneumonia is moist, it becomes thicker ; unless it shall become on the seventeenth day a green color, it will be slightly sanguinous. From the twelfth to the fourteenth day, it will be abundant, and of a purulent character. Such is the state amongst those who have a humid temperament and constitution, and in whom the disease is severe ; but those in whom the temperament and character of the disease are dry, the attack is less dangerous.
" If then, on the fourteenth day, the cough is not accompanied by purulent expectoration, and the lung becomes dry, the patient is cured. In an opposite case, give attention on the eighteenth or twenty-first day, to see if the expectoration is abating ; if it is not, ask the patient if it is sweetish. If he says yes, you may know that the lung is suppurating this condition is determined. It may last a year unless all the pus is cast off in forty days. When the patient shall respond that the expectoration has a very bad taste, his condition is mortal.
" One may thus know what to expect from the first ; for when the patient expectorates all the bad pus in twenty-two days, and no new injury is developed, he will recover. In the other case, he will die. The first of these two species of peripneumonia leaves no vestige of itself in the lungs. It is essential to be aware of all the sufferings the patient realizes, and what are the therapeutical resources to combat them. When the symptoms are moderate, success is certain; the peripneumonia is not mortal in its nature, and it will be mild. I will now give the treatment."
PLEURISY? (Traité des Maladies, Vol. III, Â§ 18, 19, 20, trad, de Gardeil 7)
When an individual is attacked with pleurisy, the following are the symptoms : pain in the side, with fever, shiverings and frequent respiration ; there is cough, and difficulty in breathing while lying down. The expectoration is bilious, and of the color of the bark of the pomegranate when there is no lesion in the lungs ; if such exists, it will be sanguineous ; when it is bilious and there is no lesion, the attack is milder. In an opposite case, it is graver, and even mortal if hiccup supervenes ; the cough brings up saliva and clots of black blood ; the patient dies on the seventh day. When he survives to the tenth day, the pleurisy is healed ; but if it goes on to the twentieth, suppuration is established, and pus is expectorated, which is finally vomited, and the cure is rendered difficult.
" There are dry pleurisies without expectoration, which are very grave. The crises occur as in humid pleurisies, but there is more need of drinks. The bilious and sanguineous crises take place at the ninth and eleventh days. It is cured more easily when from the commencement the pain is moderate, and becomes acute about the fifth or sixth day ; the disease continues then until the twelfth ; if the patient pass that he will get well. When the suffering has been moderate from the beginning, but violent from the seventh to the eighth day, the crisis is not determined until the fourteenth, after which the danger is passed.
" Pleurisy of the back differs from the preceding, in its pain seeming to be more like that of a wound. The patient groans, and the respiration is frequent. Very soon expectoration occurs in small quantities ; general prostration follows. On the third or fourth day a bloody urine is voided. Death occurs commonly about the fifth or seventh day. Those who pass these days may recover. The disease after this, becomes more tractable. It is necessary, however, to be watchful till the fourteenth day ; beyond that, the patient is safe.
" Some pleuretics expectorate pure phlegm only, whilst their urine is sanguineous, resembling the fluids of roast meats : they feel very acute pains in the front of the chest and groins. If, however, they pass the seventh day, they will get well.
" When in pleurisy there supervenes redness on the back, with heat at the shoulders, a feeling of weight and uneasiness in the abdomen, with green and fetid discharges, the patients will die on the twentieth day in consequence of this evacuation, but if they live beyond the twentieth, they will get well."
Such descriptions, as already remarked at the commencement of this chapter, have no utility for a reader unacquainted with medical studies, or for a beginner ; hut they are valuable as historic record, to establish the state of the Science at a very remote epoch, of which wc have but few remains. The experienced practitioner will discover in them many interesting features of the diseases which he has himself observed, and which prove to a certain point, the exactness of the tableaux.
From History of Medicine by P.V. Renouard M.D.