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Nimish Sanghi

Deep Reinforcement Learning with

Python
With PyTorch, TensorFlow and OpenAI Gym
1st ed.
Nimish Sanghi
Bangalore, India

Any source code or other supplementary material referenced by the

author in this book is available to readers on GitHub via the book’s
product page, located at www.​apress.​com/​978-1-4842-6808-7. For
more detailed information, please visit www.​apress.​com/​source-code.

ISBN 978-1-4842-6808-7 e-ISBN 978-1-4842-6809-4

https://doi.org/10.1007/978-1-4842-6809-4

© Nimish Sanghi 2021

Apress Standard

The use of general descriptive names, registered names, trademarks,

service marks, etc. in this publication does not imply, even in the
absence of a specific statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general
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The publisher, the authors and the editors are safe to assume that the
advice and information in this book are believed to be true and accurate
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editors give a warranty, expressed or implied, with respect to the
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Media New York, 1 New York Plaza, Suite 4600, New York, NY 10004-
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LLC is a California LLC and the sole member (owner) is Springer Science
+ Business Media Finance Inc (SSBM Finance Inc). SSBM Finance Inc is a
Delaware corporation.
This book is dedicated to my wife Suman and children, Harsh and Yash,
who allowed their time to be stolen for writing this book.
Introduction
This book is about reinforcement learning and takes you from the basics
through advanced topics. Though this book assumes no prior knowledge
of the field of reinforcement learning, it expects you to be familiar with
the basics of machine learning and specifically supervised learning.
Have you coded in Python before? Are you comfortable working with
libraries such as NumPy and scikit-learn? Have you heard of deep
learning and explored basic build blocks of training simple models in
PyTorch or TensorFlow? You should answer yes to all of these questions
to get the best out of this book. If not, I suggest you review these
concepts first; reviewing any introductory online tutorial or book from
Apress on these topics would be sufficient.
This book walks you through the basics of reinforcement learning,
spending lot of time explaining the concepts in initial chapters. If you
have prior knowledge of reinforcement learning, you can go through the
first four chapters at a fast pace. Starting in Chapter 5, the book picks up
the pace as it starts exploring advanced topics that combine deep
learning with reinforcement learning. The accompanying code hosted on
GitHub forms an integral part of this book. While the book includes
listings of the relevant code, Jupyter notebooks in the code repository
provide additional insights and practical tips on coding these
algorithms. You will be best served by reading the chapter and going
through the explanations first and then working through the code in
Jupyter notebooks. You are also encouraged to try to rewrite the code,
training agents for different additional environments found in the
OpenAI Gym library.
For a subject like this, math is unavoidable. However, we have tried
our best to keep it minimal. The book quotes a lot of research papers
that give short explanations of the approach taken. Readers wanting to
gain a deeper understanding of the theory should go through these
research papers. This book’s purpose is to introduce practitioners to the
motivation and high-level approach behind many of the latest
techniques in this field. However, by no means is it meant to provide a
complete theoretical understanding of these techniques, which is best
gained by reading the original papers.
The book is organized into ten chapters.
 Chapter 1, “Introduction to Deep Reinforcement Learning,”
introduces the topic, setting the background and motivating readers
with real-world examples of how reinforcement learning is changing the
landscape of intelligent machines. It also covers the installation of
Python and related libraries so you can run the code accompanying this
book.
Chapter 2, “Markov Decision Processes,” defines the problem in
detail that we are trying to solve in the field of reinforcement learning.
We talk about the agent and environment. We go in depth about what
constitutes a reward, value functions, model, and policy. We look at
various flavors of Markov processes. We establish the equations by
Richard Bellman as part of dynamic programming.
Chapter 3, “Model-Based Algorithms,” focuses on the setup for a
model and how the agent plans its action for optimal outcome. We also
explore the OpenAI Gym environment library, which implements many
of the common environments that we will use for coding and testing
algorithms throughout the book. Finally, we explore “value” and “policy
iteration” approaches to planning.
Chapter 4, “Model-Free Approaches,” talks about the model-free
learning methods. Under this setup, the agent has no knowledge of the
environment/model. It interacts with the environment and uses the
rewards to learn an optimal policy through a trial-and-error approach.
We specifically look at the Monte Carlo (MC) approach and the temporal
difference (TD) approach to learning. We first study them individually
and then combine the two under the concept of n-step returns and
eligibility traces.
Chapter 5, “Function Approximation,” looks at setups in which the
state of the system changes from being discrete (as will be the case until
Chapter 4) to being continuous. We study how to use parameterized
functions to represent the state and bring scalability. First, we talk about
the traditional approach of handcrafted function approximation,
especially the linear approximators. Then, we introduce the concept of
using a deep learning–based model as nonlinear function
approximators.
Chapter 6, “Deep Q-Learning,” dives deep into DeepMind to
successfully demonstrate how to use deep learning and reinforcement
learning together to design agents that can learn to play video games
such as Atari games. In this chapter, we explore how DQN works and
what tweaks are required to make it learn. We then survey the various
flavors of DQN, complete with detailed code examples, both in PyTorch
and TensorFlow.
Chapter 7, “Policy Gradient Algorithms,” switches focus to explore
the approach of learning a good policy directly in a model-free setup.
The approaches in the preceding chapters are based on first learning
value functions and then using these value functions to optimize the
policy. In this chapter, we first talk about the theoretical foundations of
the direct policy optimization approach. After establishing the
foundations, we discuss various approaches including some very recent
and highly successful algorithms, complete with implementations in
PyTorch and TensorFlow.
Chapter 8, “Combining Policy Gradients and Q-Learning,” as the
name suggests, covers how to combine the value-based DQN and policy
gradients methods to leverage the advantages of both the approaches. It
also enables us to design agents that can operate in continuous action
spaces, which is not easily feasible under approaches until Chapter 7.
We specifically look at three popular ones: deep deterministic policy
gradients (DDPG), twin delayed DDPG (TD3), and soft actor critic (SAC).
Like before, we have comprehensive implementations in PyTorch and
TensorFlow to help readers master the subject.
Chapter 9, “Integrated Planning and Learning,” is all about combining
the model-based approach from Chapter 3 and model-free approach
from Chapters 4 to 8. We explore the general framework under which
such integrations can be made possible. Finally, we explain Monte Carlo
tree search (MCTS) and how it was used to train AlphaGo, which could
beat champion Go players.
Chapter 10, “Further Exploration and Next Steps,” surveys various
other extensions of reinforcement learning, including concepts such as
scalable model-based approaches, imitation and inverse learning,
derivative-free methods, transfer and multitask learning, as well as meta
learning. The coverage here is from 30,000 feet to expose readers to new
and related concepts without getting lost in the details. We conclude by
talking about the way you should continue to explore and learn beyond
what is covered in this book.
Acknowledgments
I would like to thank the team at Apress, especially editors James
Markham, Aditee Mirashi, and Celestin John who believed in me and
helped me refine the drafts with numerous valuable suggestions. I
would like to thank technical reviewer Akshay Kulkarni who reviewed
the drafts for its correctness, checked my code, and helped me improve
the readability of the book. I would also like to thank everyone else at
Apress who played a role in making this book a reality.
I would like to thank my wife Suman who, during the pandemic time
when this was written, single-handedly took charge of keeping the
family healthy, giving me space, and giving me time to write this book.
Lastly, I would like to thank you, the reader, who has decided to
invest valuable time reading this book. Please provide your feedback,
letting me know if this book met your expectations and what could be
better. Nothing would make me happier than knowing that I was able to
play a role in expanding your knowledge. I can be reached at
nimish.sanghi@gmail.com.
Table of Contents
Chapter 1:​Introduction to Reinforcement Learning
Reinforcement Learning
Machine Learning Branches
Supervised Learning
Unsupervised Learning
Reinforcement Learning
Core Elements
Deep Learning with Reinforcement Learning
Examples and Case Studies
Autonomous Vehicles
Robots
Recommendation Systems
Finance and Trading
Healthcare
Game Playing
Libraries and Environment Setup
Alternate Way to Install Local Environment
Summary
Chapter 2:​Markov Decision Processes
Definition of Reinforcement Learning
Agent and Environment
Rewards
Markov Processes
Markov Chains
Markov Reward Processes
 Markov Decision Processes
Policies and Value Functions
Bellman Equations
Optimality Bellman Equations
Types of Solution Approaches with a Mind-Map
Summary
Chapter 3:​Model-Based Algorithms
OpenAI Gym
Dynamic Programming
Policy Evaluation/​Prediction
Policy Improvement and Iterations
Value Iteration
Generalized Policy Iteration
Asynchronous Backups
Summary
Chapter 4:​Model-Free Approaches
Estimation/​Prediction with Monte Carlo
Bias and Variance of MC Predication Methods
Control with Monte Carlo
Off-Policy MC Control
Temporal Difference Learning Methods
Temporal Difference Control
On-Policy SARSA
Q-Learning:​An Off-Policy TD Control
Maximization Bias and Double Learning
Expected SARSA Control
 Replay Buffer and Off-Policy Learning
Q-Learning for Continuous State Spaces
n-Step Returns
Eligibility Traces and TD(λ)
Relationships Between DP, MC, and TD
Summary
Chapter 5:​Function Approximation
Introduction
Theory of Approximation
Coarse Coding
Tile Encoding
Challenges in Approximation
Incremental Prediction:​MC, TD, TD(λ)
Incremental Control
Semi-gradient N-step SARSA Control
Semi-gradient SARSA(λ) Control
Convergence in Functional Approximation
Gradient Temporal Difference Learning
Batch Methods (DQN)
Linear Least Squares Method
Deep Learning Libraries
Summary
Chapter 6:​Deep Q-Learning
Deep Q Networks
Atari Game-Playing Agent Using DQN
Prioritized Replay
 Double Q-Learning
Dueling DQN
NoisyNets DQN
Categorical 51-Atom DQN (C51)
Quantile Regression DQN
Hindsight Experience Replay
Summary
Chapter 7:​Policy Gradient Algorithms
Introduction
Pros and Cons of Policy-Based Methods
Policy Representation
Policy Gradient Derivation
Objective Function
Derivative Update Rule
Intuition Behind the Update Rule
REINFORCE Algorithm
Variance Reduction with Reward to Go
Further Variance Reduction with Baselines
Actor-Critic Methods
Defining Advantage
Advantage Actor Critic
Implementation of the A2C Algorithm
Asynchronous Advantage Actor Critic
Trust Region Policy Optimization Algorithm
Proximal Policy Optimization Algorithm
Summary
Chapter 8:​Combining Policy Gradient and Q-Learning
Trade-Offs in Policy Gradient and Q-Learning
General Framework to Combine Policy Gradient with Q-
Learning
Deep Deterministic Policy Gradient
Q-Learning in DDPG (Critic)
Policy Learning in DDPG (Actor)
Pseudocode and Implementation
Code Listing
Twin Delayed DDPG
Target-Policy Smoothing
Q-Loss (Critic)
Policy Loss (Actor)
Delayed Update
Pseudocode and Implementation
Code Implementation
Reparameterizati​on Trick
Score/​Reinforce Way
Reparameterizati​on Trick and Pathwise Derivatives
Experiment
Entropy Explained
Soft Actor Critic
SAC vs.​TD3
Q-Loss with Entropy-Regularization
Policy Loss with Reparameterizati​on Trick
Pseudocode and Implementation
Code Implementation
 Summary
Chapter 9:​Integrated Planning and Learning
Model-Based Reinforcement Learning
Planning with a Learned Model
Integrating Learning and Planning (Dyna)
Dyna Q and Changing Environments
Dyna Q+
Expected vs.​Sample Updates
Exploration vs.​Exploitation
Multi-arm Bandit
Regret:​Measure of Quality of Exploration
Planning at Decision Time and Monte Carlo Tree Search
AlphaGo Walk-Through
Summary
Chapter 10:​Further Exploration and Next Steps
Model-Based RL:​Additional Approaches
World Models
Imagination-Augmented Agents (I2A)
Model-Based RL with Model-Free Fine-Tuning (MBMF)
Model-Based Value Expansion (MBVE)
Imitation Learning and Inverse Reinforcement Learning
Derivative-Free Methods
Transfer Learning and Multitask Learning
Meta-Learning
Popular RL Libraries
How to Continue Studying
Another Random Scribd Document
with Unrelated Content
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 death, or
in a milder one, a prolongation of the disease; and sweats which
occur over the whole body, with the characters of those confined to
the neck, are in like manner bad. Sweats attended with a miliary
eruption, and taking place about the neck, are bad; sweats in the
form of drops and of vapour are good. One ought to know the entire
character of sweats, for some are connected with prostration of
strength in the body, and some with intensity of the inflammation.[472]
7.[473] That state of the hypochondrium is best when it is free
from pain, soft, and of equal size on the right side and the left. But if
inflamed, or painful, or distended; or when the right and left sides are
of disproportionate sizes;—all these appearances are to be dreaded.
And if there be also pulsation in the hypochondrium, it indicates
perturbation or delirium; and the physician should examine the eyes
of such persons; for if their pupils be in rapid motion, such persons
may be expected to go mad. A swelling in the hypochondrium, that is
hard and painful, is very bad, provided it occupy the whole
hypochondrium; but if it be on either side, it is less dangerous when
on the left. Such swellings at the commencement of the disease
prognosticate speedy death; but if the fever has passed twenty days,
and the swelling has not subsided, it turns to a suppuration.[474] A
discharge of blood from the nose occurs to such in the first period,
and proves very useful; but inquiry should be made if they have
headache or indistinct vision; for if there be such, the disease will be
determined thither. The discharge of blood is rather to be expected in
those who are younger than thirty-five years. Such swellings as are
soft, free from pain, and yield to the finger, occasion more protracted
crises, and are less dangerous than the others. But if the fever
continue beyond sixty days, without any subsidence of the swelling,
it indicates that empyema is about to take place; and a swelling in
any other part of the cavity will terminate in like manner. Such, then,
as are painful, hard, and large, indicate danger of speedy death; but
such as are soft, free of pain, and yield when pressed with the finger,
are more chronic than these. Swellings in the belly less frequently
form abscesses than those in the hypochondrium; and seldomest of
all, those below the navel are converted into suppuration; but you
may rather expect a hemorrhage from the upper parts. But the
suppuration of all protracted swellings about these parts is to be
anticipated. The collections of matter there are to be thus judged of:
such as are determined outwards are the best when they are small,
when they protrude very much, and swell to a point; such as are
large and broad, and which do not swell out to a sharp point, are the
worst. Of such as break internally, the best are those which have no
external communication, but are covered and indolent; and when the
whole place is free from discoloration. That pus is best which is
white, homogeneous, smooth, and not at all fetid; the contrary to this
is the worst.
8.[475] All dropsies arising from acute diseases are bad; for they
do not remove the fever, and are very painful and fatal. The most of
them commence from the flanks and loins, but some from the liver;
in those which derive their origin from the flanks and loins the feet
swell, protracted diarrhœas supervene, which neither remove the
pains in the flanks and loins, nor soften the belly;[476] but in dropsies
which are connected with the liver there is a tickling cough, with
scarcely any perceptible expectoration, and the feet swell; there are
no evacuations from the bowels, unless such as are hard and forced;
and there are swellings about the belly, sometimes on the one side
and sometimes on the other, and these increase and diminish by
turns.[477]
 9. It is a bad symptom when the head, hands, and feet are cold,
while the belly and sides are hot; but it is a very good symptom when
the whole body is equally hot.[478] The patient ought to be able to
turn round easily, and to be agile when raised up; but if he appear
heavy in the rest of his body as well as in his hands and feet, it is
more dangerous; and if, in addition to the weight, his nails and
fingers become livid, immediate death may be anticipated; and if the
hands and feet be black it is less dangerous than if they be livid, but
the other symptoms must be attended to; for if he appear to bear the
illness well, and if certain of the salutary symptoms appear along
with these there may be hope that the disease will turn to a
deposition, so that the man may recover; but the blackened parts of
the body will drop off. When the testicles and members are retracted
upwards, they indicate strong pains and danger of death.[479]
10. With regard to sleep—as is usual with us in health, the patient
should wake during the day and sleep during the night. If this rule be
anywise altered it is so far worse: but there will be little harm
provided he sleep in the morning for the third part of the day; such
sleep as takes place after this time is more unfavorable; but the
worst of all is to get no sleep either night or day; for it follows from
this symptom that the insomnolency is connected with sorrow and
pains, or that he is about to become delirious.[480]
11. The excrement is best which is soft and consistent, is passed
at the hour which was customary to the patient when in health, in
quantity proportionate to the ingesta; for when the passages are
such, the lower belly is in a healthy state.[481] But if the discharges
be fluid, it is favorable that they are not accompanied with a noise,
nor are frequent, nor in great quantity; for the man being oppressed
by frequently getting up, must be deprived of sleep; and if the
evacuations be both frequent and large, there is danger of his falling
into deliquium animi.[482] But in proportion to the ingesta he should
have evacuations twice or thrice in the day, once at night and more
copiously in the morning, as is customary with a person in health.
The fæces should become thicker when the disease is tending to a
crisis; they ought to be yellowish and not very fetid. It is favorable