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The Analysis of Biological Data
The Analysis of Biological
Data

Second Edition

Michael C. Whitlock and Dolph

Schluter
The Analysis of Biological Data, Second Edition

Publisher: Ben Roberts

Proofreader: Kathi Townes
Art Studio: Lineworks, Inc.; Lori Heckelman
Cover Designer: Emiko Paul
Photo Researcher: Jennifer Simmons, Lumina Datamatics, Inc.
Permissions Assistant: Michael McCarthy
Compositor: Kristina Elliott at TECHarts

©2015 by W. H. Freeman and Company

Reproduction or translation of any part of this work beyond that permitted by Section 107
or 108 of the 1976 United States Copyright Act without permission of the copyright owner
is unlawful. Requests for permission or further information should be addressed to the W.
H. Freeman and Company Rights and Permissions Department. Grateful acknowledgment
for third-party permissions, which have been granted for material in this title not owned by
Macmillan Learning, appears in the Photo Credits section, which represents an extension of
this copyright page.

Cover Photo: ©www.pheromonegallery.com

ISBN: 978-1-319156-71-8

Library of Congress Cataloging-in-Publication Data

Whitlock, Michael, author.
The analysis of biological data / Michael C. Whitlock and Dolph Schluter. -- Second
edition.
pages cm
Includes bibliographical references and index.
ISBN 978-1-319156-71-8
1. Biometry--Textbooks. I. Schluter, Dolph, author. II. Title.
QH323.5.W48 2015
570.1’5195--dc23
2014010300

10 9 8 7 6 5 4
W. H. Freeman and Company
One New York Plaza
Suite 4500
10004-1562
New York, NY
www.macmillanhighered.com
To Sally and Wilson, Andrea and Maggie
 Contents in brief

Preface
Acknowledgments
About the authors

PART 1 INTRODUCTION TO STATISTICS

1. Statistics and samples
INTERLEAF 1 Biology and the history of statistics
2. Displaying data
3. Describing data
4. Estimating with uncertainty
INTERLEAF 2 Pseudoreplication
5. Probability
6. Hypothesis testing
INTERLEAF 3 Why statistical significance is not the same as biological importance

PART 2 PROPORTIONS AND FREQUENCIES

7. Analyzing proportions
INTERLEAF 4 Correlation does not require causation
8. Fitting probability models to frequency data
INTERLEAF 5 Making a plan
9. Contingency analysis: associations between
categorical variables 235
 Review Problems 1

PART 3 COMPARING NUMERICAL VALUES

10. The normal distribution
INTERLEAF 6 Controls in medical studies
11. Inference for a normal population
12. Comparing two means
INTERLEAF 7 Which test should I use?
13. Handling violations of assumptions

Review Problems 2
14. Designing experiments
INTERLEAF 8 Data dredging
15. Comparing means of more than two groups
INTERLEAF 9 Experimental and statistical mistakes

PART 4 REGRESSION AND CORRELATION

16. Correlation between numerical variables
INTERLEAF 10 Publication bias
17. Regression
INTERLEAF 11 Using species as data points

Review Problems 3

PART 5 MODERN STATISTICAL METHODS

18. Multiple explanatory variables
19. Computer-intensive methods
20. Likelihood
21. Meta-analysis: combining information from multiple
studies
Statistical tables
Literature cited
Answers to practice problems
Photo credits
Index
 Contents

Preface
Acknowledgments
About the authors

PART 1 INTRODUCTION TO STATISTICS

1. Statistics and samples
1.1 What is statistics?
1.2 Sampling populations
Example 1.2: Raining cats
Populations and samples
Properties of good samples
Random sampling
How to take a random sample
The sample of convenience
Volunteer bias
Data in the real world
1.3 Types of data and variables
Categorical and numerical variables
Explanatory and response variables
1.4 Frequency distributions and probability distributions
1.5 Types of studies
1.6 Summary
Practice problems
Assignment problems
INTERLEAF 1 Biology and the history of statistics
2. Displaying data
2.1 Guidelines for effective graphs
How to draw a bad graph
How to draw a good graph
2.2 Showing data for one variable
Showing categorical data: frequency table and bar graph
Example 2.2A: Crouching tiger
Making a good bar graph
A bar graph is usually better than a pie chart
Showing numerical data: frequency table and histogram
Example 2.2B: Abundance of desert bird species
Describing the shape of a histogram
How to draw a good histogram
Other graphs for numerical data
2.3 Showing association between two variables
Showing association between categorical variables
Example 2.3A: Reproductive effort and avian malaria
Showing association between numerical variables: scatter plot
Example 2.3B: Sins of the father
Showing association between a numerical and a categorical
variable
Example 2.3C: Blood responses to high elevation
2.4 Showing trends in time and space
Line graph
Example 2.4A: Bad science can be deadly
Maps
Example 2.4B: Biodiversity hotspots
2.5 How to make good tables
Follow similar principles for display tables
2.6 Summary
Practice problems
Assignment problems
3. Describing data
3.1 Arithmetic mean and standard deviation
Example 3.1: Gliding snakes
 The sample mean
Variance and standard deviation
Rounding means, standard deviations, and other quantities
Coefficient of variation
Calculating mean and standard deviation from a frequency table
Effect of changing measurement scale
3.2 Median and interquartile range
Example 3.2: I’d give my right arm for a female
The median
The interquartile range
The box plot
3.3 How measures of location and spread compare
Example 3.3: Disarming fish
Mean versus median
Standard deviation versus interquartile range
3.4 Cumulative frequency distribution
Percentiles and quantiles
Displaying cumulative relative frequencies
3.5 Proportions
Calculating a proportion
The proportion is like a sample mean
3.6 Summary
3.7 Quick Formula Summary
Practice problems
Assignment problems
4. Estimating with uncertainty
4.1 The sampling distribution of an estimate
Example 4.1: The length of human genes
Estimating mean gene length with a random sample
The sampling distribution of Y¯
4.2 Measuring the uncertainty of an estimate
Standard error
The standard error of Y¯
The standard error of Y¯ from data
4.3 Confidence intervals
 The 2SE rule of thumb
4.4 Error bars
4.5 Summary
4.6 Quick Formula Summary
Practice problems
Assignment problems
INTERLEAF 2 Pseudoreplication
5. Probability
5.1 The probability of an event
5.2 Venn diagrams
5.3 Mutually exclusive events
5.4 Probability distributions
Discrete probability distributions
Continuous probability distributions
5.5 Either this or that: adding probabilities
The addition rule
The probabilities of all possible mutually exclusive outcomes add
to one
The general addition rule
5.6 Independence and the multiplication rule
Multiplication rule
Example 5.6A: Smoking and high blood pressure
“And” versus “or”
Independence of more than two events
Example 5.6B: Mendel’s peas
5.7 Probability trees
Example 5.7: Sex and birth order
5.8 Dependent events
Example 5.8: Is this meat taken?
5.9 Conditional probability and Bayes’ theorem
Conditional probability
The general multiplication rule
Sampling without replacement
Bayes’ theorem
 Example 5.9: Detection of Down syndrome
5.10 Summary
Practice problems
Assignment problems
6. Hypothesis testing
6.1 Making and using hypotheses
Null hypothesis
Alternative hypothesis
To reject or not to reject
6.2 Hypothesis testing: an example
Example 6.2: The right hand of toad
Stating the hypotheses
The test statistic
The null distribution
Quantifying uncertainty: the P-value
Draw the appropriate conclusion
Reporting the results
6.3 Errors in hypothesis testing
Type I and Type II errors
6.4 When the null hypothesis is not rejected
Example 6.4: The genetics of mirror-image flowers
The test
Interpreting a non-significant result
6.5 One-sided tests
6.6 Hypothesis testing versus confidence intervals
6.7 Summary
Practice problems
Assignment problems
INTERLEAF 3 Why statistical significance is not the same as biological
importance

PART 2 PROPORTIONS AND FREQUENCIES

7. Analyzing proportions
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out by the sun, and are preserved by the cover so as not to be
dissipated by the sun; but when the person comes into the shade
the whole body equally perspires, because the sun no longer shines
upon it.[401] Wherefore, of all kinds of water, these spoil the
soonest; and rain water has a bad smell, because its particles are
collected and mixed together from most objects, so as to spoil the
soonest. And in addition to this, when attracted and raised up, being
carried about and mixed with the air, whatever part of it is turbid
and darkish is separated and removed from the other, and becomes
cloud and mist, but the most attenuated and lightest part is left, and
becomes sweet, being heated and concocted by the sun, for all
other things when concocted become sweet. While dissipated then
and not in a state of consistence it is carried aloft. But when
collected and condensed by contrary winds, it falls down wherever it
happens to be most condensed. For this is likely to happen when the
clouds being carried along and moving with a wind which does not
allow them to rest, suddenly encounters another wind and other
clouds from the opposite direction: there it is first condensed, and
what is behind is carried up to the spot, and thus it thickens,
blackens, and is conglomerated, and by its weight it falls down and
becomes rain. Such, to all appearance, are the best of waters, but
they require to be boiled and strained;[402] for otherwise they have
a bad smell, and occasion hoarseness and thickness of the voice to
those who drink them.[403] Those from snow and ice are all bad, for
when once congealed, they never again recover their former nature;
for whatever is clear, light, and sweet in them, is separated and
disappears; but the most turbid and weightiest part is left behind.
[404] You may ascertain this in the following manner: If in winter you
will pour water by measure into a vessel and expose it to the open
air until it is all frozen, and then on the following day bring it into a
warm situation where the ice will thaw, if you will measure the water
again when dissolved you will find it much less in quantity. This is a
proof that the lightest and thinnest part is dissipated and dried up by
the congelation, and not the heaviest and thickest, for that is
impossible:[405] wherefore I hold that waters from snow and ice,
and those allied to them, are the worst of any for all purposes
whatever. Such are the characters of rain-water, and those from ice
and snow.
9.[406] Men become affected with the stone, and are seized with
diseases of the kidneys, strangury, sciatica, and become ruptured,
when they drink all sorts of waters, and those from great rivers into
which other rivulets run, or from a lake into which many streams of
all sorts flow, and such as are brought from a considerable distance.
For it is impossible that such waters can resemble one another, but
one kind is sweet, another saltish and aluminous, and some flow
from thermal springs; and these being all mixed up together
disagree, and the strongest part always prevails; but the same kind
is not always the strongest, but sometimes one and sometimes
another, according to the winds, for the north wind imparts strength
to this water, and the south to that, and so also with regard to the
others. There must be deposits of mud and sand in the vessels from
such waters, and the aforesaid diseases must be engendered by
them when drunk, but why not to all I will now explain. When the
bowels are loose and in a healthy state,[407] and when the bladder is
not hot, nor the neck of the bladder very contracted, all such
persons pass water freely, and no concretion forms in the bladder;
but those in whom the belly is hot, the bladder must be in the same
condition; and when preternaturally heated, its neck becomes
inflamed; and when these things happen, the bladder does not expel
the urine, but raises its heat excessively. And the thinnest part of it
is secreted, and the purest part is passed off in the form of urine,
but the thickest and most turbid part is condensed and concreted, at
first in small quantity, but afterwards in greater; for being rolled
about in the urine, whatever is of a thick consistence it assimilates to
itself, and thus it increases and becomes indurated. And when such
persons make water, the stone forced down by the urine falls into
the neck of the bladder and stops the urine, and occasions intense
pain; so that calculous children rub their privy parts and tear at
them, as supposing that the obstruction to the urine is situated
there. As a proof that it is as I say, persons affected with calculus
have very limpid urine, because the thickest and foulest part remains
and is concreted.[408] Thus it generally is in cases of calculus. It
forms also in children from milk, when it is not wholesome, but very
hot and bilious, for it heats the bowels and bladder, so that the urine
being also heated undergoes the same change. And I hold that it is
better to give children only the most diluted wine, for such will least
burn up and dry the veins. Calculi do not form so readily in women,
for in them the urethra is short and wide, so that in them the urine
is easily expelled; neither do they rub the pudendum with their
hands, nor handle the passage like males;[409] for the urethra in
women opens direct into the pudendum, which is not the case with
men, neither in them is the urethra so wide, and they drink more
than children do.[410] Thus, or nearly so, is it with reward to them.
10. And respecting the seasons, one may judge whether the year
will prove sickly or healthy from the following observations:[411]—If
the appearances connected with the rising and setting stars be as
they should be; if there be rains in autumn; if the winter be mild,
neither very tepid nor unseasonably cold, and if in spring the rains
be seasonable, and so also in summer, the year is likely to prove
healthy. But if the winter be dry and northerly, and the spring
showery and southerly, the summer will necessarily be of a febrile
character, and give rise to ophthalmies and dysenteries.[412] For
when suffocating heat sets in all of a sudden, while the earth is
moistened by the vernal showers, and by the south wind, the heat is
necessarily doubled from the earth, which is thus soaked by rain and
heated by a burning sun, while, at the same time, men’s bellies are
not in an orderly state, nor the brain properly dried; for it is
impossible, after such a spring, but that the body and its flesh must
be loaded with humors, so that very acute fevers will attack all, but
especially those of a phlegmatic constitution. Dysenteries are also
likely to occur to women and those of a very humid temperament.
And if at the rising of the Dog-star rain and wintry storms
supervene, and if the etesian winds blow, there is reason to hope
that these diseases will cease, and that the autumn will be healthy;
but if not, it is likely to be a fatal season to children and women, but
least of all to old men; and that convalescents will pass into
quartans, and from quartans into dropsies; but if the winter be
southerly, showery and mild, but the spring northerly, dry, and of a
wintry character, in the first place women who happen to be with
child, and whose accouchement should take place in spring, are apt
to miscarry; and such as bring forth, have feeble and sickly children,
so that they either die presently or are tender, feeble, and sickly, if
they live. Such is the case with the women. The others are subject
to dysenteries[413] and dry ophthalmies, and some have catarrhs
beginning in the head and descending to the lungs. Men of a
phlegmatic temperament are likely to have dysenteries; and women,
also, from the humidity of their nature, the phlegm descending
downwards from the brain; those who are bilious, too, have dry
ophthalmies from the heat and dryness of their flesh; the aged, too,
have catarrhs from their flabbiness and melting of the veins, so that
some of them die suddenly and some become paralytic on the right
side or the left.[414] For when, the winter being southerly and the
body hot, the blood and veins are not properly constringed; a spring
that is northerly, dry, and cold, having come on, the brain when it
should have been expanded and purged, by the coryza and
hoarseness is then constringed and contracted, so that the summer
and the heat occurring suddenly, and a change supervening, these
diseases fall out. And such cities as lie well to the sun and winds,
and use good waters, feel these changes less, but such as use
marshy and pooly waters, and lie well both as regards the winds and
the sun, these all feel it more. And if the summer be dry, those
diseases soon cease, but if rainy, they are protracted; and there is
danger of any sore that there is becoming phagedenic from any
cause; and lienteries and dropsies supervene at the conclusion of
diseases; for the bowels are not readily dried up. And if the summer
be rainy and southerly, and next the autumn, the winter must, of
necessity, be sickly, and ardent fevers are likely to attack those that
are phlegmatic, and more elderly than forty years, and pleurisies and
peripneumonies[415] those that are bilious. But if the summer is
parched and northerly, but the autumn rainy and southerly,
headache and sphacelus of the brain[416] are likely to occur; and in
addition hoarseness, coryza, coughs, and in some cases,
consumption.[417] But if the season is northerly and without water,
there being no rain, neither after the Dog-star nor Arcturus; this
state agrees best with those who are naturally phlegmatic, with
those who are of a humid temperament, and with women: but it is
most inimical to the bilious; for they become much parched up, and
ophthalmies of a dry nature supervene, fevers both acute and
chronic, and in some cases melancholy;[418] for the most humid and
watery part of the bile being consumed, the thickest and most acrid
portion is left, and of the blood likewise, whence these diseases
come upon them. But all these are beneficial to the phlegmatic, for
they are thereby dried up, and reach winter not oppressed with
humors, but with them dried up.
11. Whoever studies and observes these things may be able to
foresee most of the effects which will result from the changes of the
seasons: and one ought to be particularly guarded during the
greatest changes of the seasons, and neither willingly give
medicines, nor apply the cautery to the belly, nor make incisions
there until ten or more days be past. Now, the greatest and most
dangerous are the two solstices, and especially the summer, and
also the two equinoxes, but especially the autumnal.[419] One ought
also to be guarded about the rising of the stars, especially of the
Dog-star, then of Arcturus, and then the setting of the Pleiades; for
diseases are especially apt to prove critical in those days, and some
prove fatal, some pass off, and all others change to another form
and another constitution. So it is with regard to them.
12. I wish to show, respecting Asia and Europe, how, in all
respects, they differ from one another, and concerning the figure of
the inhabitants, for they are different, and do not at all resemble one
another. To treat of all would be a long story, but I will tell you how I
think it is with regard to the greatest and most marked differences. I
say, then, that Asia differs very much from Europe as to the nature
of all things, both with regard to the productions of the earth and
the inhabitants, for everything is produced much more beautiful and
large in Asia; the country is milder, and the dispositions of the
inhabitants also are more gentle and affectionate.[420] The cause of
this is the temperature of the seasons, because it lies in the middle
of the risings of the sun[421] towards the east, and removed from
the cold (and heat),[422] for nothing tends to growth and mildness
so much as when the climate has no predominant quality, but a
general equality of temperature prevails. It is not everywhere the
same with regard to Asia, but such parts of the country as lie
intermediate between the heat and the cold, are the best supplied
with fruits and trees, and have the most genial climate, and enjoy
the purest waters, both celestial and terrestrial. For neither are they
much burnt up by the heat, nor dried up by the drought and want of
rain, nor do they suffer from the cold; since they are well watered
from abundant showers and snow, and the fruits of the season,[423]
as might be supposed, grow in abundance, both such as are raised
from seed that has been sown, and such plants as the earth
produces of its own accord, the fruits of which the inhabitants make
use of, training them from their wild state and transplanting them to
a suitable soil; the cattle also which are reared there are vigorous,
particularly prolific, and bring up young of the fairest description; the
inhabitants too, are well fed, most beautiful in shape, of large
stature, and differ little from one another either as to figure or size;
and the country itself, both as regards its constitution and mildness
of the seasons, may be said to bear a close resemblance to the
spring. Manly courage, endurance of suffering, laborious enterprise,
and high spirit, could not be produced in such a state of things
either among the native inhabitants or those of a different country,
for there pleasure necessarily reigns. For this reason, also, the forms
of wild beasts there are much varied.[424] Thus it is, as I think, with
the Egyptians and Libyans.
13. But concerning those on the right hand of the summer risings
of the sun as far as the Palus Mæotis[425] (for this is the boundary of
Europe and Asia), it is with them as follows: the inhabitants there
differ far more from one another than those I have treated of above,
owing to the differences of the seasons and the nature of the soil.
But with regard to the country itself, matters are the same there as
among all other men; for where the seasons undergo the greatest
and most rapid changes, there the country is the wildest and most
unequal; and you will find the greatest variety of mountains, forests,
plains, and meadows; but where the seasons do not change much
there the country is the most even; and, if one will consider it, so is
it also with regard to the inhabitants; for the nature of some is like
to a country covered with trees and well watered; of some, to a thin
soil deficient in water; of others, to fenny and marshy places; and of
some again, to a plain of bare and parched land.[426] For the
seasons which modify their natural frame of body are varied, and the
greater the varieties of them the greater also will be the differences
of their shapes.
14. I will pass over the smaller differences among the nations,
but will now treat of such as are great either from nature, or
custom; and, first, concerning the Macrocephali.[427] There is no
other race of men which have heads in the least resembling theirs.
At first, usage was the principal cause of the length of their head,
but now nature cooperates with usage. They think those the most
noble who have the longest heads. It is thus with regard to the
usage: immediately after the child is born, and while its head is still
tender, they fashion it with their hands, and constrain it to assume a
lengthened shape by applying bandages and other suitable
contrivances whereby the spherical form of the head is destroyed,
and it is made to increase in length. Thus, at first, usage operated,
so that this constitution was the result of force: but, in the course of
time, it was formed naturally; so that usage had nothing to do with
it; for the semen comes from all parts of the body, sound from the
sound parts, and unhealthy from the unhealthy parts. If, then,
children with bald heads are born to parents with bald heads; and
children with blue eyes to parents who have blue eyes; and if the
children of parents having distorted eyes squint also for the most
part; and if the same may be said of other forms of the body, what
is to prevent it from happening that a child with a long head should
be produced by a parent having a long head?[428] But now these
things do not happen as they did formerly, for the custom no longer
prevails owing to their intercourse with other men. Thus it appears
to me to be with regard to them.
15. As to the inhabitants of Phasis,[429] their country is fenny,
warm, humid, and wooded; copious and severe rains occur there at
all seasons; and the life of the inhabitants is spent among the fens;
for their dwellings are constructed of wood and reeds, and are
erected amidst the waters; they seldom practise walking either to
the city or the market, but sail about, up and down, in canoes
constructed out of single trees, for there are many canals there.[430]
They drink the hot and stagnant waters, both when rendered putrid
by the sun, and when swollen with rains. The Phasis itself is the
most stagnant of all rivers, and runs the smoothest;[431] all the
fruits which spring there are unwholesome, of feeble and imperfect
growth, owing to the redundance of water, and on this account they
do not ripen, for much vapor from the waters overspreads the
country. For these reasons the Phasians have shapes different from
those of all other men; for they are large in stature, and of a very
gross habit of body, so that not a joint nor vein is visible; in color
they are sallow, as if affected with jaundice. Of all men they have
the roughest voices, from their breathing an atmosphere which is
not clear, but misty and humid; they are naturally rather languid in
supporting bodily fatigue. The seasons undergo but little change
either as to heat or cold; their winds for the most part are southerly,
with the exception of one peculiar to the country, which sometimes
blows strong, is violent and hot, and is called by them the wind
cenchron. The north wind scarcely reaches them, and when it does
blow it is weak and gentle. Thus it is with regard to the different
nature and shape of the inhabitants of Asia and Europe.
16. And with regard to the pusillanimity and cowardice of the
inhabitants, the principal reason why the Asiatics are more unwarlike
and of more gentle disposition than the Europeans is, the nature of
the seasons, which do not undergo any great changes either to heat
or cold, or the like; for there is neither excitement of the
understanding nor any strong change of the body by which the
temper might be ruffled, and they be roused to inconsiderate
emotion and passion, rather than living as they do always in the
same state. It is changes of all kinds which arouse the
understanding of mankind, and do not allow them to get into a
torpid condition. For these reasons, it appears to me, the Asiatic race
is feeble, and further, owing to their laws; for monarchy prevails in
the greater part of Asia, and where men are not their own masters
nor independent, but are the slaves of others, it is not a matter of
consideration with them how they may acquire military discipline,
but how they may seem not to be warlike, for the dangers are not
equally shared, since they must serve as soldiers, perhaps endure
fatigue, and die for their masters, far from their children, their wives,
and other friends; and whatever noble and manly actions they may
perform lead only to the aggrandizement of their masters, whilst the
fruits which they reap are dangers and death; and, in addition to all
this, the lands of such persons must be laid waste by the enemy and
want of culture.[432] Thus, then, if any one be naturally warlike and
courageous, his disposition will be changed by the institutions. As a
strong proof of all this, such Greeks or barbarians in Asia as are not
under a despotic form of government, but are independent, and
enjoy the fruits of their own labors, are of all others the most
warlike; for these encounter dangers on their own account, bear the
prizes of their own valor, and in like manner endure the punishment
of their own cowardice. And you will find the Asiatics differing from
one another, for some are better and others more dastardly; of these
differences, as I stated before, the changes of the seasons are the
cause. Thus it is with Asia.
17. In Europe there is a Scythian race, called Sauromatæ, which
inhabits the confines of the Palus Mæotis, and is different from all
other races.[433] Their women mount on horseback, use the bow,
and throw the javelin from their horses, and fight with their enemies
as long as they are virgins; and they do not lay aside their virginity
until they kill three of their enemies, nor have any connection with
men until they perform the sacrifices according to law. Whoever
takes to herself a husband, gives up riding on horseback unless the
necessity of a general expedition obliges her. They have no right
breast; for while still of a tender age their mothers heat strongly a
copper instrument constructed for this very purpose, and apply it to
the right breast, which is burnt up, and its development being
arrested, all the strength and fullness are determined to the right
shoulder and arm.
18. As the other Scythians have a peculiarity of shape, and do
not resemble any other, the same observation applies to the
Egyptians, only that the latter are oppressed by heat and the former
by cold.[434] What is called the Scythian desert is a prairie,
abounding in meadows, high-lying, and well watered; for the rivers
which carry off the water from the plains are large. There live those
Scythians which are called Nomades, because they have no houses,
but live in wagons. The smallest of these wagons have four wheels,
but some have six; they are covered in with felt, and they are
constructed in the manner of houses, some having but a single
apartment, and some three; they are proof against rain, snow, and
winds. The wagons are drawn by yokes of oxen, some of two and
others of three, and all without horns, for they have no horns, owing
to the cold.[435] In these wagons the women live, but the men are
carried about on horses, and the sheep, oxen, and horses
accompany them; and they remain on any spot as long as there is
provender for their cattle, and when that fails they migrate to some
other place. They eat boiled meat, and drink the milk of mares, and
also eat hippace, which is cheese prepared from the milk of the
mare. Such is their mode of life and their customs.[436]
19. In respect of the seasons and figure of body, the Scythian
race, like the Egyptian, have a uniformity of resemblance, different
from all other nations; they are by no means prolific, and the wild
beasts which are indigenous there are small in size and few in
number, for the country lies under the Northern Bears, and the
Rhiphæan mountains, whence the north wind blows; the sun comes
very near to them only when in the summer solstice, and warms
them but for a short period, and not strongly; and the winds blowing
from the hot regions of the earth do not reach them, or but seldom,
and with little force; but the winds from the north always blow,
congealed, as they are, by the snow, the ice, and much water, for
these never leave the mountains, which are thereby rendered
uninhabitable. A thick fog covers the plains during the day, and
amidst it they live, so that winter may be said to be always present
with them; or, if they have summer, it is only for a few days, and the
heat is not very strong. Their plains are high-lying and naked, not
crowned with mountains, but extending upwards under the Northern
Bears.[437] The wild beasts there are not large, but such as can be
sheltered under-ground; for the cold of winter and the barrenness of
the country prevent their growth, and because they have no covert
nor shelter.[438] The changes of the seasons, too, are not great nor
violent, for, in fact, they change gradually; and therefore their
figures resemble one another, as they all equally use the same food,
and the same clothing summer and winter, respiring a humid and
dense atmosphere, and drinking water from snow and ice; neither
do they make any laborious exertions, for neither body nor mind is
capable of enduring fatigue when the changes of the seasons are
not great.[439] For these reasons their shapes are gross and fleshy,
with ill-marked joints, of a humid temperament, and deficient in
tone: the internal cavities, and especially those of the intestines, are
full of humors; for the belly cannot possibly be dry in such a country,
with such a constitution and in such a climate; but owing to their fat,
and the absence of hairs from their bodies, their shapes resemble
one another, the males being all alike, and so also with the women:
for the seasons being of an uniform temperature, no corruption or
deterioration takes place in the concretion of the semen, unless from
some violent cause, or from disease.[440]
 20. I will give you a strong proof of the humidity (laxity?) of their
constitutions.[441] You will find the greater part of the Scythians, and
all the Nomades, with marks of the cautery on their shoulders, arms,
wrists, breasts, hip-joints, and loins, and that for no other reason
but the humidity and flabbiness of their constitution, for they can
neither strain with their bows, nor launch the javelin from their
shoulder owing to their humidity and atony: but when they are
burnt, much of the humidity in their joints is dried up, and they
become better braced, better fed, and their joints get into a more
suitable condition.[442] They are flabby and squat at first, because,
as in Egypt, they are not swathed(?);[443] and then they pay no
attention to horsemanship, so that they may be adepts at it; and
because of their sedentary mode of life; for the males, when they
cannot be carried about on horseback, sit the most of their time in
the wagon, and rarely practise walking, because of their frequent
migrations and shiftings of situation; and as to the women, it is
amazing how flabby and sluggish they are. The Scythian race are
tawny from the cold, and not from the intense heat of the sun, for
the whiteness of the skin is parched by the cold, and becomes
tawny.
21. It is impossible that persons of such a constitution could be
prolific, for, with the man, the sexual desires are not strong, owing
to the laxity of his constitution, the softness and coldness of his
belly, from all which causes it is little likely that a man should be
given to venery; and besides, from being jaded by exercise on
horseback, the men become weak in their desires. On the part of the
men these are the causes; but on that of the women, they are
embonpoint and humidity; for the womb cannot take in the semen,
nor is the menstrual discharge such as it should be, but scanty and
at too long intervals; and the mouth of the womb is shut up by fat
and does not admit the semen; and, moreover, they themselves are
indolent and fat, and their bellies cold and soft.[444] From these
causes the Scythian race is not prolific. Their female servants furnish
a strong proof of this; for they no sooner have connection with a
man than they prove with child, owing to their active course of life
and the slenderness of body.
22. And, in addition to these, there are many eunuchs among the
Scythians, who perform female work, and speak like women. Such
persons are called effeminates.[445] The inhabitants of the country
attribute the cause of their impotence to a god, and venerate and
worship such persons, every one dreading that the like might befall
himself; but to me it appears that such affections are just as much
divine as all others are, and that no one disease is either more divine
or more human than another, but that all are alike divine, for that
each has its own nature, and that no one arises without a natural
cause.[446] But I will explain how I think that the affection takes its
rise. From continued exercise on horseback they are seized with
chronic defluxions in their joints (kedmata[447]) owing to their legs
always hanging down below their horses; they afterwards become
lame and stiff at the hip-joint, such of them, at least, as are severely
attacked with it. They treat themselves in this way: when the
disease is commencing, they open the vein behind either ear, and
when the blood flows, sleep, from feebleness, seizes them, and
afterwards they awaken, some in good health and others not. To me
it appears that the semen is altered by this treatment, for there are
veins behind the ears which, if cut, induce impotence; now, these
veins would appear to me to be cut.[448] Such persons afterwards,
when they go in to women and cannot have connection with them,
at first do not think much about it, but remain quiet; but when, after
making the attempt two, three, or more times, they succeed no
better, fancying they have committed some offence against the god
whom they blame for the affection, they put on female attire,
reproach themselves for effeminacy, play the part of women, and
perform the same work as women do. This the rich among the
Scythians endure, not the basest, but the most noble and powerful,
owing to their riding on horseback; for the poor are less affected, as
they do not ride on horses. And yet, if this disease had been more
divine than the others, it ought not to have befallen the most noble
and the richest of the Scythians alone, but all alike, or rather those
who have little, as not being able to pay honors to the gods, if,
indeed, they delight in being thus rewarded by men, and grant
favors in return; for it is likely that the rich sacrifice more to the
gods, and dedicate more votive offerings, inasmuch as they have
wealth, and worship the gods; whereas the poor, from want, do less
in this way, and, moreover, upbraid the gods for not giving them
wealth, so that those who have few possessions were more likely to
bear the punishments of these offences than the rich. But, as I
formerly said, these affections are divine just as much as others, for
each springs from a natural cause, and this disease arises among
the Scythians from such a cause as I have stated. But it attacks
other men in like manner, for whenever men ride much and very
frequently on horseback, then many are affected with rheums in the
joints, sciatica, and gout, and they are inept at venery. But these
complaints befall the Scythian, and they are the most impotent of
men for the aforesaid causes, and because they always wear
breeches, and spend the most of their time on horseback,[449] so as
not to touch their privy parts with the hand, and from the cold and
fatigue they forget the sexual desire, and do not make the attempt
until after they have lost their virility.[450] Thus it is with the race of
the Scythians.
23. The other races in Europe differ from one another, both as to
stature and shape, owing to the changes of the seasons, which are
very great and frequent, and because the heat is strong, the winters
severe, and there are frequent rains, and again protracted droughts,
and winds, from which many and diversified changes are induced.
These changes are likely to have an effect upon generation in the
coagulation of the semen, as this process cannot be the same in
summer as in winter, nor in rainy as in dry weather; wherefore, I
think, that the figures of Europeans differ more than those of
Asiatics; and they differ very much from one another as to stature in
the same city; for vitiations of the semen occur in its coagulation
more frequently during frequent changes of the seasons, than where
they are alike and equable. And the same may be said of their
dispositions, for the wild, and unsociable, and the passionate occur
in such a constitution; for frequent excitement of the mind induces
wildness, and extinguishes sociableness and mildness of disposition,
and therefore I think the inhabitants of Europe more courageous
than those of Asia; for a climate which is always the same induces
indolence, but a changeable climate, laborious exertions both of
body and mind; and from rest and indolence cowardice is
engendered, and from laborious exertions and pains, courage. On
this account the inhabitants of Europe are more warlike than the
Asiatics, and also owing to their institutions, because they are not
governed by kings like the latter, for where men are governed by
kings there they must be very cowardly, as I have stated before; for
their souls are enslaved, and they will not willingly, or readily
undergo dangers in order to promote the power of another; but
those that are free undertake dangers on their own account, and not
for the sake of others; they court hazard and go out to meet it, for
they themselves bear off the rewards of victory, and thus their
institutions contribute not a little to their courage.[451]
Such is the general character of Europe and Asia.[452]
24. And there are in Europe other tribes, differing from one
another in stature, shape, and courage: the differences are those I
formerly mentioned, and will now explain more clearly. Such as
inhabit a country which is mountainous, rugged, elevated, and well
watered, and where the changes of the seasons are very great, are
likely to have great variety of shapes among them, and to be
naturally of an enterprising and warlike disposition;[453] and such
persons are apt to have no little of the savage and ferocious in their
nature; but such as dwell in places which are low-lying, abounding in
meadows and ill ventilated, and who have a larger proportion of hot
than of cold winds, and who make use of warm waters—these are
not likely to be of large stature nor well proportioned, but are of a
broad make, fleshy, and have black hair; and they are rather of a
dark than of a light complexion, and are less likely to be phlegmatic
than bilious; courage and laborious enterprise are not naturally in
them, but may be engendered in them by means of their
institutions. And if there be rivers in the country which carry off the
stagnant and rain water from it, these may be wholesome and clear;
but if there be no rivers, but the inhabitants drink the waters of
fountains, and such as are stagnant and marshy, they must
necessarily have prominent bellies and enlarged spleens. But such as
inhabit a high country, and one that is level, windy, and well-
watered, will be large of stature, and like to one another; but their
minds will be rather unmanly and gentle. Those who live on thin, ill-
watered, and bare soils, and not well attempered in the changes of
the seasons, in such a country they are likely to be in their persons
rather hard and well braced, rather of a blond than a dark
complexion, and in disposition and passions haughty and self-willed.
For, where the changes of the seasons are most frequent, and where
they differ most from one another, there you will find their forms,
dispositions, and nature the most varied. These are the strongest of
the natural causes of difference, and next the country in which one
lives, and the waters; for, in general, you will find the forms and
dispositions of mankind to correspond with the nature of the
country; for where the land is fertile, soft, and well-watered, and
supplied with waters from very elevated situations, so as to be hot in
summer and cold in winter, and where the seasons are fine, there
the men are fleshy, have ill-formed joints,[454] and are of a humid
temperament; they are not disposed to endure labor, and, for the
most part, are base in spirit; indolence and sluggishness are visible
in them, and to the arts they are dull, and not clever nor acute.
When the country is bare, not fenced, and rugged, blasted by the
winter and scorched by the sun, there you may see the men hardy,
slender, with well-shaped joints,[454] well-braced, and shaggy; sharp
industry and vigilance accompany such a constitution; in morals and
passions they are haughty and opinionative, inclining rather to the
fierce than to the mild; and you will find them acute and ingenious
as regards the arts, and excelling in military affairs; and likewise all
the other productions of the earth corresponding to the earth itself.
[455] Thus it is with regard to the most opposite natures and shapes;
drawing conclusions from them, you may judge of the rest without
any risk of error.
 ON THE PROGNOSTICS.
THE ARGUMENT.

Of the genuineness of this work I have treated in the Preliminary

Discourse, and have also briefly touched upon its relation to two
other important treatises in the Hippocratic collection, the
“Prorrhetics” and the “Coacæ Prænotiones.” The latter subject I am
now to resume, and in doing so I mean to avail myself of the
talented dissertation of Dr. Ermerins, to which also I have already
made allusion. Indeed I am persuaded that I cannot do a more
acceptable service to my profession in Britain than by laying before
them a brief exposition of the important views brought forward in
this “Dissertatio Inauguralis.”[456]
After some preliminary observations on the ancient Temples of
Health, which are mainly derived from Sprengel’s “History of
Medicine”[457] he passes on to consider the opinion started[*? typo
for stated, but started also in googlebooks] by this author and others
before his time, that the first book of the “Prorrhetics” and the
“Coacæ Prænotiones” are the results of isolated observations made
upon the sick in the Asclepion of Cos. The probability of this opinion
being well founded he shows to be very great; and he next
endeavors to solve the question whether the first book of the
“Prorrhetics” be derived from the “Coacæ Prænotiones,” or whether
the latter be the more modern work of the two. He comes to the
conclusion that the “Prorrhetics” is the more ancient work, for the
following reasons: 1st. Because in it the names of the patients are
frequently given, which is rarely the case in the “Coacæ
Prænotiones.” 2d. Because queries and doubts are oftener found in
this book than in the other, when one takes into account the number
of presages. 3d. Because the number of observations which this
book contains is much smaller than those which the “Coacæ”
embrace. 4th. This is confirmed by the circumstance that the
enunciations of the prognoses are far less extended in the
“Prorrhetics,” whence it is clearly proved that they are not derived
from so great a field of observations as those we meet with in the
other work. He then gives a most lucid view of the parallelism which
subsists between the “Prorrhetica” and the
“Coacæ,” and, as the results of his observations upon them, he
draws the following most important conclusions:
1. “By a most fortunate occurrence certain monuments of the
medical art, as cultivated by the Asclepiadæ, are preserved to us in
the first “Prorrhetics” and the “Prænotiones Coacæ” which books
appear to be fragments and excerpts from the histories of diseases
and cures which were formerly found on the votive tablets of the
Coan temple.
2. This sacerdotal medicine was at first a certain medical
divination, which, as it was the offspring of pure observation, so the
system of prognostics of the Coans was altogether aloof from the
theories and systems of the philosophers, and is therefore to be
reckoned most worthy of our attention, both from the great love of
observation which we admire in it, and from the exquisite and
beautiful sense of the simple truth which it evinces.
3. We must keep in view the origin of these presages from
individual observations gradually collected, in order that we may
have a knowledge of this system of prognostic semeiology. Hence
we comprehend how we meet with so many doubtful propositions,
and so many uncertain and vague remarks, and that imperfect
etiology which confounded causes with their effects, and again, the
latter with the former.
4. The readers must particularly keep before their eyes this
origin, and the antiquity of those writings, if they would pass a
correct judgment on the merits of the Asclepiadæ towards the art of
medicine. Whatever in their works we have the pleasure of
possessing, all attest the infancy of the art; many things are
imperfect, and not unfrequently do we see them, while in the pursuit
of truth, groping, as it were, and proceeding with uncertain steps,
like men wandering about in darkness; but yet the method which
they applied, and to which they would seem to have betaken
themselves of their own accord, was so excellent, that nothing could
surpass it. It was the same method which Hippocrates himself
always adopted, and which, in fine, Lord Bacon, many ages
afterwards, commended as the only instrument by which truth in
medicine can be found out.
5. As this method is founded on true induction, so are its dicta to
be held the more worthy of admiration, the more they possess a
universal signification. To give an example; what assiduous
observation, and what abundance of rational experience, must have
been required for enunciating the following admirable truth, and, as
it were, law of nature: “Those things which bring alleviation with bad
signs, and do not remit with good, are troublesome and difficult.”
6. Many passages bear reference to the condition of the vital
powers, which they took into account at all times, both in making
presages and in exercising the art. For, although they had not our
theories of the vital force, they perceived its effects very well by
observation; and for this very reason, that they did not search for
the art in theories, but in observation alone, we owe so many
excellent things to them, since they did not adapt their observation
to theories, but related a trustworthy and faithful history of the
operations of nature.
7. They sought after many things from a comparison of health
with disease, in which also they rightly calculated the manners and
customs of men. Thus they call that, in the first place, the best
mode of reclining, which is adopted by the patient when in good
health, and hence they estimate the other modes as being less
good, or altogether unfavorable. Nor did they only compare health
with disease, but they compared also the symptoms of diseases with
one another, and interpreted the one from the other. Thus they first
depict and pronounce a favorable opinion on the best kind of
excretions, and then they described the other abnormal kinds, and
pass an unfavorable judgment on them.
8. They particularly relate the operations of a natura medicatrix,
which, in a region such as Greece is, and in athletic, strong bodies,
on which they appear to have practised the art, and for the most
part in acute diseases, and the few chronic ones derived from them
which they have left described, might especially be looked for. Hence
that doctrine of crises most deserving of attention, the rudiments,
indeed, of which we only have here preserved, but a just notion of
which we may easily draw from these fragments.
9. The Asclepiadæ would appear to have accommodated and
directed their art to this natural Therapia. Hence the advice that
convulsions arising from a great hemorrhage, forcibly stopped,
should be cured by the abstraction of blood. It is to be regretted that
but a few monuments of their practice remain; but these embrace
admirable imitations of nature, and the most prudent caution in
administering remedies.
10. Neither did they neglect surgery, but deliver many excellent
remarks on things pertaining to wounds, ulcers, and fractures.
11. Although it cannot be made out for certain that everything
which is preserved in these writings existed before Hippocrates,
there can be no doubt that many of them are more ancient than he.
And although we may attribute some things rather to Hippocrates
himself, it is nevertheless certain that the method of deducing the
art from observation and comparison had existed before him. Some
may, perhaps, object that these books are to be attributed to the
youth of Hippocrates, and that the others, more elaborate and
perfect, had proceeded from the same person in his old age; but this
supposition we may refute by a single argument, namely, that it
would be absurd to ascribe so many observations about so many
diseases to one man.
12. From the whole Coan system of cultivating medicine, the best
hopes might justly have been expected; and from what follows it will
be seen that the result did not disappoint this expectation.”
These deductions, I must say, appear to be most legitimately
drawn; and having thus satisfactorily made out that the “Coacæ
Prænotiones” are founded on the “Prorrhetics,” Dr. Ermerins
proceeds to make an interesting comparison between the former
and the book of “Prognostics.” Here again we can only find room for
the general conclusions.
1. “We have compared together two monuments of antiquity
embracing entirely the same doctrine, so that we may hold it as put
out of all doubt that they must have derived their origin from the
same school, only the one yields to the other in antiquity, as its more
expanded mode of expression shows.
2. The more recent work is attributed to Hippocrates by all the
critics and interpreters; the most ancient authors have made
mention of it, and all the characteristic marks by which the genuine
works of Hippocrates are distinguished from the spurious, without
doubt, are found in it; for whether you look to the brevity and
gravity of the language, or the paucity of the reasonings, the
correctness of the observations, or the dialect in which they are
expressed, or, in fine, its agreement with the whole Hippocratic
doctrine,—all these attest that “the divine old man” is the author of
this work.
3. From a comparison of the “Coacæ Prænotiones” with the
“Prognostics,” it is as clear as the light of day that Hippocrates
composed this work from them, in such a manner that he
circumscribed many of the symptoms, limited the enunciations, and
amplified them all by his own experience in the medical Art. Hence
the Prognostics may not inaptly be called the Commentary of
Hippocrates on the “Coacæ Prænotiones.”
4. With regard to the exquisite and artificial order, in which we
see many things proposed in his book, we agree entirely with
Sprengel, who thinks that they have proceeded from a more recent
describer. This is confirmed by our comparison of both works.
 5. This work exhibits the fundamental principles and originals of
the Hippocratic doctrine, and although we hardly know anything as
to the manlier in which Hippocrates composed his writings, and of
the form which he gave them, it does not seem at all out of the way
to hold this book to be the oldest of all the works which “the Father
of Medicine” has left to us.
6. Inasmuch as this work is entitled the Book of Prognostics, so it
turns on the prescience πρόνοια, that is to say, the foreknowledge of
the physician, which Hippocrates recommends to physicians for
three reasons: first, for the confidence of mankind, which it will
conciliate to the physician; then because it will free the practitioner
from all blame, if he has announced beforehand the fatal result of
diseases; and further, as being a very great instrument in effecting
the cure.
7. Like the Coan priests, Hippocrates drew his Prognostics from a
comparison of disease with health. This he held to be of so great
importance, that he first delivers physiological semeiotics, and then
adds pathological.
8. In calculating and judging of signs he neglected neither age
nor sex, and, in the first place, directed his mind to the power of
habit on the human body.
9. Nor did Hippocrates stop here, but directed care to be had of
the attack of epidemics, and the condition of the season.
10. The Prognostics of Hippocrates are not of one time or place,
but extend through every age, and through the whole world;
inasmuch as the prognostic signs have been proved to be true in
Libya, in Delos, and in Scythia, and it should be well known that
every year, and at every season of the year, bad symptoms bode ill,
and good symptoms good.
11. But he who would wish to know properly beforehand those
who will recover from a disease, and those who will die, and those in
whom the disease will persevere for many days, and those in whom
it will last for a few, should be able to comprehend and estimate the
doctrine of all the signs, and weigh in his mind and compare
together their strength. The Hippocratic foreknowledge rests not
only on the observation of the signs, but also on the understanding
of them.
12. The Book of Prognostics exhibits observations of acute
diseases, and of chronic arising from them, in which Hippocrates has
diligently noted the times and modes of the crises.
13. Such is the authority of critical days and signs, that in those
fevers which cease without the symptoms of resolution, and not
upon critical days, a relapse is to be expected.
14. The series of critical days which Hippocrates delivers,
proceeds solely upon the observation of nature. Yet neither can any
of them be exactly numbered by entire days, since neither the year
nor the months are usually numbered by entire days.”
Dr. Ermerins, in the remaining part of his Essay, shows, in a very
lucid manner, that the rules of Prognosis laid down in this treatise by
Hippocrates, are manifestly those by which he is regulated in his
other works, and more especially in the Epidemics and Aphorisms.
We must not, however, occupy room with any further exposition of
the contents of this important treatise, which does equal credit to
the author himself, and to the medical system of education pursued
in the learned university from which it emanated.

I will now give some remarks and reflections of my own on the

treatise under consideration.
In this work, then, Hippocrates appears to have had for his
object, to give such a general description of the phenomena of
disease as would apply to all the disorders of the animal frame. With
this intention he brings into review the state of the countenance, the
position of the patient in bed, the movements of the hands, the
respiration, the sweats, the state of the hypochondria, dropsies
which are the consequences of acute diseases, the sleep, the urine,
the alvine dejections, the vomitings, and the sputa. In doing this, his
uniform practice is to contrast the healthy with the morbid
appearances. Although M. Littré regards it as a treatise on special
Pathology, it appears to me to be decidedly a general work on
Semeiology. Certain it is that all the best commentators, such as
Erotian and Stephanus,[458] decidedly regard it as a semeiological
work. The class of ancient writings with which it admits of being
most closely compared, are the works on the prognostics of the
weather. On this subject Greek literature contains several works of a
very philosophical nature, such as the Phænomena of Aratus, and
several of the minor tracts of Theophrastus. Now as the object of
these authors was to connect the most striking phenomena in the
sky, the earth, and the sea, with the changes in the weather, of
which they are the precursors, so the intention of the medical writer
of Prognostics was to point out the alterations in the animal frame,
which certain preternatural symptoms usually indicate. And as the
utility of an acquaintance with prognostics of the weather to the
husbandman and sailor is sufficiently obvious, the benefit to be
derived from a knowledge of medical prognostics by the physician is
equally so. Our author, it will be seen in the Preface to this work,
enumerates three objects to be attained by cultivating an
acquaintance with prognostics; first, to attract the confidence of
one’s patients; second, to free the physician from blame by enabling
him to announce beforehand the issue of the disorder about which
he is consulted; and, third, to give him a decided advantage in
conducting the treatment by preparing him for remarkable changes
in the diseases before they occur. And, in like manner, I may be
allowed to remark, the master of a ship who shows himself prepared
for all changes of the weather, will naturally attract the confidence of
those intrusted to his charge; and whatever may be the result, he
will be freed from blame if his ship should be damaged in a storm
which he had previously predicted; and surely his knowledge of
impending commotions in the sea and sky, will be of advantage to
him by enabling him to make preparations for them.
 Looking then to the importance of general Prognostics, I have
often wondered why this branch of Semeiology is no longer
cultivated by the profession. Did not the ancient physicians follow
the best possible plan when they first described the general
phenomena of diseased action, and then applied them to particular
cases? Surely they did right in first taking a comprehensive view of
the whole subject of disease before attempting to examine the
different parts of it in detail. This, in fact, constitutes the great
superiority of the ancient savans over the modern, that the former
possessed a much greater talent for apprehending general truths
than the latter, who confine their attention to particular facts, and
too much neglect the observation of general appearances. I trust no
one will be offended if I venture to pronounce regarding the present
condition of our professional literature, that (to borrow an illustration
from the Logic of Kant) it is altogether Cyclopic,—that is to say, it
wants the eye of Philosophy, for, although we have learned to
examine particular objects with greater accuracy than our
forefathers did, the sphere of our mental vision, so to speak, is more
confined than theirs, and cannot embrace the same enlarged views
of general subjects. Surely then we might gain a useful lesson by
endeavoring to combine their more comprehensive views with our
own more accurate and minute observation.
Some people may be inclined to think that we have greatly
detracted from the credit which Hippocrates has long enjoyed as
being the undoubted author of this work, by showing that in
composing it he was so much indebted to the labors of his
predecessors. But I have long been impressed with the conviction
that in compositions even of the highest order, there is much less
originality than is generally supposed, and that true genius
frequently is displayed more in its own felicitous way of dealing with
materials formerly prepared and collected for its use than in
searching out new matter to work upon,[459] and hence it will be
found upon examination that many of the most distinguished efforts
of human intellect have consisted in the successful performance of
tasks which had been frequently attempted by previous laborers in
the same line. Many artists, before the time of Phidias, had acquired
reputation by their attempts at making the statue of Jupiter;[460] but
this did not deter him from undertaking the same task: and we may
well believe that he would avail himself of every practical lesson
which he could draw from the success or failure of his predecessors,
in perfecting that matchless performance which completely cast all
others into the background. The sad misfortunes of Œdipus had
been often represented on the Athenian stage before Sophocles
made them the subject of those inimitable dramas, which still enjoy
an unrivalled reputation, nor will it be often considered how much
assistance he may have derived from the labors of those who had
gone before him. It is well known that of all the literary
performances of Aristotle, there is no one which gained him so
enduring a reputation as his Categories, and yet it is admitted that
his division of the subject into the ten Predicaments, was taken from
the Pythagorean philosopher Archytas;[461] in short, the great merit
of Aristotle on this as on many other occasions, consisted in defining
and arranging a subject on which much had been previously effected
by the labors of his predecessors. And, to give one example more,
long before the time of Galen, the temperaments, and the facts in
physiology and pathology bearing upon Hygiene, had been
frequently and successfully investigated, but he, by recasting all
these subject-matters into his Ars Medica, composed a work which
posterity regarded as his master-performance, and every word and
tittle of which, for a succession ages, were commented upon and
admired in the Schools of Medicine. And of all our Author’s admired
performances, there is perhaps no one which has exerted so great
an influence upon the literature of the profession as the present
work, for all the Greek, Roman, and Arabian writers on medicine,
subsequent to him, make use of his terms, and copy his descriptions
of morbid phenomena.
THE BOOK OF PROGNOSTICS.

1. It appears to me a most excellent thing for the physician to

cultivate Prognosis; for by foreseeing and foretelling, in the presence
of the sick, the present, the past, and the future, and explaining the
omissions which patients have been guilty of,[462] he will be the
more readily believed to be acquainted with the circumstances of the
sick; so that men will have confidence to intrust themselves to such
a physician. And he will manage the cure best who has foreseen
what is to happen from the present state of matters. For it is
impossible to make all the sick well; this, indeed, would have been
better than to be able to foretell what is going to happen; but since
men die, some even before calling the physician, from the violence
of the disease, and some die immediately after calling him, having
lived, perhaps, only one day or a little longer, and before the
physician could bring his art to counteract the disease; it therefore
becomes necessary to know the nature of such affections, how far
they are above the powers of the constitution; and, moreover, if
there be anything divine in the diseases,[463] and to learn a
foreknowledge of this also. Thus a man will be the more esteemed
to be a good physician, for he will be the better able to treat those
aright who can be saved, from having long anticipated everything;
and by seeing and announcing beforehand those who will live and
those who will die, he will thus escape censure.[464]
2. He should observe thus in acute diseases: first, the
countenance of the patient, if it be like those of persons in health,
and more so, if like itself, for this is the best of all; whereas the most
opposite to it is the worst, such as the following; a sharp nose,
hollow eyes, collapsed temples; the ears cold, contracted, and their
lobes turned out: the skin about the forehead being rough,
distended, and parched; the color of the whole face being green,
black, livid, or lead-colored.[465] If the countenance be such at the
commencement of the disease, and if this cannot be accounted for
from the other symptoms, inquiry must be made whether the patient
has long wanted sleep; whether his bowels have been very loose;
and whether he has suffered from want of food; and if any of these
causes be confessed to, the danger is to be reckoned so far less;
and it becomes obvious, in the course of a day and a night, whether
or not the appearance of the countenance proceeded from these
causes.[466] But if none of these be said to exist, and if the
symptoms do not subside in the aforesaid time, it is to be known for
certain that death is at hand. And, also, if the disease be in a more
advanced stage either on the third or fourth day, and the
countenance be such, the same inquiries as formerly directed are to
be made, and the other symptoms are to be noted, those in the
whole countenance, those on the body, and those in the eyes; for if
they shun the light, or weep involuntarily, or squint, or if the one be
less than the other, or if the white of them be red, livid, or has black
veins in it; if there be a gum upon the eyes, if they are restless,
protruding, or are become very hollow; and if the countenance be
squalid and dark, or the color of the whole face be changed—all
these are to be reckoned bad and fatal symptoms. The physician
should also observe the appearance of the eyes from below the
eyelids in sleep; for when a portion of the white appears, owing to
the eyelids not being closed together, and when this is not
connected with diarrhœa or purgation from medicine, or when the
patient does not sleep thus from habit, it is to be reckoned an
unfavorable and very deadly symptom; but if the eyelid be
contracted, livid, or pale, or also the lip, or nose, along with some of
the other symptoms, one may know for certain that death is close at
hand. It is a mortal symptom, also, when the lips are relaxed,
pendent, cold, and blanched.
3.[467] It is well when the patient is found by his physician
reclining upon either his right or his left side, having his hands, neck,
and legs slightly bent, and the whole body lying in a relaxed state,
for thus the most of persons in health recline, and these are the best
of postures which most resemble those of healthy persons. But to lie
upon one’s back, with the hands, neck, and the legs extended, is far
less favorable. And if the patient incline forward, and sink down to
the foot of the bed, it is a still more dangerous symptom; but if he
be found with his feet naked and not sufficiently warm, and the
hands, neck, and legs tossed about in a disorderly manner and
naked, it is bad, for it indicates aberration of intellect. It is a deadly
symptom, also, when the patient sleeps constantly with his mouth
open, having his legs strongly bent and plaited together, while he
lies upon his back; and to lie upon one’s belly, when not habitual to
the patient to sleep thus while in good health, indicates delirium, or
pain in the abdominal regions. And for the patient to wish to sit
erect at the acme of a disease is a bad symptom in all acute
diseases, but particularly so in pneumonia.[468] To grind the teeth in
fevers, when such has not been the custom of the patient from
childhood, indicates madness and death, both which dangers are to
be announced beforehand as likely to happen; and if a person in
delirium do this it is a very deadly symptom. And if the patient had
an ulcer previously, or if one has occurred in the course of the
disease, it is to be observed; for if the man be about to die the sore
will become livid and dry, or yellow and dry before death.[469]
4. Respecting the movement of the hands I have these
observations to make: When in acute fevers, pneumonia, phrenitis,
or headache, the hands are waved before the face, hunting through
empty space, as if gathering bits of straw, picking the nap from the
coverlet, or tearing chaff from the wall—all such symptoms are bad
and deadly.[470]
5. Respiration, when frequent, indicates pain or inflammation in
the parts above the diaphragm: a large respiration performed at a
great interval announces delirium; but a cold respiration at nose or
mouth is a very fatal symptom. Free respiration is to be looked upon
as contributing much to the safety of the patient in all acute
diseases, such as fevers, and those complaints which come to a
crisis in forty days.[471]
6. Those sweats are the best in all acute diseases which occur on
the critical days, and completely carry off the fever. Those are
favorable, too, which taking place over the whole body, show that
the man is bearing the disease better. But those that do not produce
this effect are not beneficial. The worst are cold sweats, confined to
the head, face, and neck; these in an acute fever prognosticate