From acb5670e93f6b0926c0f20857c72360fa27c0cf6 Mon Sep 17 00:00:00 2001 From: lcerrato Date: Mon, 18 Nov 2024 14:39:05 -0500 Subject: [PATCH] (grc_conversion) EpiDoc and CTS conversion tlg0627 batch #1399 --- data/tlg0627/tlg001/__cts__.xml | 13 +- .../tlg001/tlg0627.tlg001.perseus-eng1.xml | 742 ++------------ .../tlg0627.tlg001.perseus-eng2.unicode.xml | 151 +++ .../tlg001/tlg0627.tlg001.perseus-eng2.xml | 903 +++--------------- .../tlg001/tlg0627.tlg001.perseus-eng3.xml | 133 +++ .../tlg001/tlg0627.tlg001.perseus-eng4.xml | 151 +++ .../tlg001/tlg0627.tlg001.perseus-grc2.xml | 2 +- 7 files changed, 667 insertions(+), 1428 deletions(-) create mode 100644 data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng2.unicode.xml create mode 100644 data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng3.xml create mode 100644 data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng4.xml diff --git a/data/tlg0627/tlg001/__cts__.xml b/data/tlg0627/tlg001/__cts__.xml index 5b2663456..93f41e1aa 100644 --- a/data/tlg0627/tlg001/__cts__.xml +++ b/data/tlg0627/tlg001/__cts__.xml @@ -3,6 +3,17 @@ Περὶ ἀρχαίας ἰατρικῆς - Hippocrates, Vol. 1. Jones, William Henry Samuel, editor. London: William Heinemann Ltd.; Cambridge, MA: Harvard University Press, 1923. + Hippocrates, Vol. 1. Jones, William Henry Samuel, editor. London: William Heinemann Ltd.; Cambridge, MA: Harvard University Press, 1923 (printing). + + + On Ancient Medicine + Hippocrates, The Genuine Works of Hippocrates, Vol. 1. Adams, Francis, translator. New York: William Wood and Company, 1886. + + + + Ancient Medicine + Hippocrates, Vol. 1. Jones, William Henry Samuel, translator. London: William Heinemann Ltd.; Cambridge, MA: Harvard University Press, 1923 (printing). + + diff --git a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng1.xml b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng1.xml index 403d5041f..8641715f4 100644 --- a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng1.xml +++ b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng1.xml @@ -1,675 +1,133 @@ + - + - On Ancient Medicine + On Ancient Medicine Hippocrates Francis Adams + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + National Library of Medicine History of Medicine Division - Cultural Heritage Langauge Technologies + Cultural Heritage Language Technologies Kansas City Missouri - February 20, 2003 + February 20, 2003 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0627.tlg001.perseus-eng3.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + - The Genuine Works of Hippocrates - Hippocrates - Francis Adams - - New York - William Wood & Company - 1886 - + The Genuine Works of Hippocrates + Hippocrates + Francis Adams + + New York + William Wood and Company + 1886 + + 1 + Internet Archive + -

Data Entry

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This pointer pattern extracts section.

+ - English + English + + + CTS and EpiDoc conversion. + - - -
- PART 1 -

Whoever having undertaken to speak or write on Medicine, have first laid down for - themselves some hypothesis to their argument, such as hot, or cold, or moist, or - dry, or whatever else they choose (thus reducing their subject within a narrow - compass, and supposing only one or two original causes of diseases or of death - among mankind), are all clearly mistaken in much that they say; and this is the - more reprehensible as relating to an art which all men avail themselves of on - the most important occasions, and the good operators and practitioners in which - they hold in especial honor. For there are practitioners, some bad and some far - otherwise, which, if there had been no such thing as Medicine, and if nothing - had been investigated or found out in it, would not have been the case, but all - would have been equally unskilled and ignorant of it, and everything concerning - the sick would have been directed by chance. But now it is not so; for, as in - all the other arts, those who practise them differ much from one another in - dexterity and knowledge, so is it in like manner with Medicine. Wherefore I have - not thought that it stood in need of an empty hypothesis, like those subjects - which are occult and dubious, in attempting to handle which it is necessary to - use some hypothesis; as, for example, with regard to things above us and things - below the earth; if any one should treat of these and undertake to declare how - they are constituted, the reader or hearer could not find out, whether what is - delivered be true or false; for there is nothing which can be referred to in - order to discover the truth.

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- PART 2 -

But all these requisites belong of old to Medicine, and an origin and way have - been found out, by which many and elegant discoveries have been - made, during a length of time, and others will yet be found out, if a person - possessed of the proper ability, and knowing those discoveries which have been - made, should proceed from them to prosecute his investigations. But whoever, - rejecting and despising all these, attempts to pursue another course and form of - inquiry, and says he has discovered anything, is deceived himself and deceives - others, for the thing is impossible. And for what reason it is impossible, I - will now endeavor to explain, by stating and showing what the art really is. - From this it will be manifest that discoveries cannot possibly be made in any - other way. And most especially, it appears to me, that whoever treats of this - art should treat of things which are familiar to the common people. For of - nothing else will such a one have to inquire or treat, but of the diseases under - which the common people have labored, which diseases and the causes of their - origin and departure, their increase and decline, illiterate persons cannot - easily find out themselves, but still it is easy for them to understand these - things when discovered and expounded by others. For it is nothing more than that - every one is put in mind of what had occurred to himself. But whoever does not - reach the capacity of the illiterate vulgar and fails to make them listen to - him, misses his mark. Wherefore, then, there is no necessity for any hypothesis. -

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- PART 3 -

For the art of Medicine would not have been invented at first, nor would it have - been made a subject of investigation (for there would have been no need of it), - if when men are indisposed, the same food and other articles of regimen which - they eat and drink when in good health were proper for them, and if no others - were preferable to these. But now necessity itself made medicine to be sought - out and discovered by men, since the same things when administered to the sick, - which agreed with them when in good health, neither did nor do agree with them. - But to go still further back, I hold that the diet and food which people in - health now use would not have been discovered, provided it had suited with man - to eat and drink in like manner as the ox, the horse, and all other animals, - except man, do of the productions of the earth, such as fruits, weeds, and - grass; for from such things these animals grow, live free of - disease, and require no other kind of food. And, at first, I am of opinion that - man used the same sort of food, and that the present articles of diet had been - discovered and invented only after a long lapse of time, for when they suffered - much and severely from strong and brutish diet, swallowing things which were - raw, unmixed, and possessing great strength, they became exposed to strong pains - and diseases, and to early deaths. It is likely, indeed, that from habit they - would suffer less from these things then than we would now, but still they would - suffer severely even then; and it is likely that the greater number, and those - who had weaker constitutions, would all perish; whereas the stronger would hold - out for a longer time, as even nowadays some, in consequence of using strong - articles of food, get off with little trouble, but others with much pain and - suffering. From this necessity it appears to me that they would search out the - food befitting their nature, and thus discover that which we now use: and that - from wheat, by macerating it, stripping it of its hull, grinding it all down, - sifting, toasting, and baking it, they formed bread; and from barley they formed - cake (maza), performing many operations in regard to it; they boiled, they - roasted, they mixed, they diluted those things which are strong and of intense - qualities with weaker things, fashioning them to the nature and powers of man, - and considering that the stronger things Nature would not be able to manage if - administered, and that from such things pains, diseases, and death would arise, - but such as Nature could manage, that from them food, growth, and health, would - arise. To such a discovery and investigation what more suitable name could one - give than that of Medicine? since it was discovered for the health of man, for - his nourishment and safety, as a substitute for that kind of diet by which - pains, diseases, and deaths were occasioned.

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- PART 4 -

And if this is not held to be an art, I do not object. For it is not suitable to - call any one an artist of that which no one is ignorant of, but which all know - from usage and necessity. But still the discovery is a great one, and requiring - much art and investigation. Wherefore those who devote themselves to gymnastics - and training, are always making some new discovery, by pursuing the - same line of inquiry, where, by eating and drinking certain things, they are - improved and grow stronger than they were.

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- PART 5 -

Let us inquire then regarding what is admitted to be Medicine; namely, that which - was invented for the sake of the sick, which possesses a name and practitioners, - whether it also seeks to accomplish the same objects, and whence it derived its - origin. To me, then, it appears, as I said at the commencement, that nobody - would have sought for medicine at all, provided the same kinds of diet had - suited with men in sickness as in good health. Wherefore, even yet, such races - of men as make no use of medicine, namely, barbarians, and even certain of the - Greeks, live in the same way when sick as when in health; that is to say, they - take what suits their appetite, and neither abstain from, nor restrict - themselves in anything for which they have a desire. But those who have - cultivated and invented medicine, having the same object in view as those of - whom I formerly spoke, in the first place, I suppose, diminished the quantity of - the articles of food which they used, and this alone would be sufficient for - certain of the sick, and be manifestly beneficial to them, although not to all, - for there would be some so affected as not to be able to manage even small - quantities of their usual food, and as such persons would seem to require - something weaker, they invented soups, by mixing a few strong things with much - water, and thus abstracting that which was strong in them by dilution and - boiling. But such as could not manage even soups, laid them aside, and had - recourse to drinks, and so regulated them as to mixture and quantity, that they - were administered neither stronger nor weaker than what was required.

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- PART 6 -

But this ought to be well known, that soups do not agree with certain persons in - their diseases, but, on the contrary, when administered both the fevers and the - pains are exacerbated, and it becomes obvious that what was given has proved - food and increase to the disease, but a wasting and weakness to the body. But - whatever persons so affected partook of solid food, or cake, or bread, even in - small quantity, would be ten times and more decidedly injured than those who had - taken soups, for no other reason than from the strength of the food - in reference to the affection; and to whomsoever it is proper to take soups and - not eat solid food, such a one will be much more injured if he eat much than if - he eat little, but even little food will be injurious to him. But all the causes - of the sufferance refer themselves to this rule, that the strongest things most - especially and decidedly hurt man, whether in health or in disease.

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- PART 7 -

What other object, then, had he in view who is called a physician, and is - admitted to be a practitioner of the art, who found out the regimen and diet - befitting the sick, than he who originally found out and prepared for all - mankind that kind of food which we all now use, in place of the former savage - and brutish mode of living? To me it appears that the mode is the same, and the - discovery of a similar nature. The one sought to abstract those things which the - constitution of man cannot digest, because of their wildness and intemperature, - and the other those things which are beyond the powers of the affection in which - any one may happen to be laid up. Now, how does the one differ from the other, - except that the latter admits of greater variety, and requires more application, - whereas the former was the commencement of the process?

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- PART 8 -

And if one would compare the diet of sick persons with that of persons in health, - he will find it not more injurious than that of healthy persons in comparison - with that of wild beasts and of other animals. For, suppose a man laboring under - one of those diseases which are neither serious and unsupportable, nor yet - altogether mild, but such as that, upon making any mistake in diet, it will - become apparent, as if he should eat bread and flesh, or any other of those - articles which prove beneficial to healthy persons, and that, too, not in great - quantity, but much less than he could have taken when in good health; and that - another man in good health, having a constitution neither very feeble, nor yet - strong, eats of those things which are wholesome and strengthening to an ox or a - horse, such as vetches, barley, and the like, and that, too, not in great - quantity, but much less than he could take; the healthy person who did so would - be subjected to no less disturbance and danger than the sick person who took - bread or cake unseasonably. All these things are proofs that - Medicine is to be prosecuted and discovered by the same method as the other. -

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- PART 9 -

And if it were simply, as is laid down, that such things as are stronger prove - injurious, but such as are weaker prove beneficial and nourishing, both to sick - and healthy persons, it were an easy matter, for then the safest rule would be - to circumscribe the diet to the lowest point. But then it is no less mistake, - nor one that injuries a man less, provided a deficient diet, or one consisting - of weaker things than what are proper, be administered. For, in the constitution - of man, abstinence may enervate, weaken, and kill. And there are many other - ills, different from those of repletion, but no less dreadful, arising from - deficiency of food; wherefore the practice in those cases is more varied, and - requires greater accuracy. For one must aim at attaining a certain measure, and - yet this measure admits neither weight nor calculation of any kind, by which it - may be accurately determined, unless it be the sensation of the body; wherefore - it is a task to learn this accurately, so as not to commit small blunders either - on the one side or the other, and in fact I would give great praise to the - physician whose mistakes are small, for perfect accuracy is seldom to be seen, - since many physicians seem to me to be in the same plight as bad pilots, who, if - they commit mistakes while conducting the ship in a calm do not expose - themselves, but when a storm and violent hurricane overtake them, they then, - from their ignorance and mistakes, are discovered to be what they are, by all - men, namely, in losing their ship. And thus bad and commonplace physicians, when - they treat men who have no serious illness, in which case one may commit great - mistakes without producing any formidable mischief (and such complaints occur - much more frequently to men than dangerous ones): under these circumstances, - when they commit mistakes, they do not expose themselves to ordinary men; but - when they fall in with a great, a strong, and a dangerous disease, then their - mistakes and want of skill are made apparent to all. Their punishment is not far - off, but is swift in overtaking both the one and the other.He means both - the pilot and physician. -

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- PART 10 -

And that no less mischief happens to a man from unseasonable depletion than from - repletion, may be clearly seen upon reverting to the consideration of persons in - health. For, to some, with whom it agrees to take only one meal in the day, and - they have arranged it so accordingly; whilst others, for the same reason, also - take dinner, and this they do because they find it good for them, and not like - those persons who, for pleasure or from any casual circumstance, adopt the one - or the other custom and to the bulk of mankind it is of little consequence which - of these rules they observe, that is to say, whether they make it a practice to - take one or two meals. But there are certain persons who cannot readily change - their diet with impunity; and if they make any alteration in it for one day, or - even for a part of a day, are greatly injured thereby. Such persons, provided - they take dinner when it is not their wont, immediately become heavy and - inactive, both in body and mind, and are weighed down with yawning, slumbering, - and thirst; and if they take supper in addition, they are seized with - flatulence, tormina, and diarrhea, and to many this has been the commencement of - a serious disease, when they have merely taken twice in a day the same food - which they have been in the custom of taking once. And thus, also, if one who - has been accustomed to dine, and this rule agrees with him, should not dine at - the accustomed hour, he will straightway feel great loss of strength, trembling, - and want of spirits, the eyes of such a person will become more pallid, his - urine thick and hot, his mouth bitter; his bowels will seem, as it were, to hang - loose; he will suffer from vertigo, lowness of spirit, and inactivity,- such are - the effects; and if he should attempt to take at supper the same food which he - was wont to partake of at dinner, it will appear insipid, and he will not be - able to take it off; and these things, passing downwards with tormina and - rumbling, burn up his bowels; he experiences insomnolency or troubled and - disturbed dreams; and to many of them these symptoms are the commencement of - some disease.

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- PART 11 -

But let us inquire what are the causes of these things which happened to them. To - him, then, who was accustomed to take only one meal in the day, they happened - because he did not wait the proper time, until his bowels had - completely derived benefit from and had digested the articles taken at the - preceding meal, and until his belly had become soft, and got into a state of - rest, but he gave it a new supply while in a state of heat and fermentation, for - such bellies digest much more slowly, and require more rest and ease. And as to - him who had been accustomed to dinner, since, as soon as the body required food, - and when the former meal was consumed, and he wanted refreshment, no new supply - was furnished to it, he wastes and is consumed from want of food. For all the - symptoms which I describe as befalling to this man I refer to want of food. And - I also say that all men who, when in a state of health, remain for two or three - days without food, experience the same unpleasant symptoms as those which I - described in the case of him who had omitted to take dinner.

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- PART 12 -

Wherefore, I say, that such constitutions as suffer quickly and strongly from - errors in diet, are weaker than others that do not; and that a weak person is in - a state very nearly approaching to one in disease; but a person in disease is - the weaker, and it is, therefore, more likely that he should suffer if he - encounters anything that is unseasonable. It is difficult, seeing that there is - no such accuracy in the Art, to hit always upon what is most expedient, and yet - many cases occur in medicine which would require this accuracy, as we shall - explain. But on that account, I say, we ought not to reject the ancient Art, as - if it were not, and had not been properly founded, because it did not attain - accuracy in all things, but rather, since it is capable of reaching to the - greatest exactitude by reasoning, to receive it and admire its discoveries, made - from a state of great ignorance, and as having been well and properly made, and - not from chance.

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- PART 13 -

But I wish the discourse to revert to the new method of those who prosecute their - inquiries in the Art by hypothesis. For if hot, or cold, or moist, or dry, be - that which proves injurious to man, and if the person who would treat him - properly must apply cold to the hot, hot to the cold, moist to the dry, and dry - to the moist- let me be presented with a man, not indeed one of a strong - constitution, but one of the weaker, and let him eat wheat, such as - it is supplied from the thrashing-floor, raw and unprepared, with raw meat, and - let him drink water. By using such a diet I know that he will suffer much and - severely, for he will experience pains, his body will become weak, and his - bowels deranged, and he will not subsist long. What remedy, then, is to be - provided for one so situated? Hot? or cold? or moist? or dry? For it is clear - that it must be one or other of these. For, according to this principle, if it - is one of the which is injuring the patient, it is to be removed by its - contrary. But the surest and most obvious remedy is to change the diet which the - person used, and instead of wheat to give bread, and instead of raw flesh, - boiled, and to drink wine in addition to these; for by making these changes it - is impossible but that he must get better, unless completely disorganized by - time and diet. What, then, shall we say? whether that, as he suffered from cold, - these hot things being applied were of use to him, or the contrary? I should - think this question must prove a puzzler to whomsoever it is put. For whether - did he who prepared bread out of wheat remove the hot, the cold, the moist, or - the dry principle in it?- for the bread is consigned both to fire and to water, - and is wrought with many things, each of which has its peculiar property and - nature, some of which it loses, and with others it is diluted and mixed.

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- PART 14 -

And this I know, moreover, that to the human body it makes a great difference - whether the bread be fine or coarse; of wheat with or without the hull, whether - mixed with much or little water, strongly wrought or scarcely at all, baked or - raw- and a multitude of similar differences; and so, in like manner, with the - cake (maza); the powers of each, too, are great, and the one nowise like the - other. Whoever pays no attention to these things, or, paying attention, does not - comprehend them, how can he understand the diseases which befall a man? For, by - every one of these things, a man is affected and changed this way or that, and - the whole of his life is subjected to them, whether in health, convalescence, or - disease. Nothing else, then, can be more important or more necessary to know - than these things. So that the first inventors, pursuing their investigations - properly, and by a suitable train of reasoning, according to the nature of man, made their discoveries, and thought the Art worthy of being - ascribed to a god, as is the established belief. For they did not suppose that - the dry or the moist, the hot or the cold, or any of these are either injurious - to man, or that man stands in need of them, but whatever in each was strong, and - more than a match for a man's constitution, whatever he could not manage, that - they held to be hurtful, and sought to remove. Now, of the sweet, the strongest - is that which is intensely sweet; of the bitter, that which is intensely bitter; - of the acid, that which is intensely acid; and of all things that which is - extreme, for these things they saw both existing in man, and proving injurious - to him. For there is in man the bitter and the salt, the sweet and the acid, the - sour and the insipid, and a multitude of other things having all sorts of powers - both as regards quantity and strength. These, when all mixed and mingled up with - one another, are not apparent, neither do they hurt a man; but when any of them - is separate, and stands by itself, then it becomes perceptible, and hurts a man. - And thus, of articles of food, those which are unsuitable and hurtful to man - when administered, every one is either bitter, or intensely so, or saltish or - acid, or something else intense and strong, and therefore we are disordered by - them in like manner as we are by the secretions in the body. But all those - things which a man eats and drinks are devoid of any such intense and - well-marked quality, such as bread, cake, and many other things of a similar - nature which man is accustomed to use for food, with the exception of condiments - and confectioneries, which are made to gratify the palate and for luxury. And - from those things, when received into the body abundantly, there is no disorder - nor dissolution of the powers belonging to the body; but strength, growth, and - nourishment result from them, and this for no other reason than because they are - well mixed, have nothing in them of an immoderate character, nor anything - strong, but the whole forms one simple and not strong substance.

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- PART 15 -

I cannot think in what manner they who advance this doctrine, and transfer Art - from the cause I have described to hypothesis, will cure men according to the - principle which they have laid down. For, as far as I know, neither the hot nor - the cold, nor the dry, nor the moist, has ever been found unmixed - with any other quality; but I suppose they use the same articles of meat and - drink as all we other men do. But to this substance they give the attribute of - being hot, to that cold, to that dry, and to that moist. Since it would be - absurd to advise the patient to take something hot, for he would straightway ask - what it is? so that he must either play the fool, or have recourse to some one - of the well known substances; and if this hot thing happen to be sour, and that - hot thing insipid, and this hot thing has the power of raising a disturbance in - the body (and there are many other kinds of heat, possessing many opposite - powers), he will be obliged to administer some one of them, either the hot and - the sour, or the hot and the insipid, or that which, at the same time, is cold - and sour (for there is such a substance), or the cold and the insipid. For, as I - think, the very opposite effects will result from either of these, not only in - man, but also in a bladder, a vessel of wood, and in many other things possessed - of far less sensibility than man; for it is not the heat which is possessed of - great efficacy, but the sour and the insipid, and other qualities as described - by me, both in man and out of man, and that whether eaten or drunk, rubbed in - externally, and otherwise applied.

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- PART 16 -

But I think that of all the qualities heat and cold exercise the least operation - in the body, for these reasons: as long time as hot and cold are mixed up with - one another they do not give trouble, for the cold is attempered and rendered - more moderate by the hot, and the hot by the cold; but when the one is wholly - separate from the other, then it gives pain; and at that season when cold is - applied it creates some pain to a man, but quickly, for that very reason, heat - spontaneously arises in him without requiring any aid or preparation. And these - things operate thus both upon men in health and in disease. For example, if a - person in health wishes to cool his body during winter, and bathes either in - cold water or in any other way, the more he does this, unless his body be fairly - congealed, when he resumes his clothes and comes into a place of shelter, his - body becomes more heated than before. And thus, too, if a person wish to be - warmed thoroughly either by means of a hot bath or strong fire, and straight-way having the same clothing on, takes up his abode again in the - place he was in when he became congealed, he will appear much colder, and more - disposed to chills than before. And if a person fan himself on account of a - suffocating heat, and having procured refrigeration for himself in this manner, - cease doing so, the heat and suffocation will be ten times greater in his case - than in that of a person who does nothing of the kind. And, to give a more - striking example, persons travelling in the snow, or otherwise in rigorous - weather, and contracting great cold in their feet, their hands, or their head, - what do they not suffer from inflammation and tingling when they put on warm - clothing and get into a hot place? In some instances, blisters arise as if from - burning with fire, and they do not suffer from any of those unpleasant symptoms - until they become heated. So readily does either of these pass into the other; - and I could mention many other examples. And with regard to the sick, is it not - in those who experience a rigor that the most acute fever is apt to break out? - And yet not so strongly neither, but that it ceases in a short time, and, for - the most part, without having occasioned much mischief; and while it remains, it - is hot, and passing over the whole body, ends for the most part in the feet, - where the chills and cold were most intense and lasted longest; and, when sweat - supervenes, and the fever passes off, the patient is much colder than if he had - not taken the fever at all. Why then should that which so quickly passes into - the opposite extreme, and loses its own powers spontaneously, be reckoned a - mighty and serious affair? And what necessity is there for any great remedy for - it?

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- PART 17 -

One might here say- but persons in ardent fevers, pneumonia, and other formidable - diseases, do not quickly get rid of the heat, nor experience these rapid - alterations of heat and cold. And I reckon this very circumstance the strongest - proof that it is not from heat simply that men get into the febrile state, - neither is it the sole cause of the mischief, but that this species of heat is - bitter, and that acid, and the other saltish, and many other varieties; and - again there is cold combined with other qualities. These are what proves - injurious; heat, it is true, is present also, possessed of strength as being - that which conducts, is exacerbated and increased along with the - other, but has no power greater than what is peculiar to itself.

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- PART 18 -

With regard to these symptoms, in the first place those are most obvious of which - we have all often had experience. Thus, then, in such of us as have a coryza and - defluxion from the nostrils, this discharge is much more acrid than that which - formerly was formed in and ran from them daily; and it occasions swelling of the - nose, and it inflames, being of a hot and extremely ardent nature, as you may - know, if you apply your hand to the place; and, if the disease remains long, the - part becomes ulcerated although destitute of flesh and hard; and the heat in the - nose ceases, not when the defluxion takes place and the inflammation is present, - but when the running becomes thicker and less acrid, and more mixed with the - former secretion, then it is that the heat ceases. But in all those cases in - which this decidedly proceeds from cold alone, without the concourse of any - other quality, there is a change from cold to hot, and from hot to cold, and - these quickly supervene, and require no coction. But all the others being - connected, as I have said, with acrimony and intemperance of humors, pass off in - this way by being mixed and concocted.

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- PART 19 -

But such defluxions as are determined to the eyes being possessed of strong and - varied acrimonies, ulcerate the eyelids, and in some cases corrode the and parts - below the eyes upon which they flow, and even occasion rupture and erosion of - the tunic which surrounds the eyeball. But pain, heat, and extreme burning - prevail until the defluxions are concocted and become thicker, and concretions - form about the eyes, and the coction takes place from the fluids being mixed up, - diluted, and digested together. And in defluxions upon the throat, from which - are formed hoarseness, cynanche, crysipelas, and pneumonia, all these have at - first saltish, watery, and acrid discharges, and with these the diseases gain - strength. But when the discharges become thicker, more concocted, and are freed - from all acrimony, then, indeed, the fevers pass away, and the other symptoms - which annoyed the patient; for we must account those things the cause of each - complaint, which, being present in a certain fashion, the complaint exists, but - it ceases when they change to another combination. But those which - originate from pure heat or cold, and do not participate in any other quality, - will then cease when they undergo a change from cold to hot, and from hot to - cold; and they change in the manner I have described before. Wherefore, all the - other complaints to which man is subject arise from powers (qualities?). Thus, - when there is an overflow of the bitter principle, which we call yellow bile, - what anxiety, burning heat, and loss of strength prevail! but if relieved from - it, either by being purged spontaneously, or by means of a medicine seasonably - administered, the patient is decidedly relieved of the pains and heat; but while - these things float on the stomach, unconcocted and undigested, no contrivance - could make the pains and fever cease; and when there are acidities of an acrid - and aeruginous character, what varieties of frenzy, gnawing pains in the bowels - and chest, and inquietude, prevail! and these do not cease until the acidities - be purged away, or are calmed down and mixed with other fluids. The coction, - change, attenuation, and thickening into the form of humors, take place through - many and various forms; therefore the crises and calculations of time are of - great importance in such matters; but to all such changes hot and cold are but - little exposed, for these are neither liable to putrefaction nor thickening. - What then shall we say of the change? that it is a combination (crasis) of these - humors having different powers toward one another. But the hot does not loose - its heat when mixed with any other thing except the cold; nor again, the cold, - except when mixed with the hot. But all other things connected with man become - the more mild and better in proportion as they are mixed with the more things - besides. But a man is in the best possible state when they are concocted and at - rest, exhibiting no one peculiar quality; but I think I have said enough in - explanation of them.

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- PART 20 -

Certain sophists and physicians say that it is not possible for any one to know - medicine who does not know what man is [and how he was made and how - constructed], and that whoever would cure men properly, must learn this in the - first place. But this saying rather appertains to philosophy, as Empedocles and - certain others have described what man in his origin is, and how he first was made and constructed. But I think whatever such has been said or - written by sophist or physician concerning nature has less connection with the - art of medicine than with the art of painting. And I think that one cannot know - anything certain respecting nature from any other quarter than from medicine; - and that this knowledge is to be attained when one comprehends the whole subject - of medicine properly, but not until then; and I say that this history shows what - man is, by what causes he was made, and other things accurately. Wherefore it - appears to me necessary to every physician to be skilled in nature, and strive - to know, if he would wish to perform his duties, what man is in relation to the - articles of food and drink, and to his other occupations, and what are the - effects of each of them to every one. And it is not enough to know simply that - cheese is a bad article of food, as disagreeing with whoever eats of it to - satiety, but what sort of disturbance it creates, and wherefore, and with what - principle in man it disagrees; for there are many other articles of food and - drink naturally bad which affect man in a different manner. Thus, to illustrate - my meaning by an example, undiluted wine drunk in large quantity renders a man - feeble; and everybody seeing this knows that such is the power of wine, and the - cause thereof; and we know, moreover, on what parts of a man's body it - principally exerts its action; and I wish the same certainty to appear in other - cases. For cheese (since we used it as an example) does not prove equally - injurious to all men, for there are some who can take it to satiety without - being hurt by it in the least, but, on the contrary, it is wonderful what - strength it imparts to those it agrees with; but there are some who do not bear - it well, their constitutions are different, and they differ in this respect, - that what in their body is incompatible with cheese, is roused and put in - commotion by such a thing; and those in whose bodies such a humor happens to - prevail in greater quantity and intensity, are likely to suffer the more from - it. But if the thing had been pernicious to of man, it would have hurt all. - Whoever knows these things will not suffer from it.

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- PART 21 -

During convalescence from diseases, and also in protracted - diseases, many disorders occur, some spontaneously, and some from certain things - accidentally administered. I know that the common herd of physicians, like the - vulgar, if there happen to have been any innovation made about that day, such as - the bath being used, a walk taken, or any unusual food eaten, all which were - better done than otherwise, attribute notwithstanding the cause of these - disorders, to some of these things, being ignorant of the true cause but - proscribing what may have been very proper. Now this ought not to be so; but one - should know the effects of a bath or a walk unseasonably applied; for thus there - will never be any mischief from these things, nor from any other thing, nor from - repletion, nor from such and such an article of food. Whoever does not know what - effect these things produce upon a man, cannot know the consequences which - result from them, nor how to apply them.

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- PART 22 -

And it appears to me that one ought also to know what diseases arise in man from - the powers, and what from the structures. What do I mean by this? By powers, I - mean intense and strong juices; and by structures, whatever conformations there - are in man. For some are hollow, and from broad contracted into narrow; some - expanded, some hard and round, some broad and suspended,Meaning probably - the diaphragm, with its membranes. some stretched, some long, some - dense, some rare and succulent,Meaning the mammae, according to - Heurnius. some spongy and of loose texture.Such as the spleen - and lungs. Now, then, which of these figures is the best calculated - to suck to itself and attract humidity from another body? Whether what is hollow - and expanded, or what is solid and round, or what is hollow, and from broad, - gradually turning narrow? I think such as from hollow and broad are contracted - into narrow: this may be ascertained otherwise from obvious facts: thus, if you - gape wide with the mouth you cannot draw in any liquid; but by protruding, - contracting, and compressing the lips, and still more by using a tube, you can - readily draw in whatever you wish. And thus, too, the instruments which are used - for cupping are broad below and gradually become narrow, and are so con-structed in order to suck and draw in from the fleshy parts. The - nature and construction of the parts within a man are of a like nature; the - bladder, the head, the uterus in woman; these parts clearly attract, and are - always filled with a juice which is foreign to them. Those parts which are - hollow and expanded are most likely to receive any humidity flowing into them, - but cannot attract it in like manner. Those parts which are solid and round - could not attract a humidity, nor receive it when it flows to them, for it would - glide past, and find no place of rest on them. But spongy and rare parts, such - as the spleen, the lungs, and the breasts, drink up especially the juices around - them, and become hardened and enlarged by the accession of juices. Such things - happen to these organs especially. For it is not with the spleen as with the - stomach, in which there is a liquid, which it contains and evacuates every day; - but when it (the spleen) drinks up and receives a fluid into itself, the hollow - and lax parts of it are filled, even the small interstices; and, instead of - being rare and soft, it becomes hard and dense, and it can neither digest nor - discharge its contents: these things it suffers, owing to the nature of its - structure. Those things which engender flatulence or tormina in the body, - naturally do so in the hollow and broad parts of the body, such as the stomach - and chest, where they produce rumbling noises; for when they do not fill the - parts so as to be stationary, but have changes of place and movements, there - must necessarily be noise and apparent movements from them. But such parts as - are fleshy and soft, in these there occur torpor and obstructions, such as - happen in apoplexy. But when it (the flatus?) encounters a broad and resisting - structure, and rushes against such a part, and this happens when it is by nature - not strong so as to be able to withstand it without suffering injury; nor soft - and rare, so as to receive or yield to it, but tender, juicy, full of blood, and - dense, like the liver, owing to its density and broadness, it resists and does - not yield. But flatus, when it obtains admission, increases and becomes - stronger, and rushes toward any resisting object; but owing to its tenderness, - and the quantity of blood which it (the liver) contains, it cannot be without - uneasiness; and for these reasons the most acute and frequent pains occur in the region of it, along with suppurations and chronic tumors - (phymata). These symptoms also occur in the site of the diaphragm, but much less - frequently; for the diaphragm is a broad, expanded, and resisting substance, of - a nervous (tendinous?) and strong nature, and therefore less susceptible of - pain; and yet pains and chronic abscesses do occur about it.

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- PART 23 -

There are both within and without the body many other kinds of structure, which - differ much from one another as to sufferings both in health and disease; such - as whether the head be small or large; the neck slender or thick, long or short; - the belly long or round; the chest and ribs broad or narrow; and many others - besides, all which you ought to be acquainted with, and their differences; so - that knowing the causes of each, you may make the more accurate - observations.

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- PART 24 -

And, as has been formerly stated, one ought to be acquainted with the powers of - juices, and what action each of them has upon man, and their alliances towards - one another. What I say is this: if a sweet juice change to another kind, not - from any admixture, but because it has undergone a mutation within itself; what - does it first become?- bitter? salt? austere? or acid? I think acid. And hence, - an acid juice is the most improper of all things that can be administered in - cases in which a sweet juice is the most proper. Thus, if one should succeed in - his investigations of external things, he would be the better able always to - select the best; for that is best which is farthest removed from that which is - unwholesome.

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Whoever having undertaken to speak or write on Medicine, have first laid down for themselves some hypothesis to their argument, such as hot, or cold, or moist, or dry, or whatever else they choose (thus reducing their subject within a narrow compass, and supposing only one or two original causes of diseases or of death among mankind), are all clearly mistaken in much that they say; and this is the more reprehensible as relating to an art which all men avail themselves of on the most important occasions, and the good operators and practitioners in which they hold in especial honor. For there are practitioners, some bad and some far otherwise, which, if there had been no such thing as Medicine, and if nothing had been investigated or found out in it, would not have been the case, but all would have been equally unskilled and ignorant of it, and everything concerning the sick would have been directed by chance. But now it is not so; for, as in all the other arts, those who practise them differ much from one another in dexterity and knowledge, so is it in like manner with Medicine. Wherefore I have not thought that it stood in need of an empty hypothesis, like those subjects which are occult and dubious, in attempting to handle which it is necessary to use some hypothesis; as, for example, with regard to things above us and things below the earth; if any one should treat of these and undertake to declare how they are constituted, the reader or hearer could not find out, whether what is delivered be true or false; for there is nothing which can be referred to in order to discover the truth.

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But all these requisites belong of old to Medicine, and an origin and way have been found out, by which many and elegant discoveries have been made, during a length of time, and others will yet be found out, if a person possessed of the proper ability, and knowing those discoveries which have been made, should proceed from them to prosecute his investigations. But whoever, rejecting and despising all these, attempts to pursue another course and form of inquiry, and says he has discovered anything, is deceived himself and deceives others, for the thing is impossible. And for what reason it is impossible, I will now endeavor to explain, by stating and showing what the art really is. From this it will be manifest that discoveries cannot possibly be made in any other way. And most especially, it appears to me, that whoever treats of this art should treat of things which are familiar to the common people. For of nothing else will such a one have to inquire or treat, but of the diseases under which the common people have labored, which diseases and the causes of their origin and departure, their increase and decline, illiterate persons cannot easily find out themselves, but still it is easy for them to understand these things when discovered and expounded by others. For it is nothing more than that every one is put in mind of what had occurred to himself. But whoever does not reach the capacity of the illiterate vulgar and fails to make them listen to him, misses his mark. Wherefore, then, there is no necessity for any hypothesis.

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For the art of Medicine would not have been invented at first, nor would it have been made a subject of investigation (for there would have been no need of it), if when men are indisposed, the same food and other articles of regimen which they eat and drink when in good health were proper for them, and if no others were preferable to these. But now necessity itself made medicine to be sought out and discovered by men, since the same things when administered to the sick, which agreed with them when in good health, neither did nor do agree with them. But to go still further back, I hold that the diet and food which people in health now use would not have been discovered, provided it had suited with man to eat and drink in like manner as the ox, the horse, and all other animals, except man, do of the productions of the earth, such as fruits, weeds, and grass; for from such things these animals grow, live free of disease, and require no other kind of food. And, at first, I am of opinion that man used the same sort of food, and that the present articles of diet had been discovered and invented only after a long lapse of time, for when they suffered much and severely from strong and brutish diet, swallowing things which were raw, unmixed, and possessing great strength, they became exposed to strong pains and diseases, and to early deaths. It is likely, indeed, that from habit they would suffer less from these things then than we would now, but still they would suffer severely even then; and it is likely that the greater number, and those who had weaker constitutions, would all perish; whereas the stronger would hold out for a longer time, as even nowadays some, in consequence of using strong articles of food, get off with little trouble, but others with much pain and suffering. From this necessity it appears to me that they would search out the food befitting their nature, and thus discover that which we now use: and that from wheat, by macerating it, stripping it of its hull, grinding it all down, sifting, toasting, and baking it, they formed bread; and from barley they formed cake (maza), performing many operations in regard to it; they boiled, they roasted, they mixed, they diluted those things which are strong and of intense qualities with weaker things, fashioning them to the nature and powers of man, and considering that the stronger things Nature would not be able to manage if administered, and that from such things pains, diseases, and death would arise, but such as Nature could manage, that from them food, growth, and health, would arise. To such a discovery and investigation what more suitable name could one give than that of Medicine? since it was discovered for the health of man, for his nourishment and safety, as a substitute for that kind of diet by which pains, diseases, and deaths were occasioned.

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And if this is not held to be an art, I do not object. For it is not suitable to call any one an artist of that which no one is ignorant of, but which all know from usage and necessity. But still the discovery is a great one, and requiring much art and investigation. Wherefore those who devote themselves to gymnastics and training, are always making some new discovery, by pursuing the same line of inquiry, where, by eating and drinking certain things, they are improved and grow stronger than they were.

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Let us inquire then regarding what is admitted to be Medicine; namely, that which was invented for the sake of the sick, which possesses a name and practitioners, whether it also seeks to accomplish the same objects, and whence it derived its origin. To me, then, it appears, as I said at the commencement, that nobody would have sought for medicine at all, provided the same kinds of diet had suited with men in sickness as in good health. Wherefore, even yet, such races of men as make no use of medicine, namely, barbarians, and even certain of the Greeks, live in the same way when sick as when in health; that is to say, they take what suits their appetite, and neither abstain from, nor restrict themselves in anything for which they have a desire. But those who have cultivated and invented medicine, having the same object in view as those of whom I formerly spoke, in the first place, I suppose, diminished the quantity of the articles of food which they used, and this alone would be sufficient for certain of the sick, and be manifestly beneficial to them, although not to all, for there would be some so affected as not to be able to manage even small quantities of their usual food, and as such persons would seem to require something weaker, they invented soups, by mixing a few strong things with much water, and thus abstracting that which was strong in them by dilution and boiling. But such as could not manage even soups, laid them aside, and had recourse to drinks, and so regulated them as to mixture and quantity, that they were administered neither stronger nor weaker than what was required.

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But this ought to be well known, that soups do not agree with certain persons in their diseases, but, on the contrary, when administered both the fevers and the pains are exacerbated, and it becomes obvious that what was given has proved food and increase to the disease, but a wasting and weakness to the body. But whatever persons so affected partook of solid food, or cake, or bread, even in small quantity, would be ten times and more decidedly injured than those who had taken soups, for no other reason than from the strength of the food in reference to the affection; and to whomsoever it is proper to take soups and not eat solid food, such a one will be much more injured if he eat much than if he eat little, but even little food will be injurious to him. But all the causes of the sufferance refer themselves to this rule, that the strongest things most especially and decidedly hurt man, whether in health or in disease.

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What other object, then, had he in view who is called a physician, and is admitted to be a practitioner of the art, who found out the regimen and diet befitting the sick, than he who originally found out and prepared for all mankind that kind of food which we all now use, in place of the former savage and brutish mode of living? To me it appears that the mode is the same, and the discovery of a similar nature. The one sought to abstract those things which the constitution of man cannot digest, because of their wildness and intemperature, and the other those things which are beyond the powers of the affection in which any one may happen to be laid up. Now, how does the one differ from the other, except that the latter admits of greater variety, and requires more application, whereas the former was the commencement of the process?

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And if one would compare the diet of sick persons with that of persons in health, he will find it not more injurious than that of healthy persons in comparison with that of wild beasts and of other animals. For, suppose a man laboring under one of those diseases which are neither serious and unsupportable, nor yet altogether mild, but such as that, upon making any mistake in diet, it will become apparent, as if he should eat bread and flesh, or any other of those articles which prove beneficial to healthy persons, and that, too, not in great quantity, but much less than he could have taken when in good health; and that another man in good health, having a constitution neither very feeble, nor yet strong, eats of those things which are wholesome and strengthening to an ox or a horse, such as vetches, barley, and the like, and that, too, not in great quantity, but much less than he could take; the healthy person who did so would be subjected to no less disturbance and danger than the sick person who took bread or cake unseasonably. All these things are proofs that Medicine is to be prosecuted and discovered by the same method as the other.

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And if it were simply, as is laid down, that such things as are stronger prove injurious, but such as are weaker prove beneficial and nourishing, both to sick and healthy persons, it were an easy matter, for then the safest rule would be to circumscribe the diet to the lowest point. But then it is no less mistake, nor one that injuries a man less, provided a deficient diet, or one consisting of weaker things than what are proper, be administered. For, in the constitution of man, abstinence may enervate, weaken, and kill. And there are many other ills, different from those of repletion, but no less dreadful, arising from deficiency of food; wherefore the practice in those cases is more varied, and requires greater accuracy. For one must aim at attaining a certain measure, and yet this measure admits neither weight nor calculation of any kind, by which it may be accurately determined, unless it be the sensation of the body; wherefore it is a task to learn this accurately, so as not to commit small blunders either on the one side or the other, and in fact I would give great praise to the physician whose mistakes are small, for perfect accuracy is seldom to be seen, since many physicians seem to me to be in the same plight as bad pilots, who, if they commit mistakes while conducting the ship in a calm do not expose themselves, but when a storm and violent hurricane overtake them, they then, from their ignorance and mistakes, are discovered to be what they are, by all men, namely, in losing their ship. And thus bad and commonplace physicians, when they treat men who have no serious illness, in which case one may commit great mistakes without producing any formidable mischief (and such complaints occur much more frequently to men than dangerous ones): under these circumstances, when they commit mistakes, they do not expose themselves to ordinary men; but when they fall in with a great, a strong, and a dangerous disease, then their mistakes and want of skill are made apparent to all. Their punishment is not far off, but is swift in overtaking both the one and the other.He means both the pilot and physician.

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And that no less mischief happens to a man from unseasonable depletion than from repletion, may be clearly seen upon reverting to the consideration of persons in health. For, to some, with whom it agrees to take only one meal in the day, and they have arranged it so accordingly; whilst others, for the same reason, also take dinner, and this they do because they find it good for them, and not like those persons who, for pleasure or from any casual circumstance, adopt the one or the other custom and to the bulk of mankind it is of little consequence which of these rules they observe, that is to say, whether they make it a practice to take one or two meals. But there are certain persons who cannot readily change their diet with impunity; and if they make any alteration in it for one day, or even for a part of a day, are greatly injured thereby. Such persons, provided they take dinner when it is not their wont, immediately become heavy and inactive, both in body and mind, and are weighed down with yawning, slumbering, and thirst; and if they take supper in addition, they are seized with flatulence, tormina, and diarrhea, and to many this has been the commencement of a serious disease, when they have merely taken twice in a day the same food which they have been in the custom of taking once. And thus, also, if one who has been accustomed to dine, and this rule agrees with him, should not dine at the accustomed hour, he will straightway feel great loss of strength, trembling, and want of spirits, the eyes of such a person will become more pallid, his urine thick and hot, his mouth bitter; his bowels will seem, as it were, to hang loose; he will suffer from vertigo, lowness of spirit, and inactivity,- such are the effects; and if he should attempt to take at supper the same food which he was wont to partake of at dinner, it will appear insipid, and he will not be able to take it off; and these things, passing downwards with tormina and rumbling, burn up his bowels; he experiences insomnolency or troubled and disturbed dreams; and to many of them these symptoms are the commencement of some disease.

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But let us inquire what are the causes of these things which happened to them. To him, then, who was accustomed to take only one meal in the day, they happened because he did not wait the proper time, until his bowels had completely derived benefit from and had digested the articles taken at the preceding meal, and until his belly had become soft, and got into a state of rest, but he gave it a new supply while in a state of heat and fermentation, for such bellies digest much more slowly, and require more rest and ease. And as to him who had been accustomed to dinner, since, as soon as the body required food, and when the former meal was consumed, and he wanted refreshment, no new supply was furnished to it, he wastes and is consumed from want of food. For all the symptoms which I describe as befalling to this man I refer to want of food. And I also say that all men who, when in a state of health, remain for two or three days without food, experience the same unpleasant symptoms as those which I described in the case of him who had omitted to take dinner.

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Wherefore, I say, that such constitutions as suffer quickly and strongly from errors in diet, are weaker than others that do not; and that a weak person is in a state very nearly approaching to one in disease; but a person in disease is the weaker, and it is, therefore, more likely that he should suffer if he encounters anything that is unseasonable. It is difficult, seeing that there is no such accuracy in the Art, to hit always upon what is most expedient, and yet many cases occur in medicine which would require this accuracy, as we shall explain. But on that account, I say, we ought not to reject the ancient Art, as if it were not, and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well and properly made, and not from chance.

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But I wish the discourse to revert to the new method of those who prosecute their inquiries in the Art by hypothesis. For if hot, or cold, or moist, or dry, be that which proves injurious to man, and if the person who would treat him properly must apply cold to the hot, hot to the cold, moist to the dry, and dry to the moist- let me be presented with a man, not indeed one of a strong constitution, but one of the weaker, and let him eat wheat, such as it is supplied from the thrashing-floor, raw and unprepared, with raw meat, and let him drink water. By using such a diet I know that he will suffer much and severely, for he will experience pains, his body will become weak, and his bowels deranged, and he will not subsist long. What remedy, then, is to be provided for one so situated? Hot? or cold? or moist? or dry? For it is clear that it must be one or other of these. For, according to this principle, if it is one of the which is injuring the patient, it is to be removed by its contrary. But the surest and most obvious remedy is to change the diet which the person used, and instead of wheat to give bread, and instead of raw flesh, boiled, and to drink wine in addition to these; for by making these changes it is impossible but that he must get better, unless completely disorganized by time and diet. What, then, shall we say? whether that, as he suffered from cold, these hot things being applied were of use to him, or the contrary? I should think this question must prove a puzzler to whomsoever it is put. For whether did he who prepared bread out of wheat remove the hot, the cold, the moist, or the dry principle in it?- for the bread is consigned both to fire and to water, and is wrought with many things, each of which has its peculiar property and nature, some of which it loses, and with others it is diluted and mixed.

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And this I know, moreover, that to the human body it makes a great difference whether the bread be fine or coarse; of wheat with or without the hull, whether mixed with much or little water, strongly wrought or scarcely at all, baked or raw- and a multitude of similar differences; and so, in like manner, with the cake (maza); the powers of each, too, are great, and the one nowise like the other. Whoever pays no attention to these things, or, paying attention, does not comprehend them, how can he understand the diseases which befall a man? For, by every one of these things, a man is affected and changed this way or that, and the whole of his life is subjected to them, whether in health, convalescence, or disease. Nothing else, then, can be more important or more necessary to know than these things. So that the first inventors, pursuing their investigations properly, and by a suitable train of reasoning, according to the nature of man, made their discoveries, and thought the Art worthy of being ascribed to a god, as is the established belief. For they did not suppose that the dry or the moist, the hot or the cold, or any of these are either injurious to man, or that man stands in need of them, but whatever in each was strong, and more than a match for a man’s constitution, whatever he could not manage, that they held to be hurtful, and sought to remove. Now, of the sweet, the strongest is that which is intensely sweet; of the bitter, that which is intensely bitter; of the acid, that which is intensely acid; and of all things that which is extreme, for these things they saw both existing in man, and proving injurious to him. For there is in man the bitter and the salt, the sweet and the acid, the sour and the insipid, and a multitude of other things having all sorts of powers both as regards quantity and strength. These, when all mixed and mingled up with one another, are not apparent, neither do they hurt a man; but when any of them is separate, and stands by itself, then it becomes perceptible, and hurts a man. And thus, of articles of food, those which are unsuitable and hurtful to man when administered, every one is either bitter, or intensely so, or saltish or acid, or something else intense and strong, and therefore we are disordered by them in like manner as we are by the secretions in the body. But all those things which a man eats and drinks are devoid of any such intense and well-marked quality, such as bread, cake, and many other things of a similar nature which man is accustomed to use for food, with the exception of condiments and confectioneries, which are made to gratify the palate and for luxury. And from those things, when received into the body abundantly, there is no disorder nor dissolution of the powers belonging to the body; but strength, growth, and nourishment result from them, and this for no other reason than because they are well mixed, have nothing in them of an immoderate character, nor anything strong, but the whole forms one simple and not strong substance.

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I cannot think in what manner they who advance this doctrine, and transfer Art from the cause I have described to hypothesis, will cure men according to the principle which they have laid down. For, as far as I know, neither the hot nor the cold, nor the dry, nor the moist, has ever been found unmixed with any other quality; but I suppose they use the same articles of meat and drink as all we other men do. But to this substance they give the attribute of being hot, to that cold, to that dry, and to that moist. Since it would be absurd to advise the patient to take something hot, for he would straightway ask what it is? so that he must either play the fool, or have recourse to some one of the well known substances; and if this hot thing happen to be sour, and that hot thing insipid, and this hot thing has the power of raising a disturbance in the body (and there are many other kinds of heat, possessing many opposite powers), he will be obliged to administer some one of them, either the hot and the sour, or the hot and the insipid, or that which, at the same time, is cold and sour (for there is such a substance), or the cold and the insipid. For, as I think, the very opposite effects will result from either of these, not only in man, but also in a bladder, a vessel of wood, and in many other things possessed of far less sensibility than man; for it is not the heat which is possessed of great efficacy, but the sour and the insipid, and other qualities as described by me, both in man and out of man, and that whether eaten or drunk, rubbed in externally, and otherwise applied.

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But I think that of all the qualities heat and cold exercise the least operation in the body, for these reasons: as long time as hot and cold are mixed up with one another they do not give trouble, for the cold is attempered and rendered more moderate by the hot, and the hot by the cold; but when the one is wholly separate from the other, then it gives pain; and at that season when cold is applied it creates some pain to a man, but quickly, for that very reason, heat spontaneously arises in him without requiring any aid or preparation. And these things operate thus both upon men in health and in disease. For example, if a person in health wishes to cool his body during winter, and bathes either in cold water or in any other way, the more he does this, unless his body be fairly congealed, when he resumes his clothes and comes into a place of shelter, his body becomes more heated than before. And thus, too, if a person wish to be warmed thoroughly either by means of a hot bath or strong fire, and straight-way having the same clothing on, takes up his abode again in the place he was in when he became congealed, he will appear much colder, and more disposed to chills than before. And if a person fan himself on account of a suffocating heat, and having procured refrigeration for himself in this manner, cease doing so, the heat and suffocation will be ten times greater in his case than in that of a person who does nothing of the kind. And, to give a more striking example, persons travelling in the snow, or otherwise in rigorous weather, and contracting great cold in their feet, their hands, or their head, what do they not suffer from inflammation and tingling when they put on warm clothing and get into a hot place? In some instances, blisters arise as if from burning with fire, and they do not suffer from any of those unpleasant symptoms until they become heated. So readily does either of these pass into the other; and I could mention many other examples. And with regard to the sick, is it not in those who experience a rigor that the most acute fever is apt to break out? And yet not so strongly neither, but that it ceases in a short time, and, for the most part, without having occasioned much mischief; and while it remains, it is hot, and passing over the whole body, ends for the most part in the feet, where the chills and cold were most intense and lasted longest; and, when sweat supervenes, and the fever passes off, the patient is much colder than if he had not taken the fever at all. Why then should that which so quickly passes into the opposite extreme, and loses its own powers spontaneously, be reckoned a mighty and serious affair? And what necessity is there for any great remedy for it?

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One might here say- but persons in ardent fevers, pneumonia, and other formidable diseases, do not quickly get rid of the heat, nor experience these rapid alterations of heat and cold. And I reckon this very circumstance the strongest proof that it is not from heat simply that men get into the febrile state, neither is it the sole cause of the mischief, but that this species of heat is bitter, and that acid, and the other saltish, and many other varieties; and again there is cold combined with other qualities. These are what proves injurious; heat, it is true, is present also, possessed of strength as being that which conducts, is exacerbated and increased along with the other, but has no power greater than what is peculiar to itself.

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With regard to these symptoms, in the first place those are most obvious of which we have all often had experience. Thus, then, in such of us as have a coryza and defluxion from the nostrils, this discharge is much more acrid than that which formerly was formed in and ran from them daily; and it occasions swelling of the nose, and it inflames, being of a hot and extremely ardent nature, as you may know, if you apply your hand to the place; and, if the disease remains long, the part becomes ulcerated although destitute of flesh and hard; and the heat in the nose ceases, not when the defluxion takes place and the inflammation is present, but when the running becomes thicker and less acrid, and more mixed with the former secretion, then it is that the heat ceases. But in all those cases in which this decidedly proceeds from cold alone, without the concourse of any other quality, there is a change from cold to hot, and from hot to cold, and these quickly supervene, and require no coction. But all the others being connected, as I have said, with acrimony and intemperance of humors, pass off in this way by being mixed and concocted.

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But such defluxions as are determined to the eyes being possessed of strong and varied acrimonies, ulcerate the eyelids, and in some cases corrode the and parts below the eyes upon which they flow, and even occasion rupture and erosion of the tunic which surrounds the eyeball. But pain, heat, and extreme burning prevail until the defluxions are concocted and become thicker, and concretions form about the eyes, and the coction takes place from the fluids being mixed up, diluted, and digested together. And in defluxions upon the throat, from which are formed hoarseness, cynanche, crysipelas, and pneumonia, all these have at first saltish, watery, and acrid discharges, and with these the diseases gain strength. But when the discharges become thicker, more concocted, and are freed from all acrimony, then, indeed, the fevers pass away, and the other symptoms which annoyed the patient; for we must account those things the cause of each complaint, which, being present in a certain fashion, the complaint exists, but it ceases when they change to another combination. But those which originate from pure heat or cold, and do not participate in any other quality, will then cease when they undergo a change from cold to hot, and from hot to cold; and they change in the manner I have described before. Wherefore, all the other complaints to which man is subject arise from powers (qualities?). Thus, when there is an overflow of the bitter principle, which we call yellow bile, what anxiety, burning heat, and loss of strength prevail! but if relieved from it, either by being purged spontaneously, or by means of a medicine seasonably administered, the patient is decidedly relieved of the pains and heat; but while these things float on the stomach, unconcocted and undigested, no contrivance could make the pains and fever cease; and when there are acidities of an acrid and aeruginous character, what varieties of frenzy, gnawing pains in the bowels and chest, and inquietude, prevail! and these do not cease until the acidities be purged away, or are calmed down and mixed with other fluids. The coction, change, attenuation, and thickening into the form of humors, take place through many and various forms; therefore the crises and calculations of time are of great importance in such matters; but to all such changes hot and cold are but little exposed, for these are neither liable to putrefaction nor thickening. What then shall we say of the change? that it is a combination (crasis) of these humors having different powers toward one another. But the hot does not loose its heat when mixed with any other thing except the cold; nor again, the cold, except when mixed with the hot. But all other things connected with man become the more mild and better in proportion as they are mixed with the more things besides. But a man is in the best possible state when they are concocted and at rest, exhibiting no one peculiar quality; but I think I have said enough in explanation of them.

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Certain sophists and physicians say that it is not possible for any one to know medicine who does not know what man is [and how he was made and how constructed], and that whoever would cure men properly, must learn this in the first place. But this saying rather appertains to philosophy, as Empedocles and certain others have described what man in his origin is, and how he first was made and constructed. But I think whatever such has been said or written by sophist or physician concerning nature has less connection with the art of medicine than with the art of painting. And I think that one cannot know anything certain respecting nature from any other quarter than from medicine; and that this knowledge is to be attained when one comprehends the whole subject of medicine properly, but not until then; and I say that this history shows what man is, by what causes he was made, and other things accurately. Wherefore it appears to me necessary to every physician to be skilled in nature, and strive to know, if he would wish to perform his duties, what man is in relation to the articles of food and drink, and to his other occupations, and what are the effects of each of them to every one. And it is not enough to know simply that cheese is a bad article of food, as disagreeing with whoever eats of it to satiety, but what sort of disturbance it creates, and wherefore, and with what principle in man it disagrees; for there are many other articles of food and drink naturally bad which affect man in a different manner. Thus, to illustrate my meaning by an example, undiluted wine drunk in large quantity renders a man feeble; and everybody seeing this knows that such is the power of wine, and the cause thereof; and we know, moreover, on what parts of a man’s body it principally exerts its action; and I wish the same certainty to appear in other cases. For cheese (since we used it as an example) does not prove equally injurious to all men, for there are some who can take it to satiety without being hurt by it in the least, but, on the contrary, it is wonderful what strength it imparts to those it agrees with; but there are some who do not bear it well, their constitutions are different, and they differ in this respect, that what in their body is incompatible with cheese, is roused and put in commotion by such a thing; and those in whose bodies such a humor happens to prevail in greater quantity and intensity, are likely to suffer the more from it. But if the thing had been pernicious to of man, it would have hurt all. Whoever knows these things will not suffer from it.

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During convalescence from diseases, and also in protracted diseases, many disorders occur, some spontaneously, and some from certain things accidentally administered. I know that the common herd of physicians, like the vulgar, if there happen to have been any innovation made about that day, such as the bath being used, a walk taken, or any unusual food eaten, all which were better done than otherwise, attribute notwithstanding the cause of these disorders, to some of these things, being ignorant of the true cause but proscribing what may have been very proper. Now this ought not to be so; but one should know the effects of a bath or a walk unseasonably applied; for thus there will never be any mischief from these things, nor from any other thing, nor from repletion, nor from such and such an article of food. Whoever does not know what effect these things produce upon a man, cannot know the consequences which result from them, nor how to apply them.

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And it appears to me that one ought also to know what diseases arise in man from the powers, and what from the structures. What do I mean by this? By powers, I mean intense and strong juices; and by structures, whatever conformations there are in man. For some are hollow, and from broad contracted into narrow; some expanded, some hard and round, some broad and suspended,Meaning probably the diaphragm, with its membranes. some stretched, some long, some dense, some rare and succulent,Meaning the mammae, according to Heurnius. some spongy and of loose texture.Such as the spleen and lungs. Now, then, which of these figures is the best calculated to suck to itself and attract humidity from another body? Whether what is hollow and expanded, or what is solid and round, or what is hollow, and from broad, gradually turning narrow? I think such as from hollow and broad are contracted into narrow: this may be ascertained otherwise from obvious facts: thus, if you gape wide with the mouth you cannot draw in any liquid; but by protruding, contracting, and compressing the lips, and still more by using a tube, you can readily draw in whatever you wish. And thus, too, the instruments which are used for cupping are broad below and gradually become narrow, and are so constructed in order to suck and draw in from the fleshy parts. The nature and construction of the parts within a man are of a like nature; the bladder, the head, the uterus in woman; these parts clearly attract, and are always filled with a juice which is foreign to them. Those parts which are hollow and expanded are most likely to receive any humidity flowing into them, but cannot attract it in like manner. Those parts which are solid and round could not attract a humidity, nor receive it when it flows to them, for it would glide past, and find no place of rest on them. But spongy and rare parts, such as the spleen, the lungs, and the breasts, drink up especially the juices around them, and become hardened and enlarged by the accession of juices. Such things happen to these organs especially. For it is not with the spleen as with the stomach, in which there is a liquid, which it contains and evacuates every day; but when it (the spleen) drinks up and receives a fluid into itself, the hollow and lax parts of it are filled, even the small interstices; and, instead of being rare and soft, it becomes hard and dense, and it can neither digest nor discharge its contents: these things it suffers, owing to the nature of its structure. Those things which engender flatulence or tormina in the body, naturally do so in the hollow and broad parts of the body, such as the stomach and chest, where they produce rumbling noises; for when they do not fill the parts so as to be stationary, but have changes of place and movements, there must necessarily be noise and apparent movements from them. But such parts as are fleshy and soft, in these there occur torpor and obstructions, such as happen in apoplexy. But when it (the flatus?) encounters a broad and resisting structure, and rushes against such a part, and this happens when it is by nature not strong so as to be able to withstand it without suffering injury; nor soft and rare, so as to receive or yield to it, but tender, juicy, full of blood, and dense, like the liver, owing to its density and broadness, it resists and does not yield. But flatus, when it obtains admission, increases and becomes stronger, and rushes toward any resisting object; but owing to its tenderness, and the quantity of blood which it (the liver) contains, it cannot be without uneasiness; and for these reasons the most acute and frequent pains occur in the region of it, along with suppurations and chronic tumors (phymata). These symptoms also occur in the site of the diaphragm, but much less frequently; for the diaphragm is a broad, expanded, and resisting substance, of a nervous (tendinous?) and strong nature, and therefore less susceptible of pain; and yet pains and chronic abscesses do occur about it.

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There are both within and without the body many other kinds of structure, which differ much from one another as to sufferings both in health and disease; such as whether the head be small or large; the neck slender or thick, long or short; the belly long or round; the chest and ribs broad or narrow; and many others besides, all which you ought to be acquainted with, and their differences; so that knowing the causes of each, you may make the more accurate observations.

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And, as has been formerly stated, one ought to be acquainted with the powers of juices, and what action each of them has upon man, and their alliances towards one another. What I say is this: if a sweet juice change to another kind, not from any admixture, but because it has undergone a mutation within itself; what does it first become?- bitter? salt? austere? or acid? I think acid. And hence, an acid juice is the most improper of all things that can be administered in cases in which a sweet juice is the most proper. Thus, if one should succeed in his investigations of external things, he would be the better able always to select the best; for that is best which is farthest removed from that which is unwholesome.

 diff --git a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng2.unicode.xml b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng2.unicode.xml new file mode 100644 index 000000000..6733b0a8d --- /dev/null +++ b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng2.unicode.xml @@ -0,0 +1,151 @@ + + + + + + + On Ancient Medicine + Hippocrates + William Henry Samuel Jones + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + + National Library of Medicine History of Medicine Division + + + + Cultural Heritage Language Technologies + Kansas City Missouri + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0627.tlg001.perseus-eng4.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + + + + + + Hippocrates + Hippocrates + William Henry Samuel Jones + + London + William Heinemann Ltd. + Cambridge, MA + Harvard University Press + 1923 + + 1 + + Loeb Classical Library + Internet Archive + + + + + + + +

Data Entry

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This pointer pattern extracts section.

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All who, on attempting to speak or to write on medicine, have assumed for themselves a postulate as a basis for their discussion—heat, cold, moisture, dryness, or anything else that they may fancy—who narrow down the causal principle of diseases and of death among men, and make it the same in all cases, postulating one thing or two, all these obviously blunder in many points even of their statements,Or, reading καινοῖσι κτλ., of their novelties. but they are most open to censure because they blunder in what is an art, and one which all men use on the most important occasions, and give the greatest honours to the good craftsmen and practitioners in it. Some practitioners are poor, others very excellent; this would not be the case if an art of medicine did not exist at all, and had not been the subject of any research and discovery, but all would be equally inexperienced and unlearned therein, and the treatment of the sick would be in all respects haphazard. But it is not so; just as in all other arts the workers vary much in skill and in knowledge,Or manual skill and intelligence. so also is it in the case of medicine. Wherefore I have deemed that it has no need of an empty postulate,Or, reading χαινῆς, a novel postulate. But the writer’s objection is not that the postulate is novel, but that it is a postulate. A postulate, he says, is empty in a sphere where accurate and verifiable knowledge is possible. Only in regions where science cannot penetrate are ὑποθέσεις legitimate. For this reason I read κενῆς. as do insoluble mysteries, about which any exponent must use a postulate, for example, things in the sky or below the earth. If a man were to learn and declare the state of these, neither to the speaker himself nor to his audience would it be clear whether his statements were true or not. For there is no test the application of which would give certainty.

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But medicine has long had all its means to hand, and has discovered both a principle and a method, through which the discoveries made during a long period are many and excellent, while full discovery will be made, if the inquirer be competent, conduct his researches with knowledge of the discoveries already made, and make them his starting-point. But anyone who, casting aside and rejecting all these means, attempts to conduct research in any other way or after another fashion, and asserts that he has found out anything, is and has been the victim of deception.Or, with the reading suggested, both deceives and is deceived. His assertion is impossible; the causes of its impossibility I will endeavour to expound by a statement and exposition of what the art is.Or, reading ὅτι ἔστιν, that the art really is an art, really exists. In this way it will be manifest that by any other means discoveries are impossible. But it is particularly necessary, in my opinion, for one who discusses this art to discuss things familiar to ordinary folk. For the subject of inquiry and discussion is simply and solely the sufferings of these same ordinary folk when they are sick or in pain. Now to learn by themselves how their own sufferings come about and cease, and the reasons why they get worse or better, is not an easy task for ordinary folk; but when these things have been discovered and are set forth by another, it is simple. For merely an effort of memory is required of each man when he listens to a statement of his experiences. But if you miss being understood by laymen, and fail to put your hearers in this condition, you will miss reality. Therefore for this reason also medicine has no need of any postulate.

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For the art of medicine would never have been discovered to begin with, nor would any medical research have been conducted—for there would have been no need for medicine—if sick men had profited by the same mode of living and regimen as the food, drink and mode of living of men in health, and if there had been no other things for the sick better than these. But the fact is that sheer necessity has caused men to seek and to find medicine, because sick men did not, and do not, profit by the same regimen as do men in health. To trace the matter yet further back, I hold that not even the mode of living and nourishment enjoyed at the present time by men in health would have been discovered, had a man been satisfied with the same food and drink as satisfy an ox, a horse, and every animal save man, for example the products of the earth—fruits, wood and grass. For on these they are nourished, grow, and live without pain, having no need at all of any other kind of living. Yet I am of opinion that to begin with man also used this sort of nourishment. Our present ways of living have, I think, been discovered and elaborated during a long period of time. For many and terrible were the sufferings of men from strong and brutish living when they partook of crude foods, uncompounded and possessing great powersOr strong qualities.—the same in fact as men would suffer at the present day, falling into violent pains and diseases quickly followed by death. Formerly indeed they probably suffered less, because they were used to it, but they suffered severely even then. The majority naturally perished, having too weak a constitution, while the stronger resisted longer, just as at the present time some men easily deal with strong foods, while others do so only with many severe pains. For this reason the ancients too seem to me to have sought for nourishment that harmonised with their constitution, and to have discovered that which we use now. So from wheat, after steeping it, winnowing, grinding and sifting, kneading, baking, they produced bread, and from barley they produced cake. Experimenting with food they boiled or baked, after mixing, many other things, combining the strong and uncompounded with the weaker components so as to adapt all to the constitution and power of man, thinking that from foods which, being too strong, the human constitution cannot assimilate when eaten, will come pain, disease, and death, while from such as can be assimilated will come nourishment, growth and health. To this discovery and research what juster or more appropriate name could be given than medicine, seeing that it has been discovered with a view to the health, saving and nourishment of man, in the place of that mode of living from which came the pain, disease and death?

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That it is not commonly considered an art is not unnatural, for it is inappropriate to call anyone an artist in a craft in which none are laymen, but all possess knowledge through being compelled to use it. Nevertheless the discovery was a great one, implying much investigation and art. At any rate even at the present day those who study gymnastics and athletic exercises are constantly making some fresh discovery by investigating on the same method what food and what drink are best assimilated and make a man grow stronger.

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Let us consider also whether the acknowledged art of medicine, that was discovered for the treatment of the sick and has both a name and artists, has the same object as the other art,I.e. that of dieting in health. See Chapter VII. and what its origin was. In my opinion, as I said at the beginning, nobody would have even sought for medicine, if the same ways of life had suited both the sick and those in health. At any rate even at the present day such as do not use medical science, foreigners and some Greeks, live as do those in health, just as they please, and would neither forgo nor restrict the satisfaction of any of their desires. But those who sought for and discovered medicine, having the same intention as the men I discussed above, in the first place, I think, lessened the bulk of the foods, and, without altering their character, greatly diminished their quantity. But they found that this treatment was sufficient only occasionally, and although clearly beneficial with some patients, it was not so in all cases, as some were in such a condition that they could not assimilate even small quantities of food. As such patients were thought to need weaker nutriment, slops were invented by mixing with much water small quantities of strong foods, and by taking away from their strength by compounding and boiling. Those that were not able to assimilate them were refused even these slops, and were reduced to taking liquids, these moreover being so regulated in composition and quantity as to be moderate, and nothing was administered that was either more or less, or less compounded, than it ought to be.

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It must be clearly understood that some are not benefited in disease by slops, but when they take them, their fever and pain grow manifestly worse, and it is plain that what is taken proves nourishment and increase to the disease, but wears away and enfeebles the body. Any men who in this condition take dry food, barley-cake or bread, even though it be very little, will be hurt ten times more, and more obviously, than if they take slops, simply and solely because the food is too strong for their condition; and a man to whom slops are beneficial, but not solid food, will suffer much more harm if he eat more than if he eat little, though he will feel pain even if he eat little. Now all the causes of the pain can be reduced to one, namely, it is the strongest foods that hurt a man most and most obviously, whether he be well or ill.

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What difference then can be seen between the purpose of him we call physician, who is an acknowledged handicraftsman, the discoverer of the mode of life and of the nourishment suitable for the sick, and his who discovered and prepared originally nourishment for all men, which we now use, instead of the old savage and brutish mode of living ? My own view is that their reasoning was identical and the discovery one and the same. The one sought to do away with those things which, when taken, the constitution of man in health could not assimilate because of their brutish and uncompounded character, the other those things which the temporary condition of an individual prevented him from assimilating. How do the two pursuits differ, except in their scopeOr appearance. The two pursuits are really one, but they appear to a superficial observer to differ. and in that the latter is more complex and requires the greater application, while the former is the starting point and came first in time ?

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A consideration of the diet of the sick, as compared with that of men in health, would show that the diet of wild beasts and of animals generally is not more harmful, as compared with that of men in health.The text here is very uncertain; I have combined that of Littré with that of Kéhlewein so as to give a good sense: The diet of men in health is as injurious to the sick as the diet of wild beasts is to men in health. Take a man sick of a disease which is neither severe and desperate nor yet altogether mild, but likely to be pronounced under wrong treatment, and suppose that he resolved to eat bread, and meat, or any other food that is beneficial to men in health, not much of it, but far less than he could have taken had he been well; take again a man in health, with a constitution neither altogether weak nor altogether strong, and suppose he were to eat one of the foods that would be beneficial and strength-giving to an ox or a horse, vetches or barley or something similar, not much of it, but far less than he could take. If the man in health did this he would suffer no less pain and danger than that sick man who took bread or barley-cake at a time when he ought not. All this goes to prove that this art of medicine, if research be continued on the same method, can all be discovered.

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If the matter were simple, as in these instances, and both sick and well were hurt by too strong foods, benefited and nourished by weaker foods, there would be no difficulty. For recourse to weaker food must have secured a great degree of safety. But as it is, if a man takes insufficient food, the mistake is as great as that of excess, and harms the man just as much. For abstinence has upon the human constitution a most powerful effect, to enervate, to weaken and to kill. Depletion produces many other evils, different from those of repletion, but just as severe. Wherefore the greater complexity of these ills requires a more exact method of treatment. For it is necessary to aim at some measure. But no measure, neither number nor weight, by reference to which knowledge can be made exact, can be found except bodily feeling. Wherefore it is laborious to make knowledge so exact that only small mistakes are made here and there. And that physician who makes only small mistakes would win my hearty praise. Perfectly exact truth is but rarely to be seen. For most physicians seem to me to be in the same case as bad pilots; the mistakes of the latter are unnoticed so long as they are steering in a calm, but, when a great storm overtakes them with a violent gale, all men realise clearly then that it is their ignorance and blundering which have lost the ship. So also when bad physicians, who comprise the great majority, treat men who are suffering from no serious complaint, so that the greatest blunders would not affect them seriously—such illnesses occur very often, being far more common than serious disease—they are not shown up in their true colours to laymen if their errors are confined to such cases; but when they meet with a severe, violent and dangerous illness, then it is that their errors and want of skill are manifest to all. The punishment of the impostor, whether sailor or doctor, is not postponed, but follows speedily.

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That the discomforts a man feels after unseasonable abstinence are no less than those of unseasonable repletion, it were well to learn by a reference to men in health. For some of them benefit by taking one meal only each day, and because of this benefit they make a rule of having only one meal; others again, because of the same reason, that they are benefited thereby, take lunch also. Moreover some have adopted one or other of these two practices for the sake of pleasure or for some other chance reason. For the great majority of men can follow indifferently either the one habit or the other, and can take lunch or only one daily meal. Others again, if they were to do anything outside what is beneficial, would not get off easily, but if they change their respective ways for a single day, nay, for a part of a single day, they suffer excessive discomfort. Some, who lunch although lunch does not suit them, forthwith become heavy and sluggish in body and in mind, a prey to yawning, drowsiness and thirst; while, if they go on to eat dinner as well, flatulence follows with colic and violent diarrhœa. Many have found such action to result in a serious illness, even if the quantity of food they take twice a day be no greater than that which they have grown accustomed to digest once a day. On the other hand, if a man who has grown accustomed, and has found it beneficial, to take lunch, should miss taking it, he suffers, as soon as the lunch-hour is passed, from prostrating weakness, trembling and faintness. Hollowness of the eyes follows; urine becomes paler and hotter, and the mouth bitter; his bowels seem to hang; there come dizziness, depression and listlessness. Besides all this, when he attempts to dine, he has the following troubles: his food is less pleasant, and he cannot digest what formerly he used to dine on when he had lunch. The mere food, descending into the bowels with colic and noise, burns them, and disturbed sleep follows, accompanied by wild and troubled dreams. Many such sufferers also have found these symptoms the beginning of an illness.

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It is necessary to inquire into the cause why such symptoms come to these men. The one who had grown accustomed to one meal suffered, I think, because he did not wait sufficient time, until his digestive organs had completely digested and assimilated the food taken the day before, and until they had become empty and quiet, but had taken fresh food while the organs were still in a state of hot turmoil and ferment. Such organs digest much more slowly than others, and need longer rest and quiet. The man accustomed to take lunch, since no fresh nourishment was given him as soon as his body needed nourishment, when the previous meal was digested and there was nothing to sustain him, naturally wastes and pines away through want. For I put down to want all the symptoms which I have said such a man shows. And I assert furthermore that all other men besides, who when in good health fast for two or three days, will show the same symptoms as I have said those exhibit who do not take their lunch.

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Such constitutions, I contend, that rapidly and severely feel the effects of errors, are weaker than the others. A weak man is but one step removed from a sickly man, but a sickly man is weaker still, and is more apt to suffer distress whenever he misses the due season. And, while the art can admit of such nice exactness, it is difficult always to attain perfect accuracy. But many departments of medicine have reached such a pitch of exactness, and I will speak about them later. I declare, however, that we ought not to reject the ancient art as non-existent, or on the ground that its method of inquiry is faulty, just because it has not attained exactness in every detail, but much rather, because it has been able by reasoning to rise from deep ignorance to approximately perfect accuracy, I think we ought to admire the discoveries as the work, not of chance, but of inquiry rightly and correctly conducted.

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But I want to return to the theory of those who prosecute their researches in the art after the novel fashion, building on a postulate. For if there be such a thing as heat, or cold, or dryness, or moistness, which injures a man, it necessarily follows that the scientific healer will counteract cold with hot, hot with cold, moist with dry and dry with moist. Now suppose we have a man whose constitution is not strong, but weaker than the average. Let this man’s food be wheat straight from the threshing-floor, unworked and uncooked, and raw meat, and let his drink be water. The use of this diet will assuredly cause him much severe suffering; he will experience pains and physical weakness, his digestion will be ruined and he will not be able to live long. Well, what remedy should be prepared for a man in this condition ? Heat or cold or dryness or moistness ? One of these, plainly; for, according to the theory of the new school, if the injury was caused by one of the opposites, the other opposite ought to be a specific. Of course the most obvious as well as the most reliable medicine would be to abandon his old diet, and to give him bread instead of wheat, boiled meat instead of raw meat, and besides these things, a little wine to drink. This change must restore him to his health, unless indeed it has been entirely ruined by long continuance of the diet. What then shall we say ? That he was suffering from cold, and that the taking of these hot things benefited him ? Or shall we say the opposite ? I think that I have nonplussed my opponent. For is it the heat of the wheat, or the cold, or the dryness, or the moistness, that the baker took away from it ? For a thing which has been exposed to fire and to water, and has been made by many other things, each of which has its own individual propertyOr power. and nature, has lost some of its qualities and has been mixed and combined with others.

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Of course I know also that it makes a difference to a man’s body whether bread be of bolted or of unbolted flour, whether it be of winnowed or of unwinnowed wheat, whether it be kneaded with much water or with little, whether it be thoroughly kneaded or unkneaded, whether it be thoroughly baked or underbaked, and there are countless other differences. Barley-cake varies in just the same way. The propertiesOr powers. too of each variety are powerful, and no one is like to any other. But how could he who has not considered these truths, or who considers them without learning, know anything about human ailments ? For each of these differences produces in a human being an effect and a change of one sort or another, and upon these differences is based all the dieting of a man, whether he be in health, recovering from an illness, or suffering from one. Accordingly there could surely be nothing more useful or more necessary to know than these things, and how the first discoverers, pursuing their inquiries excellently and with suitable application of reason to the nature of man, made their discoveries, and thought the art worthy to be ascribed to a god, as in fact is the usual belief. For they did not consider that the dry or the moist or the hot or the cold or anything else of the kind injures a man, or that he has need of any such thing, but they considered that it is the strength of each thing, that which, being too powerful for the human constitution, it cannot assimilate, which causes harm, and this they sought to take away. The strongest part of the sweet is the sweetest, of the bitter the most bitter, of the acid the most acid, and each of all the component parts of man has its extreme. For these they saw are component parts of man, and that they are injurious to him; for there is in man salt and bitter, sweet and acid, astringent and insipid,Or flat, the opposite of sharp. and a vast number of other things, possessing properties of all sorts, both in number and in strength. These, when mixed and compounded with one another are neither apparent nor do they hurt a man; but when one of them is separated off, and stands alone, then it is apparent and hurts a man. Moreover, of the foods that are unsuitable for us and hurt a man when taken, each one of them is either bitter, or salt, or acid, or something else uncompounded and strong, and for this reason we are disordered by them, just as we are by the secretions separated off in the body. But all things that a man eats or drinks are plainly altogether free from such an uncompounded and potent humour, e.g. bread, cake, and suchlike, which men are accustomed constantly to use in great quantity, except the highly seasoned delicacies which gratify his appetite and greed. And from such foods, when plentifully partaken of by a man, there arises no disorder at all or isolation of the powersOr properties. resident in the body, but strength, growth and nourishment in great measure arise from them, for no other reason except that they are well compounded, and have nothing undiluted and strong, but form a single, simple whole.

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I am at a loss to understand how those who maintain the other view, and abandon the old method to rest the art on a postulate, treat their patients on the lines of their postulate. For they have not discovered, I think, an absolute hot or cold, dry or moist, that participates in no other form. But I think that they have at their disposal the same foods and the same drinks as we all use, and to one they add the attribute of being hot, to another, cold, to another, dry, to another, moist, since it would be futile to order a patient to take something hot, as he would at once ask, What hot thing? So that they must either talk nonsense or have recourse to one of these known substances. And if one hot thing happens to be astringent, and another hot thing insipid, and a third hot thing causes flatulence (for there are many various kinds of hot things, possessing many opposite powers), surely it will make a difference whether he administers the hot astringent thing, or the hot insipid thing, or that which is cold and astringent at the same time (for there is such a thing), or the cold insipid thing. For I am sure that each of these pairs produces exactly the opposite of that produced by the other, not only in a man, but in a leathern or wooden vessel, and in many other things less sensitive than man. For it is not the heat which possesses the great power, but the astringent and the insipid, and the other qualities I have mentioned, both in man and out of man, whether eaten or drunk, whether applied externally as ointment or as plaster.

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And I believe that of all the powersOr properties. none hold less sway in the body than cold and heat. My reasons are these. So long as the hot and cold in the body are mixed up together, they cause no pain. For the hot is tempered and moderated by the cold, and the cold by the hot. But when either is entirely separated from the other, then it causes pain. And at that season, when cold comes upon a man and causes him some pain, for that very reason internal heat first is present quickly and spontaneously, without needing any help or preparation. The result is the same, whether men be diseased or in health. For instance, if a man in health will cool his body in winter, either by a cold bath or in any other way, the more he cools it (provided that his body is not entirely frozen) the more he becomes hotter than before when he puts his clothes on and enters his shelter. Again, if he will make himself thoroughly hot by means of either a hot bath of a large fire, and afterwards wear the same clothes and stay in the same place as he did when chilled, he feels far colder and besides more shivery than before. Or if a man fan himself because of the stifling heat and make coolness for himself, on ceasing to do this in this way he will feel ten times the stifling heat felt by one who does nothing of the sort.

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Now the following is much stronger evidence still. All who go afoot through snow or great cold, and become over-chilled in feet, hands or head, suffer at night very severely from burning and tingling when they come into a warm place and wrap up; in some cases blisters arise like those caused by burning in fire. But it is not until they are warmed that they experience these symptoms. So ready is cold to pass into heat and heat into cold. I could give a multitude of other proofs. But in the case of sick folk, is it not those who have suffered from shivering in whom breaks out the most acute fever? And not only is it not powerful, but after a while does it not subside, generally without doing harm all the time it remains, hot as it is? And passing through all the body it ends in most cases in the feet, where the shivering and chill were most violent and lasted unusually long. Again, when the fever disappears with the breaking out of the perspiration, it cools the patient so that he is far colder than if he had never been attacked at all. What important or serious consequence, therefore, could come from that thing on which quickly supervenes in this way its exact opposite, spontaneously annulling its effect?Or power. Or what need has it of elaborate treatment?

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An opponent may retort, But patients whose fever comes from ardent fevers,καῦσος was almost certainly a form of remittent malaria. See my Malaria and Greek History (index). pneumonia, or other virulent disease, do not quickly get rid of their feverishness, and in these cases the heat and cold no longer alternate. Now I consider that herein lies my strongest evidence that men are not feverish merely through heat, and that it could not be the sole cause of the harm; the truth being that one and the same thing is both bitter and hot, or acid and hot, or salt and hot, with numerous other combinations, and cold again combines with other powers.Or properties. It is these things which cause the harm. Heat, too, is present, but merely as a concomitant, having the strength of the directing factor which is aggravated and increases with the other factor, but having no powerOr effect. greater than that which properly belongs to it.

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That this is so is plain if we consider the following pieces of evidence. First we have the more obvious symptoms, which all of us often experience and will continue so to do. In the first place, those of us who suffer from cold in the head, with discharge from the nostrils, generally find this discharge more acrid than that which previously formed there and daily passed from the nostrils; it makes the nose swell, and inflames it to an extremely fiery heat, as is shown if you put your hand upon it.Or, with the MSS. reading, And if you keep putting your hand to it, and the catarrh last a long time, etc. And if the disease be present for an unusually long time, the part actually becomes ulcered, although it is without flesh and hard. But in some way the heat of the nostril ceases, not when the discharge takes place and the inflammation is present, but when the running becomes thicker and less acrid, being matured and more mixed than it was before, then it is that the heat finally ceases. But in cases where the evil obviously comes from cold alone, unaccompanied by anything else, there is always the same change, heat following chill and chill heat, and these supervene at once, and need no coction. In all other instances, where acrid and unmixed humours come into play, I am confident that the cause is the same, and that restoration results from coction and mixture.

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Again, such discharges as settle in the eyes, possessing powerful, acrid humours of all sorts, ulcerate the eyelids, and in some cases eat into the parts on to which they run, the cheeks and under the eyes; and they rupture and eat through the covering of the eyeball. But pains, burning and intense inflammation prevail until the discharges are concocted and become thicker, so that rheum is formed from them. This coction is the result of mixture, compounding and digestion. Secondly, the discharges that settle in the throat, giving rise to soreness, angina, erysipelas and pneumonia, all these at first emit salt, watery and acrid humours, whereby the diseases are strengthened. But when they become thicker and more matured, and throw off all trace of their acridness, then the fevers too subside with the other symptoms that distress the patient. We must surely consider the cause of each complaint to be those things the presence of which of necessity produces a complaint of a specific kind, which ceases when they change into another combination. All conditions, then, resulting from heat or cold pure and simple, with no other powerOr quality. as a factor, must cease when heat changes into cold or cold into heat. This change takes place in the manner I have described above. Moreover, all other complaints to which man is liable arise from powers.Or qualities. Thus, when there is an out-pouring of the bitter principle, which we call yellow bile, great nausea, burning and weakness prevail. When the patient gets rid of it, sometimes by purgation, either spontaneous or by medicine, if the purging be seasonable he manifestly gets rid both of the pains and of the heat. But so long as these bitter particles are undissolved, undigested and uncompounded, by no possible means can the pains and fevers be stayed. And those who are attacked by pungent and acrid acids suffer greatly from frenzy, from gnawings of the bowels and chest, and from restlessness.Or distress. No relief from these symptoms is secured until the acidity is purged away, or calmed down and mixed with the other humours. But coction, alteration, thinning or thickening into the form of humours through other forms of all sorts (wherefrom crises also and fixing their periods derive great importance in cases of illness)—to all these things surely heat and cold are not in the least liable. For neither could either ferment or thicken. †For what shall we call it? Combinations of humours that exhibit a powerOr property. that varies with the various factors.There are many reasons for supposing that this sentence is either (a) in its wrong place, or (b) an interpolation. It seems quite irrelevant, and αὐτῶν should grammatically refer to τὸ θερμὸν and τὸ ψυχρόν, but there is not a crasis of these, but only of χυμοί. Hot and cold mixed produce only hot or cold, not a crasis. The sentence might be more relevantly placed at the end of Chapter XVIII, as an explanation of the process ἀποκαθίστασθαι πεφθέντα καὶ κρηθέντα. But transposition will not remove the other difficulties of the sentence. What is αὐτό? Health or disease? If health, then there is but one crasis producing it, not many, having various properties. If disease, then it cannot be a crasis at all, but ἀκρασία. Finally, ἄλλην πρὸς ἄλληλα is dubious Greek. The whole sentence looks like an interpolation, though it is hard to say why it was introduced. The scribe of M seems to have felt the difficulties, for he wrote κρῆσις, πλὴν for ἄλλην, and ἔχουσα.† Since the hot will give up its heat only when mixed with the cold, and the cold can be neutralized only by the hot. But all other components of man become milder and better the greater the number of other components with which they are mixed. A man is in the best possible condition when there is complete coction and rest, with no particular powerOr property. displayed. About this I think that I have given a full explanation.

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Certain physicians and philosophers assert that nobody can know medicine who is ignorant what a man is; he who would treat patients properly must, they say, learn this. But the question they raise is one for philosophy; it is the province of those who, like Empedocles, have written on natural science,About nature, how the universe was born and grew out of primal elements. We might almost trauslate φὐσις by evolution. what man is from the beginning, how he came into being at the first, and from what elements he was originally constructed. But my view is, first, that all that philosophers or physicians have said or written on natural science no more pertains to medicine than to painting.Or, perhaps, pertains even less to medicine than to literature. I also hold that clear knowledge about natural science can be acquired from medicine and from no other source, and that one can attain this knowledge when medicine itself has been properly comprehended, but till then it is quite impossible—I mean to possess this information, what man is, by what causes he is made, and similar points accurately. Since this at least I think a physician must know, and be at great pains to know, about natural science, if he is going to perform aught of his duty, what man is in relation to foods and drinks, and to habits generally, and what will be the effects of each on each individual. It is not sufficient to learn simply that cheese is a bad food, as it gives a pain to one who eats a surfeit of it; we must know what the pain is, the reasons for it, and which constituent of man is harmfully affected. For there are many other bad foods and bad drinks, which affect a man in different ways. I would therefore have the point put thus:—Undiluted wine, drunk in large quantity, produces a certain effect upon a man. All who know this would realise that this is a power of wine, and that wine itself is to blame,See Appendix on p. 64. and we know through what parts of a man it chiefly exerts this power. Such nicety of truth I wish to be manifest in all other instances. To take my former example, cheese does not harm all men alike; some can eat their fill of it without the slightest hurt, nay, those it agrees with are wonderfully strengthened thereby. Others come off badly. So the constitutions of these men differ, and the difference lies in the constituent of the body which is hostile to cheese, and is roused and stirred to action under its influence. Those in whom a humour of such a kind is present in greater quantity, and with greater control over the body, naturally suffer more severely. But if cheese were bad for the human constitution without exception, it would have hurt all. He who knows the above truths will not fall into the following errors.

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In convalescence from illness, and also in protracted illnesses, many disturbances occur, some spontaneously and some from things casually administered. I am aware that most physicians, like laymen, if the patient has done anything unusual near the day of the disturbance—taken a bath or a walk, or eaten strange food, these things being all beneficial—nevertheless assign the cause to one of them, and, while ignorant of the real cause, stop what may have been of the greatest value. Instead of so doing they ought to know what will be the result of a bath unseasonably taken or of fatigue. For the trouble caused by each of these things is also peculiar to each, and so with surfeit or such and such food. Whoever therefore fails to know how each of these particulars affects a man will be able neither to discover their consequences nor to use them properly.

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I hold that it is also necessary to know which diseased states arise from powers and which from structures. What I mean is roughly that a power is an intensity and strength of the humours, while structures are the conformations to be found in the human body, some of which are hollow, taperingOr contracting. from wide to narrow; some are expanded, some hard and round, some broad and suspended, some stretched, some long, some close in texture, some loose in texture and fleshy, some spongy and porous. Now which structure is best adapted to draw and attract to itself fluid from the rest of the body, the hollow and expanded, the hard and round, or the hollow and tapering? I take it that the best adapted is the broad hollow that tapers. One should learn this thoroughly from unenclosed objectsi. e. objects that are not concealed, as are the internal organs. that can be seen. For example, if you open the mouth wide you will draw in no fluid; but if you protrude and contract it, compressing the lips, and then insert a tube, you can easily draw up any liquid you wish. Again, cupping instruments, which are broad and tapering, are so constructed on purpose to draw and attract blood from the flesh. There are many other instruments of a similar nature. Of the parts within the human frame, the bladder, the head, and the womb are of this structure. These obviously attract powerfully, and are always full of a fluid from without. Hollow and expanded parts are especially adapted for receiving fluid that has flowed into them, but are not so suited for attraction. Round solids will neither attract fluid nor receive it when it has flowed into them, for it would slip round and find no place on which to rest. Spongy, porous parts, like the spleen, lungs and breasts, will drink up readily what is in contact with them, and these parts especially harden and enlarge on the addition of fluid. They will not be evacuated every day, as are bowels, where the fluid is inside, while the bowels themselves contain it externally; but when one of these parts drinks up the fluid and takes it to itself, the porous hollows, even the small ones, are every-where filled, and the soft, porous part becomes hard and close, and neither digests nor discharges. This happens because of the nature of its structure. When wind and flatulence are produced in the body, the rumbling noise naturally occurs in the hollow, broad parts, such as the bowels and the chest. For when the flatulence does not fill a part so as to be at rest, but moves and changes its position, it cannot be but that thereby noise and perceptible movements take place. In soft, fleshy parts occur numbness and obstructions, such as happen in apoplexy. And when flatulence meets a broad, resisting body, and rushes on it, and this happens by nature to be neither strong so as to endure its violence without harm, nor soft and porous so as to give way and admit it, but tender, fleshy, full of blood, and close, like the liver, because it is close and broad it resists without yielding, while the flatulence being checked increases and becomes stronger, dashing violently against the obstacle. But owing to its tenderness and the blood it contains, the part cannot be free from pain, and this is why the sharpest and most frequent pains occur in this region, and abscesses and tumours are very common. Violent pain, but much less severe, is also felt under the diaphragm. For the diaphragm is an extended, broad and resisting substance, of a stronger and more sinewy texture, and so there is less pain. But here too occur pains and tumours.

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There are many other structural forms, both internal and external, which differ widely from one another with regard to the experiences of a patient and of a healthy subject, such as whether the head be large or small, the neck thin or thick, long or short, the bowels long or round, the chest and ribs broad or narrow, and there are very many other things, the differences between which must all be known, so that knowledge of the causes of each thing may ensure that the proper precautions are taken.

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As I have said before, we must examine the powers of humours, and what the effect of each is upon man, and how they are related to one another. Let me give an example. If a humour that is sweet assumes another form, not by admixture, but by a self-caused change, what will it first become, bitter, or salt, or astringent, or acid? I think acid. Therefore where sweet humour is the least suitable of all, acid humour is the next least suitable to be administered.Because:— +

(1) Health is a crasis of all the humours, none being in excess;

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(2) Sweet humour passes readily into acid;

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(3) Therefore, when sweet is the least suitable as a remedy (there being an excess of it already), acid (which is likely to be reinforced from the sweet) is the next least suitable.

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Kéhlewein’s text makes sense only if we transpose ὀξύς and γλυκύς. If you want ὀξὺς χυμός for crasis you can get it best by adding ὀξύς, next best by adding γλυκύς, which naturally turns into ὀξύς.

If a man can in this way conduct with success inquiries outside the human body, he will always be able to select the very best treatment. And the best is always that which is farthest removed from the unsuitable.

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+APPENDIX ON CHAPTER XX, p. 54. +

οἰνος ἄκρητος πολλὸς ποθεὶς διατίθησί πως τὸν ἄνθρωπον· καὶ πάντες ἄν αἱ εἰδότες τοῦτο γνοίησαν, ὅτι αὕτη δύναμις οἲνου καὶ αὺτὸς αἴτιος.

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So A; other MSS. have ἀσθενέα after ἄνθρωπον, ἰδόντες for οἱ εἰδότες, ἡ after αὕτη and ἐστιν after αὐτός.

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This passage contradicts the general argument, which is that in medicine statements about foods must not be made ἁπλῶς. Cheese is not bad food; it is only bad in certain conditions, and in certain ways, and at certain times. In these circumstances cheese has a δύναμις which does not belong to cheese in itself, but is latent until certain conditions call it forth. The error, says the writer, is not made in the case of wine. Everybody knows that in itself wine is not bad; it is drinking to excess, or at wrong times, which is mischievous.

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Now the reading of A (in fact any MS. reading) makes the writer say that wine itself is to blame (αὐτὸς αἴτιος)—an obvious contradiction of the general argument. My colleague the Rev. H. J. Chaytor most ingeniously suggests that αὐτός refers not to wine but to the man. He would therefore translate this δύναμις of wine and the man himself are to blame. But not only is it more natural for αὐτός to refer to wine, but the writer’s whole point is that in and by itself no food is αἴτιος. A food is a cause only in certain conditions, or, rather, certain conditions call forth certain δυνάμεις.

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I think, therefore, that the right reading is ὅτι τοιαύτη δύναμις οἵνου καὶ οὐκ αὐτὸς αἵτιος. Such and such a δύναμις of wine (i. e. a δύναμις caused by excess of wine acting upon the human φύσιις) is to blame and not mere wine by itself. ὅτι τοιαύτη might easily turn into ὅτι αὕτη, and the omission of οὐ by scribes is not uncommon.

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There is an attractive vigour about the reading ἰδόντες for οἱ εἰδότες, and it may be correct. Anybody can see at a glance that in the case of wine it is excess, etc., and not merely wine itself which is to blame.

+ + diff --git a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng2.xml b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng2.xml index 7aa98ff13..6733b0a8d 100644 --- a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng2.xml +++ b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng2.xml @@ -1,816 +1,151 @@ + - + On Ancient Medicine Hippocrates - W. H. S. Jones + William Henry Samuel Jones + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + National Library of Medicine History of Medicine Division + + Cultural Heritage Language Technologies + Kansas City Missouri + February 1, 2005 + Trustees of Tufts University Medford, MA - Perseus Project + Perseus Digital Library Project + Perseus 4.0 + tlg0627.tlg001.perseus-eng4.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + - + - Hippocrates Collected Works I + Hippocrates Hippocrates - W. H. S. Jones + William Henry Samuel Jones - Cambridge + London + William Heinemann Ltd. + Cambridge, MA Harvard University Press - 1923 + 1923 + 1 + Loeb Classical Library + Internet Archive - - - - -

Data Entry

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This pointer pattern extracts section.

+ + - English - Greek + English + Greek + + CTS and EpiDoc conversion. + - - -
- PART 1 -

I. ALL who, on attempting to speak or to write on medicine, - have assumed for themselves a postulate as a basis for their discussion--heat, - cold, moisture, dryness, or anything else that they may fancy--who narrow down - the causal principle of diseases and of death among men, and make it the same in - all cases, postulating one thing or two, all these obviously blunder in many - points even of their statements,Or, reading KAINOI=S1I - K.T.L., "of their - novelties." but they are most open to censure because they blunder in - what is an art, and one which all men use on the most important occasions, and - give the greatest honours to the good craftsmen and practitioners in it. Some - practitioners are poor, others very excellent ; this would not be the case if an - art of medicine did not exist at all, and had not been the subject of any - research and discovery, but all would be equally inexperienced and unlearned - therein, and the treatment of the sick would be in all respects haphazard. But - it is not so ; just as in all other arts the workers vary much in skill and in - knowledge,Or "manual skill" and "intelligence." so also is it - in the case of medicine. Wherefore I have deemed that it has

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no need of an empty postulate,Or, reading XAINH=S2, "a novel postulate." But the writer's objection is - not that the postulate is novel, but that it is a - postulate. A postulate, he says, is "empty" in a sphere where accurate and - verifiable knowledge is possible. Only in regions where science cannot - penetrate are U(POQE/S1EIS2 legitimate. - For this reason I read KENH=S2. as - do insoluble mysteries, about which any exponent must use a postulate, for - example, things in the sky or below the earth. If a man were to learn and - declare the state of these, neither to the speaker himself nor to his audience - would it be clear whether his statements were true or not. For there is no test - the application of which would give certainty.

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- PART 2 -

II. But medicine has long had all its means to hand, and has discovered both a - principle and a method, through which the discoveries made during a long period - are many and excellent, while full discovery will be made, if the inquirer be - competent, conduct his researches with knowledge of the discoveries already - made, and make them his starting-point. But anyone who, casting aside and - rejecting all these means, attempts to conduct research in any other way or - after another fashion, and asserts that he has found out anything, is and has - been the victim of deception.Or, with the reading suggested, "both - deceives and is deceived." His assertion is impossible ; the causes - of its impossibility I will endeavour to expound by a statement and exposition - of what the art is.Or, reading O(/TI - E)/S1TIN, "that the art really is an art, really - exists." In this way it will be manifest that by any other means - discoveries are impossible. But it is particularly necessary, in my opinion, for - one who discusses this art to discuss things familiar to ordinary folk. For the - subject of inquiry and discussion is simply and solely the sufferings of these - same

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ordinary folk when they are sick or in pain. Now to learn by themselves how their - own sufferings come about and cease, and the reasons why they get worse or - better, is not an easy task for ordinary folk ; but when these things have been - discovered and are set forth by another, it is simple. For merely an effort of - memory is required of each man when he listens to a statement of his - experiences. But if you miss being understood by laymen, and fail to put your - hearers in this condition, you will miss reality. Therefore for this reason also - medicine has no need of any postulate.

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- PART 3 -

III. For the art of medicine would never have been discovered to begin with, nor - would any medical research have been conducted--for there would have been no - need for medicine--if sick men had profited by the same mode of living and - regimen as the food, drink and mode of living of men in health, and if there had - been no other things for the sick better than these. But the fact is that sheer - necessity has caused men to seek and to find medicine, because sick men did not, - and do not, profit by the same regimen as do men in health. To trace the matter - yet further back, I hold that not even the mode of living and nourishment - enjoyed at the present time by men in health would have been discovered, had a - man been satisfied with the same food and drink as satisfy an ox, a horse, and - every animal save man, for example the products of the earth--fruits, wood and - grass. For on these they are nourished, grow, and live without pain, having no - need at all of any other kind of living. Yet I am of opinion that to begin with - man also used this sort of nourishment. Our present ways of living have, I - think, been

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discovered and elaborated during a long period of time. For many and terrible - were the sufferings of men from strong and brutish living when they partook of - crude foods, uncompounded and possessing great powersOr "strong - qualities."--the same in fact as men would suffer at the present day, - falling into violent pains and diseases quickly followed by death. Formerly - indeed they probably suffered less, because they were used to it, but they - suffered severely even then. The majority naturally perished, having too weak a - constitution, while the stronger resisted longer, just as at the present time - some men easily deal with strong foods, while others do so only with many severe - pains. For this reason the ancients too seem to me to have sought for - nourishment that harmonised with their constitution, and to have discovered that - which we use now. So from wheat, after steeping it, winnowing, grinding and - sifting, kneading, baking, they produced bread, and from barley they produced - cake. Experimenting with food they boiled or baked, after mixing, many other - things, combining the strong and uncompounded with the weaker components so as - to adapt all to the constitution and power of man, thinking that from foods - which, being too strong, the human constitution cannot assimilate when eaten, - will come pain, disease, and death, while from such as can be assimilated will - come nourishment, growth and health. To this discovery and research what juster - or more appropriate name

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could be given than medicine, seeing that it has been discovered with a view to - the health, saving and nourishment of man, in the place of that mode of living - from which came the pain, disease and death?

-
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- PART 4 -

IV. That it is not commonly considered an art is not unnatural, for it is - inappropriate to call anyone an artist in a craft in which none are laymen, but - all possess knowledge through being compelled to use it. Nevertheless the - discovery was a great one, implying much investigation and art. At any rate even - at the present day those who study gymnastics and athletic exercises are - constantly making some fresh discovery by investigating on the same method what - food and what drink are best assimilated and make a man grow stronger.

-
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- PART 5 -

V. Let us consider also whether the acknowledged art of medicine, that was - discovered for the treatment of the sick and has both a name and artists, has - the same object as the other art,I.e. that of dieting - in health. See Chapter VII. and what its origin was. In my opinion, - as I said at the beginning, nobody would have even sought for medicine, if the - same ways of life had suited both the sick and those in health. At any rate even - at the present day such as do not use medical science, foreigners and some - Greeks, live as do those in health, just as they please, and would neither forgo - nor restrict the satisfaction of any of their desires. But those who sought for - and discovered medicine, having the same intention as the men I discussed above, - in the first place, I think, lessened the bulk of the foods, and, without - altering their character, greatly diminished their quantity. But they found that - this treatment was

- -

sufficient only occasionally, and although clearly beneficial with some patients, - it was not so in all cases, as some were in such a condition that they could not - assimilate even small quantities of food. As such patients were thought to need - weaker nutriment, slops were invented by mixing with much water small quantities - of strong foods, and by taking away from their strength by compounding and - boiling. Those that were not able to assimilate them were refused even these - slops, and were reduced to taking liquids, these moreover being so regulated in - composition and quantity as to be moderate, and nothing was administered that - was either more or less, or less compounded, than it ought to be.

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- PART 6 -

VI. It must be clearly understood that some are not benefited in disease by - slops, but when they take them, their fever and pain grow manifestly worse, and - it is plain that what is taken proves nourishment and increase to the disease, - but wears away and enfeebles the body. Any men who in this condition take dry - food, barley-cake or bread, even though it be very little, will be hurt ten - times more, and more obviously, than if they take slops, simply and solely - because the food is too strong for their condition ; and a man to whom slops are - beneficial, but not solid food, will suffer much more harm if he eat more than - if he eat little, though he will feel pain even if he eat little. Now all the - causes of the pain can be reduced to one, namely, it is the strongest foods that - hurt a man most and most obviously, whether he be well or ill.

- -
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- PART 7 -

VII. What difference then can be seen between the purpose of him we call - physician, who is an acknowledged handicraftsman, the discoverer of the mode of - life and of the nourishment suitable for the sick, and his who discovered and - prepared originally nourishment for all men, which we now use, instead of the - old savage and brutish mode of living ? My own view is that their reasoning was - identical and the discovery one and the same. The one sought to do away with - those things which, when taken, the constitution of man in health could not - assimilate because of their brutish and uncompounded character, the other those - things which the temporary condition of an individual prevented him from - assimilating. How do the two pursuits differ, except in their scopeOr - "appearance." The two pursuits are really one, but they appear to a - superficial observer to differ. and in that the latter is more - complex and requires the greater application, while the former is the starting - point and came first in time ?

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- PART 8 -

VIII. A consideration of the diet of the sick, as compared with that of men in - health, would show that the diet of wild beasts and of animals generally is not - more harmful, as compared with that of men in health.The text here is very - uncertain ; I have combined that of Littré with that of Kéhlewein so as to - give a good sense : "The diet of men in health is as injurious to the sick - as the diet of wild beasts is to men in health." Take a man sick of a - disease which is neither severe and desperate nor yet altogether mild, but - likely to be pronounced under wrong treatment, and suppose that he resolved to - eat bread, and meat, or any other food that is beneficial to men in health, not - much of it, but far less than he could have taken had he been well ; take again - a man in health, with a constitution neither altogether weak nor altogether

- -

strong, and suppose he were to eat one of the foods that would be beneficial and - strength-giving to an ox or a horse, vetches or barley or something similar, not - much of it, but far less than he could take. If the man in health did this he - would suffer no less pain and danger than that sick man who took bread or - barley-cake at a time when he ought not. All this goes to prove that this art of - medicine, if research be continued on the same method, can all be - discovered.

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- PART 9 -

IX. If the matter were simple, as in these instances, and both sick and well were - hurt by too strong foods, benefited and nourished by weaker foods, there would - be no difficulty. For recourse to weaker food must have secured a great degree - of safety. But as it is, if a man takes insufficient food, the mistake is as - great as that of excess, and harms the man just as much. For abstinence has upon - the human constitution a most powerful effect, to enervate, to weaken and to - kill. Depletion produces many other evils, different from those of repletion, - but just as severe. Wherefore the greater complexity of these ills requires a - more exact method of treatment. For it is necessary to aim at some measure. But - no measure, neither number nor weight, by reference to which knowledge can be - made exact, can be found except bodily feeling. Wherefore it is laborious to - make knowledge so exact that only small mistakes are made here and there. And - that physician who makes only small mistakes would win my hearty praise. - Perfectly exact truth is but rarely to be seen. For most physicians seem to me - to be in the same

- -

case as bad pilots ; the mistakes of the latter are unnoticed so long as they are - steering in a calm, but, when a great storm overtakes them with a violent gale, - all men realise clearly then that it is their ignorance and blundering which - have lost the ship. So also when bad physicians, who comprise the great - majority, treat men who are suffering from no serious complaint, so that the - greatest blunders would not affect them seriously--such illnesses occur very - often, being far more common than serious disease--they are not shown up in - their true colours to laymen if their errors are confined to such cases ; but - when they meet with a severe, violent and dangerous illness, then it is that - their errors and want of skill are manifest to all. The punishment of the - impostor, whether sailor or doctor, is not postponed, but follows speedily.

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- PART 10 -

X. That the discomforts a man feels after unseasonable abstinence are no less - than those of unseasonable repletion, it were well to learn by a reference to - men in health. For some of them benefit by taking one meal only each day, and - because of this benefit they make a rule of having only one meal ; others again, - because of the same reason, that they are benefited thereby, take lunch also. - Moreover some have adopted one or other of these two practices for the sake of - pleasure or for some other chance reason. For the great majority of men can - follow indifferently either the one habit or the other, and can take lunch or - only one daily meal. Others again, if they were to do anything outside what is - beneficial, would not get off easily, but if they

- -

change their respective ways for a single day, nay, for a part of a single day, - they suffer excessive discomfort. Some, who lunch although lunch does not suit - them, forthwith become heavy and sluggish in body and in mind, a prey to - yawning, drowsiness and thirst ; while, if they go on to eat dinner as well, - flatulence follows with colic and violent diarrhœa. Many have found such action - to result in a serious illness, even if the quantity of food they take twice a - day be no greater than that which they have grown accustomed to digest once a - day. On the other hand, if a man who has grown accustomed, and has found it - beneficial, to take lunch, should miss taking it, he suffers, as soon as the - lunch-hour is passed, from prostrating weakness, trembling and faintness. - Hollowness of the eyes follows ; urine becomes paler and hotter, and the mouth - bitter ; his bowels seem to hang ; there come dizziness, depression and - listlessness. Besides all this, when he attempts to dine, he has the following - troubles : his food is less pleasant, and he cannot digest what formerly he used - to dine on when he had lunch. The mere food, descending into the bowels with - colic and noise, burns them, and disturbed sleep follows, accompanied by wild - and troubled dreams. Many such sufferers also have found these symptoms the - beginning of an illness.

-
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- PART 11 -

XI. It is necessary to inquire into the cause why such symptoms come to these - men. The one who had grown accustomed to one meal suffered, I think, because he - did not wait sufficient time, until his digestive organs had completely digested - and assimilated the food taken the day before, and until they had become empty - and quiet, but had taken fresh

- -

food while the organs were still in a state of hot turmoil and ferment. Such - organs digest much more slowly than others, and need longer rest and quiet. The - man accustomed to take lunch, since no fresh nourishment was given him as soon - as his body needed nourishment, when the previous meal was digested and there - was nothing to sustain him, naturally wastes and pines away through want. For I - put down to want all the symptoms which I have said such a man shows. And I - assert furthermore that all other men besides, who when in good health fast for - two or three days, will show the same symptoms as I have said those exhibit who - do not take their lunch.

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- PART 12 -

XII. Such constitutions, I contend, that rapidly and severely feel the effects of - errors, are weaker than the others. A weak man is but one step removed from a - sickly man, but a sickly man is weaker still, and is more apt to suffer distress - whenever he misses the due season. And, while the art can admit of such nice - exactness, it is difficult always to attain perfect accuracy. But many - departments of medicine have reached such a pitch of exactness, and I will speak - about them later. I declare, however, that we ought not to reject the ancient - art as non-existent, or on the ground that its method of inquiry is faulty, just - because it has not attained exactness in every detail, but much rather, because - it has been able by reasoning to rise from deep ignorance to approximately - perfect accuracy, I think we ought to admire the discoveries as the work, not of - chance, but of inquiry rightly and correctly conducted.

- -
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- PART 13 -

XIII. But I want to return to the theory of those who prosecute their researches - in the art after the novel fashion, building on a postulate. For if there be - such a thing as heat, or cold, or dryness, or moistness, which injures a man, it - necessarily follows that the scientific healer will counteract cold with hot, - hot with cold, moist with dry and dry with moist. Now suppose we have a man - whose constitution is not strong, but weaker than the average. Let this man's - food be wheat straight from the threshing-floor, unworked and uncooked, and raw - meat, and let his drink be water. The use of this diet will assuredly cause him - much severe suffering ; he will experience pains and physical weakness, his - digestion will be ruined and he will not be able to live long. Well, what remedy - should be prepared for a man in this condition ? Heat or cold or dryness or - moistness ? One of these, plainly ; for, according to the theory of the new - school, if the injury was caused by one of the opposites, the other opposite - ought to be a specific. Of course the most obvious as well as the most reliable - medicine would be to abandon his old diet, and to give him bread instead of - wheat, boiled meat instead of raw meat, and besides these things, a little wine - to drink. This change must restore him to his health, unless indeed it has been - entirely ruined by long continuance of the diet. What then shall we say ? That - he was suffering from cold, and that the taking of these hot things benefited - him ? Or shall we say the opposite ? I think that I have nonplussed my opponent. - For is it the heat of the wheat, or the cold, or the dryness, or the moistness, - that the baker took away from it ? For a thing which has been

- -

exposed to fire and to water, and has been made by many other things, each of - which has its own individual propertyOr "power." and nature, has - lost some of its qualities and has been mixed and combined with others.

-
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- PART 14 -

XIV. Of course I know also that it makes a difference to a man's body whether - bread be of bolted or of unbolted flour, whether it be of winnowed or of - unwinnowed wheat, whether it be kneaded with much water or with little, whether - it be thoroughly kneaded or unkneaded, whether it be thoroughly baked or - underbaked, and there are countless other differences. Barley-cake varies in - just the same way. The propertiesOr "powers." too of each variety - are powerful, and no one is like to any other. But how could he who has not - considered these truths, or who considers them without learning, know anything - about human ailments ? For each of these differences produces in a human being - an effect and a change of one sort or another, and upon these differences is - based all the dieting of a man, whether he be in health, recovering from an - illness, or suffering from one. Accordingly there could surely be nothing more - useful or more necessary to know than these things, and how the first - discoverers, pursuing their inquiries excellently and with suitable application - of reason to the nature of man, made their discoveries, and thought the art - worthy to be ascribed to a god, as in fact is the usual belief. For they did not - consider that the dry or the moist or the hot or the cold or anything else of - the kind injures a man, or that he has need of any such thing, but they - considered that it is the strength of each thing, that which, being too powerful - for the human constitution, it cannot assimilate, which causes harm, and

- -

this they sought to take away. The strongest part of the sweet is the sweetest, - of the bitter the most bitter, of the acid the most acid, and each of all the - component parts of man has its extreme. For these they saw are component parts - of man, and that they are injurious to him ; for there is in man salt and - bitter, sweet and acid, astringent and insipid,Or "flat," the opposite of - "sharp." and a vast number of other things, possessing properties of - all sorts, both in number and in strength. These, when mixed and compounded with - one another are neither apparent nor do they hurt a man ; but when one of them - is separated off, and stands alone, then it is apparent and hurts a man. - Moreover, of the foods that are unsuitable for us and hurt a man when taken, - each one of them is either bitter, or salt, or acid, or something else - uncompounded and strong, and for this reason we are disordered by them, just as - we are by the secretions separated off in the body. But all things that a man - eats or drinks are plainly altogether free from such an uncompounded and potent - humour, e.g. bread, cake, and suchlike, which men are - accustomed constantly to use in great quantity, except the highly seasoned - delicacies which gratify his appetite and greed. And from such foods, when - plentifully partaken of by a man, there arises no disorder at all or isolation - of the powersOr "properties." resident in the body, but strength, - growth and nourishment in great measure arise from them, for no other reason - except that they are well compounded, and have nothing undiluted and strong, but - form a single, simple whole.

- -
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- PART 15 -

XV. I am at a loss to understand how those who maintain the other view, and - abandon the old method to rest the art on a postulate, treat their patients on - the lines of their postulate. For they have not discovered, I think, an absolute - hot or cold, dry or moist, that participates in no other form. But I think that - they have at their disposal the same foods and the same drinks as we all use, - and to one they add the attribute of being hot, to another, cold, to another, - dry, to another, moist, since it would be futile to order a patient to take - something hot, as he would at once ask, " What hot thing ? " So that they must - either talk nonsense or have recourse to one of these known substances. And if - one hot thing happens to be astringent, and another hot thing insipid, and a - third hot thing causes flatulence (for there are many various kinds of hot - things, possessing many opposite powers), surely it will make a difference - whether he administers the hot astringent thing, or the hot insipid thing, or - that which is cold and astringent at the same time (for there is such a thing), - or the cold insipid thing. For I am sure that each of these pairs produces - exactly the opposite of that produced by the other, not only in a man, but in a - leathern or wooden vessel, and in many other things less sensitive than man. For - it is not the heat which possesses the great power, but the astringent and the - insipid, and the other qualities I have mentioned, both in man and out of man, - whether eaten or drunk, whether applied externally as ointment or as - plaster.

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- PART 16 -

XVI. And I believe that of all the powersOr "properties." none hold - less sway in the body than cold and heat. My reasons are these. So long as the - hot and cold in the body are mixed up together, they cause no pain. For the hot - is tempered and moderated by the cold, and the cold by the hot. But when either - is entirely separated from the other, then it causes pain. And at that season, - when cold comes upon a man and causes him some pain, for that very reason - internal heat first is present quickly and spontaneously, without needing any - help or preparation. The result is the same, whether men be diseased or in - health. For instance, if a man in health will cool his body in winter, either by - a cold bath or in any other way, the more he cools it (provided that his body is - not entirely frozen) the more he becomes hotter than before when he puts his - clothes on and enters his shelter. Again, if he will make himself thoroughly hot - by means of either a hot bath of a large fire, and afterwards wear the same - clothes and stay in the same place as he did when chilled, he feels far colder - and besides more shivery than before. Or if a man fan himself because of the - stifling heat and make coolness for himself, on ceasing to do this in this way - he will feel ten times the stifling heat felt by one who does nothing of the - sort.

-

Now the following is much stronger evidence still. All who go afoot through snow - or great cold, and become over-chilled in feet, hands or head, suffer at

- -

night very severely from burning and tingling when they come into a warm place - and wrap up ; in some cases blisters arise like those caused by burning in fire. - But it is not until they are warmed that they experience these symptoms. So - ready is cold to pass into heat and heat into cold. I could give a multitude of - other proofs. But in the case of sick folk, is it not those who have suffered - from shivering in whom breaks out the most acute fever? And not only is it not - powerful, but after a while does it not subside, generally without doing harm - all the time it remains, hot as it is? And passing through all the body it ends - in most cases in the feet, where the shivering and chill were most violent and - lasted unusually long. Again, when the fever disappears with the breaking out of - the perspiration, it cools the patient so that he is far colder than if he had - never been attacked at all. What important or serious consequence, therefore, - could come from that thing on which quickly supervenes in this way its exact - opposite, spontaneously annulling its effect?Or "power." Or what - need has it of elaborate treatment?

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- PART 17 -

XVII. An opponent may retort, "But patients whose fever comes from ardent - fevers,KAU=S1OS2 was almost - certainly a form of remittent malaria. See my Malaria and - Greek HistS1ry (index). - pneumonia, or other virulent disease, do not quickly get rid of their - feverishness, and in these cases the heat and cold no longer alternate." Now I - consider that herein lies my strongest evidence that men are not feverish merely - through heat, and that it could not be the sole cause of the harm ; the truth - being that one and the same thing is both bitter and hot, or acid and

- -

hot, or salt and hot, with numerous other combinations, and cold again combines - with other powers.Or "properties." It is these things which cause - the harm. Heat, too, is present, but merely as a concomitant, having the - strength of the directing factor which is aggravated and increases with the - other factor, but having no powerOr "effect." greater than that - which properly belongs to it.

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- PART 18 -

XVIII. That this is so is plain if we consider the following pieces of evidence. - First we have the more obvious symptoms, which all of us often experience and - will continue so to do. In the first place, those of us who suffer from cold in - the head, with discharge from the nostrils, generally find this discharge more - acrid than that which previously formed there and daily passed from the nostrils - ; it makes the nose swell, and inflames it to an extremely fiery heat, as is - shown if you put your hand upon it.Or, with the MSS. reading, "And if you - keep putting your hand to it, and the catarrh last a long time," etc. - And if the disease be present for an unusually long time, the part actually - becomes ulcered, although it is without flesh and hard. But in some way the heat - of the nostril ceases, not when the discharge takes place and the inflammation - is present, but when the running becomes thicker and less acrid, being matured - and more mixed than it was before, then it is that the heat finally ceases. But - in cases where the evil obviously comes from cold alone, unaccompanied by - anything else, there is always the same change, heat following chill and chill - heat, and these supervene at once, and need no coction. In all other - instances,

- -

where acrid and unmixed humours come into play, I am confident that the cause is - the same, and that restoration results from coction and mixture.

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- PART 19 -

XIX. Again, such discharges as settle in the eyes, possessing powerful, acrid - humours of all sorts, ulcerate the eyelids, and in some cases eat into the parts - on to which they run, the cheeks and under the eyes ; and they rupture and eat - through the covering of the eyeball. But pains, burning and intense inflammation - prevail until the discharges are concocted and become thicker, so that rheum is - formed from them. This coction is the result of mixture, compounding and - digestion. Secondly, the discharges that settle in the throat, giving rise to - soreness, angina, erysipelas and pneumonia, all these at first emit salt, watery - and acrid humours, whereby the diseases are strengthened. But when they become - thicker and more matured, and throw off all trace of their acridness, then the - fevers too subside with the other symptoms that distress the patient. We must - surely consider the cause of each complaint to be those things the presence of - which of necessity produces a complaint of a specific kind, which ceases when - they change into another combination. All conditions, then, resulting from heat - or cold pure and simple, with no other powerOr "quality." as a - factor, must cease when heat changes into cold or cold into heat. This change - takes place in the manner I have described above. Moreover, all other complaints - to which man is liable arise from powers.Or "qualities." Thus, when - there is an out-pouring of the bitter principle, which we call yellow

- -

bile, great nausea, burning and weakness prevail. When the patient gets rid of - it, sometimes by purgation, either spontaneous or by medicine, if the purging be - seasonable he manifestly gets rid both of the pains and of the heat. But so long - as these bitter particles are undissolved, undigested and uncompounded, by no - possible means can the pains and fevers be stayed. And those who are attacked by - pungent and acrid acids suffer greatly from frenzy, from gnawings of the bowels - and chest, and from restlessness.Or "distress." No relief from - these symptoms is secured until the acidity is purged away, or calmed down and - mixed with the other humours. But coction, alteration, thinning or thickening - into the form of humours through other forms of all sorts (wherefrom crises also - and fixing their periods derive great importance in cases of illness)--to all - these things surely heat and cold are not in the least liable. For neither could - either ferment or thicken. †For what shall we call it? Combinations of humours - that exhibit a powerOr "property." that varies with the various - factors.There are many reasons for supposing that this sentence is - either (a) in its wrong place, or (b) an interpolation. It seems quite irrelevant, and AU)TW=N should grammatically refer to TO\ QERMO\N and TO\ - YUXRO/N, but there is not a crasis of - these, but only of XUMOI/. Hot and cold - mixed produce only hot or cold, not a crasis. The sentence might be more - relevantly placed at the end of Chapter XVIII, as an explanation of the - process A)POKAQI/S1TAS1QAI PEFQE/NTA KAI\ - KRHQE/NTA. But transposition will not remove the other - difficulties of the sentence. What is AU)TO/? Health or disease? If health, then there is but one crasis producing it, not "many, having various - properties." If disease, then it cannot be a crasis at all, but A)KRAS1I/A. Finally, A)/LLHN PRO\S2 A)/LLHLA is dubious Greek. The whole sentence - looks like an interpolation, though it is hard to say why it was introduced. - The scribe of M seems to have felt the difficulties, for he wrote KRH=S1IS2, PLH\N for A)/LLHN, and E)/XOUS1A.† Since the hot will give up its heat only when - mixed with the cold, and the cold can be

- -

neutralized only by the hot. But all other components of man become milder and - better the greater the number of other components with which they are mixed. A - man is in the best possible condition when there is complete coction and rest, - with no particular powerOr "property." displayed. About this I - think that I have given a full explanation.

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- PART 20 -

XX. Certain physicians and philosophers assert that nobody can know medicine who - is ignorant what a man is ; he who would treat patients properly must, they say, - learn this. But the question they raise is one for philosophy ; it is the - province of those who, like Empedocles, have written on natural - science,About "nature," how the universe was born and grew out of - primal elements. We might almost trauslate FU)S1IS2 by "evolution." what man is from the - beginning, how he came into being at the first, and from what elements he was - originally constructed. But my view is, first, that all that philosophers or - physicians have said or written on natural science no more pertains to medicine - than to painting.Or, perhaps, "pertains even less to medicine than to - literature." I also hold that clear knowledge about natural science - can be acquired from medicine and from no other source, and that one can attain - this knowledge when medicine itself has been properly comprehended, but till - then it is quite impossible--I mean to possess this information, what man is, by - what causes he is made, and similar points accurately. Since this at least I - think a physician must know, and be at great pains to know, about natural - science, if he is going to perform aught of his duty, what man is in relation to - foods and drinks,

- -

and to habits generally, and what will be the effects of each on each individual. - It is not sufficient to learn simply that cheese is a bad food, as it gives a - pain to one who eats a surfeit of it ; we must know what the pain is, the - reasons for it, and which constituent of man is harmfully affected. For there - are many other bad foods and bad drinks, which affect a man in different ways. I - would therefore have the point put thus :--"Undiluted wine, drunk in large - quantity, produces a certain effect upon a man." All who know this would realise - that this is a power of wine, and that wine itself is to blame,See - Appendix on p. 64. and we know through what parts of a man it chiefly - exerts this power. Such nicety of truth I wish to be manifest in all other - instances. To take my former example, cheese does not harm all men alike ; some - can eat their fill of it without the slightest hurt, nay, those it agrees with - are wonderfully strengthened thereby. Others come off badly. So the - constitutions of these men differ, and the difference lies in the constituent of - the body which is hostile to cheese, and is roused and stirred to action under - its influence. Those in whom a humour of such a kind is present in greater - quantity, and with greater control over the body, naturally suffer more - severely. But if cheese were bad for the human constitution without exception, - it would have hurt all. He who knows the above truths will not fall into the - following errors.

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- PART 21 -

XXI. In convalescence from illness, and also in protracted illnesses, many - disturbances occur, some spontaneously and some from things casually

- -

administered. I am aware that most physicians, like laymen, if the patient has - done anything unusual near the day of the disturbance--taken a bath or a walk, - or eaten strange food, these things being all beneficial--nevertheless assign - the cause to one of them, and, while ignorant of the real cause, stop what may - have been of the greatest value. Instead of so doing they ought to know what - will be the result of a bath unseasonably taken or of fatigue. For the trouble - caused by each of these things is also peculiar to each, and so with surfeit or - such and such food. Whoever therefore fails to know how each of these - particulars affects a man will be able neither to discover their consequences - nor to use them properly.

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- PART 22 -

XXII. I hold that it is also necessary to know which diseased states arise from - powers and which from structures. What I mean is roughly that a "power" is an - intensity and strength of the humours, while "structures" are the conformations - to be found in the human body, some of which are hollow, taperingOr - "contracting." from wide to narrow ; some are expanded, some hard and - round, some broad and suspended, some stretched, some long, some close in - texture, some loose in texture and fleshy, some spongy and porous. Now which - structure is best adapted to draw and attract to itself fluid from the rest of - the body, the hollow and expanded, the hard and round, or the hollow and - tapering? I take it that the best adapted is the broad hollow that tapers. One - should learn this thoroughly from unenclosed objectsi. - e. objects that are not concealed, as are the internal - organs. that can be

- -

seen. For example, if you open the mouth wide you will draw in no fluid ; but if - you protrude and contract it, compressing the lips, and then insert a tube, you - can easily draw up any liquid you wish. Again, cupping instruments, which are - broad and tapering, are so constructed on purpose to draw and attract blood from - the flesh. There are many other instruments of a similar nature. Of the parts - within the human frame, the bladder, the head, and the womb are of this - structure. These obviously attract powerfully, and are always full of a fluid - from without. Hollow and expanded parts are especially adapted for receiving - fluid that has flowed into them, but are not so suited for attraction. Round - solids will neither attract fluid nor receive it when it has flowed into them, - for it would slip round and find no place on which to rest. Spongy, porous - parts, like the spleen, lungs and breasts, will drink up readily what is in - contact with them, and these parts especially harden and enlarge on the addition - of fluid. They will not be evacuated every day, as are bowels, where the fluid - is inside, while the bowels themselves contain it externally ; but when one of - these parts drinks up the fluid and takes it to itself, the porous hollows, even - the small ones, are every-where filled, and the soft, porous part becomes hard - and close, and neither digests nor discharges. This happens because of the - nature of its structure. When wind and flatulence are produced in the body, - the

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rumbling noise naturally occurs in the hollow, broad parts, such as the bowels - and the chest. For when the flatulence does not fill a part so as to be at rest, - but moves and changes its position, it cannot be but that thereby noise and - perceptible movements take place. In soft, fleshy parts occur numbness and - obstructions, such as happen in apoplexy. And when flatulence meets a broad, - resisting body, and rushes on it, and this happens by nature to be neither - strong so as to endure its violence without harm, nor soft and porous so as to - give way and admit it, but tender, fleshy, full of blood, and close, like the - liver, because it is close and broad it resists without yielding, while the - flatulence being checked increases and becomes stronger, dashing violently - against the obstacle. But owing to its tenderness and the blood it contains, the - part cannot be free from pain, and this is why the sharpest and most frequent - pains occur in this region, and abscesses and tumours are very common. Violent - pain, but much less severe, is also felt under the diaphragm. For the diaphragm - is an extended, broad and resisting substance, of a stronger and more sinewy - texture, and so there is less pain. But here too occur pains and tumours.

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- PART 23 -

XXIII. There are many other structural forms, both internal and external, which - differ widely from one another with regard to the experiences of a patient and - of a healthy subject, such as whether the head be large or small, the neck thin - or thick, long or short, the bowels long or round, the chest and

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ribs broad or narrow, and there are very many other things, the differences - between which must all be known, so that knowledge of the causes of each thing - may ensure that the proper precautions are taken.

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- PART 24 -

XXIV. As I have said before, we must examine the powers of humours, and what the - effect of each is upon man, and how they are related to one another. Let me give - an example. If a humour that is sweet assumes another form, not by admixture, - but by a self-caused change, what will it first become, bitter, or salt, or - astringent, or acid? I think acid. Therefore where sweet humour is the least - suitable of all, acid humour is the next least suitable to be - administered.Because :--

(1) Health is a crasis of all the humours, none being in excess ;

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(2) Sweet humour passes readily into acid ;

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(3) Therefore, when sweet is the least suitable as a remedy (there being - an excess of it already), acid (which is likely to be reinforced from - the sweet) is the next least suitable.

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Kéhlewein's text makes sense only if we transpose O)CU/S2 and GLUKU/S2. - If you want O)CU\S XUMO/S1 for crasis you can get it best by adding O)CU/S2, next best by adding GLUKU/S, which naturally turns into - O)CU/S2.

If a man can - in this way conduct with success inquiries outside the human body, he will - always be able to select the very best treatment. And the best is always that - which is farthest removed from the unsuitable.

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- APPENDIX -

APPENDIX ON CHAPTER XX, - p. 54.

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OI)NOS A)/KRHTOS POLLO\S2 POQEI\S2 DIATI/QHS1I/ PWS2 TO\N - A)/NQRWPON: KAI\ PA/NTES2 A)/N AI( EI)DO/TES2 TOU=TO GNOI/HS1AN, O(/TI - AU(/TH DU/NAMIS2 OI)\NOU KAI\ AU\TO\S2 AI)/TIOS2.

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So A ; other MSS. have A)S1QENE/A after - A)/NQRWPON, I)DO/NTES2 for OI( EI)DO/TES2, H( after AU(/TH and E)S1TIN after - AU)TO/S2.

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This passage contradicts the general argument, which is that in medicine - statements about foods must not be made A(PLW=S2. Cheese is not bad food ; it is only bad in certain - conditions, and in certain ways, and at certain times. In these circumstances - cheese has a DU/NAMIS which does not belong to - cheese in itself, but is latent until certain conditions call it forth. The - error, says the writer, is not made in the case of wine. Everybody knows that in - itself wine is not bad ; it is drinking to excess, or at wrong times, which is - mischievous.

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Now the reading of A (in fact any MS. reading) makes the writer say that wine - itself is to blame (AU)TO\S2 - AI)/TIOS2)--an obvious contradiction of the general argument. My - colleague the Rev. H. J. Chaytor most ingeniously suggests that AU)TO/S2 refers not to wine but to the man. He - would therefore translate "this DU/NAMIS of - wine and the man himself are to blame." But not only is it more natural for - AU)TO/S2 to refer to wine, but the - writer's whole point is that in and by itself no food is - AI)/TIOS2. A food is a cause only in - certain conditions, or, rather, certain conditions call forth certain DUNA/MEIS2.

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I think, therefore, that the right reading is O(/TI - TOIAU/TH DU/NAMIS2 OI(/NOU KAI\ OU)K AU)TO\S2 AI(/TIOS2. "Such and - such a DU/NAMIS of wine (i. - e. a DU/NAMIS2 caused by excess of - wine acting upon the human FU/SIIS2) is to - blame and not mere wine by itself." O(/TI - TOIAU/TH might easily turn into O(/TI - AU(/TH, and the omission of OU) - by scribes is not uncommon.

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There is an attractive vigour about the reading I)DO/NTES2 for OI( EI)DO/TES2, - and it may be correct. "Anybody can see at a glance that in the case of wine it - is excess, etc., and not merely wine itself which is to blame."

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All who, on attempting to speak or to write on medicine, have assumed for themselves a postulate as a basis for their discussion—heat, cold, moisture, dryness, or anything else that they may fancy—who narrow down the causal principle of diseases and of death among men, and make it the same in all cases, postulating one thing or two, all these obviously blunder in many points even of their statements,Or, reading καινοῖσι κτλ., of their novelties. but they are most open to censure because they blunder in what is an art, and one which all men use on the most important occasions, and give the greatest honours to the good craftsmen and practitioners in it. Some practitioners are poor, others very excellent; this would not be the case if an art of medicine did not exist at all, and had not been the subject of any research and discovery, but all would be equally inexperienced and unlearned therein, and the treatment of the sick would be in all respects haphazard. But it is not so; just as in all other arts the workers vary much in skill and in knowledge,Or manual skill and intelligence. so also is it in the case of medicine. Wherefore I have deemed that it has no need of an empty postulate,Or, reading χαινῆς, a novel postulate. But the writer’s objection is not that the postulate is novel, but that it is a postulate. A postulate, he says, is empty in a sphere where accurate and verifiable knowledge is possible. Only in regions where science cannot penetrate are ὑποθέσεις legitimate. For this reason I read κενῆς. as do insoluble mysteries, about which any exponent must use a postulate, for example, things in the sky or below the earth. If a man were to learn and declare the state of these, neither to the speaker himself nor to his audience would it be clear whether his statements were true or not. For there is no test the application of which would give certainty.

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But medicine has long had all its means to hand, and has discovered both a principle and a method, through which the discoveries made during a long period are many and excellent, while full discovery will be made, if the inquirer be competent, conduct his researches with knowledge of the discoveries already made, and make them his starting-point. But anyone who, casting aside and rejecting all these means, attempts to conduct research in any other way or after another fashion, and asserts that he has found out anything, is and has been the victim of deception.Or, with the reading suggested, both deceives and is deceived. His assertion is impossible; the causes of its impossibility I will endeavour to expound by a statement and exposition of what the art is.Or, reading ὅτι ἔστιν, that the art really is an art, really exists. In this way it will be manifest that by any other means discoveries are impossible. But it is particularly necessary, in my opinion, for one who discusses this art to discuss things familiar to ordinary folk. For the subject of inquiry and discussion is simply and solely the sufferings of these same ordinary folk when they are sick or in pain. Now to learn by themselves how their own sufferings come about and cease, and the reasons why they get worse or better, is not an easy task for ordinary folk; but when these things have been discovered and are set forth by another, it is simple. For merely an effort of memory is required of each man when he listens to a statement of his experiences. But if you miss being understood by laymen, and fail to put your hearers in this condition, you will miss reality. Therefore for this reason also medicine has no need of any postulate.

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For the art of medicine would never have been discovered to begin with, nor would any medical research have been conducted—for there would have been no need for medicine—if sick men had profited by the same mode of living and regimen as the food, drink and mode of living of men in health, and if there had been no other things for the sick better than these. But the fact is that sheer necessity has caused men to seek and to find medicine, because sick men did not, and do not, profit by the same regimen as do men in health. To trace the matter yet further back, I hold that not even the mode of living and nourishment enjoyed at the present time by men in health would have been discovered, had a man been satisfied with the same food and drink as satisfy an ox, a horse, and every animal save man, for example the products of the earth—fruits, wood and grass. For on these they are nourished, grow, and live without pain, having no need at all of any other kind of living. Yet I am of opinion that to begin with man also used this sort of nourishment. Our present ways of living have, I think, been discovered and elaborated during a long period of time. For many and terrible were the sufferings of men from strong and brutish living when they partook of crude foods, uncompounded and possessing great powersOr strong qualities.—the same in fact as men would suffer at the present day, falling into violent pains and diseases quickly followed by death. Formerly indeed they probably suffered less, because they were used to it, but they suffered severely even then. The majority naturally perished, having too weak a constitution, while the stronger resisted longer, just as at the present time some men easily deal with strong foods, while others do so only with many severe pains. For this reason the ancients too seem to me to have sought for nourishment that harmonised with their constitution, and to have discovered that which we use now. So from wheat, after steeping it, winnowing, grinding and sifting, kneading, baking, they produced bread, and from barley they produced cake. Experimenting with food they boiled or baked, after mixing, many other things, combining the strong and uncompounded with the weaker components so as to adapt all to the constitution and power of man, thinking that from foods which, being too strong, the human constitution cannot assimilate when eaten, will come pain, disease, and death, while from such as can be assimilated will come nourishment, growth and health. To this discovery and research what juster or more appropriate name could be given than medicine, seeing that it has been discovered with a view to the health, saving and nourishment of man, in the place of that mode of living from which came the pain, disease and death?

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That it is not commonly considered an art is not unnatural, for it is inappropriate to call anyone an artist in a craft in which none are laymen, but all possess knowledge through being compelled to use it. Nevertheless the discovery was a great one, implying much investigation and art. At any rate even at the present day those who study gymnastics and athletic exercises are constantly making some fresh discovery by investigating on the same method what food and what drink are best assimilated and make a man grow stronger.

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Let us consider also whether the acknowledged art of medicine, that was discovered for the treatment of the sick and has both a name and artists, has the same object as the other art,I.e. that of dieting in health. See Chapter VII. and what its origin was. In my opinion, as I said at the beginning, nobody would have even sought for medicine, if the same ways of life had suited both the sick and those in health. At any rate even at the present day such as do not use medical science, foreigners and some Greeks, live as do those in health, just as they please, and would neither forgo nor restrict the satisfaction of any of their desires. But those who sought for and discovered medicine, having the same intention as the men I discussed above, in the first place, I think, lessened the bulk of the foods, and, without altering their character, greatly diminished their quantity. But they found that this treatment was sufficient only occasionally, and although clearly beneficial with some patients, it was not so in all cases, as some were in such a condition that they could not assimilate even small quantities of food. As such patients were thought to need weaker nutriment, slops were invented by mixing with much water small quantities of strong foods, and by taking away from their strength by compounding and boiling. Those that were not able to assimilate them were refused even these slops, and were reduced to taking liquids, these moreover being so regulated in composition and quantity as to be moderate, and nothing was administered that was either more or less, or less compounded, than it ought to be.

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It must be clearly understood that some are not benefited in disease by slops, but when they take them, their fever and pain grow manifestly worse, and it is plain that what is taken proves nourishment and increase to the disease, but wears away and enfeebles the body. Any men who in this condition take dry food, barley-cake or bread, even though it be very little, will be hurt ten times more, and more obviously, than if they take slops, simply and solely because the food is too strong for their condition; and a man to whom slops are beneficial, but not solid food, will suffer much more harm if he eat more than if he eat little, though he will feel pain even if he eat little. Now all the causes of the pain can be reduced to one, namely, it is the strongest foods that hurt a man most and most obviously, whether he be well or ill.

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What difference then can be seen between the purpose of him we call physician, who is an acknowledged handicraftsman, the discoverer of the mode of life and of the nourishment suitable for the sick, and his who discovered and prepared originally nourishment for all men, which we now use, instead of the old savage and brutish mode of living ? My own view is that their reasoning was identical and the discovery one and the same. The one sought to do away with those things which, when taken, the constitution of man in health could not assimilate because of their brutish and uncompounded character, the other those things which the temporary condition of an individual prevented him from assimilating. How do the two pursuits differ, except in their scopeOr appearance. The two pursuits are really one, but they appear to a superficial observer to differ. and in that the latter is more complex and requires the greater application, while the former is the starting point and came first in time ?

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A consideration of the diet of the sick, as compared with that of men in health, would show that the diet of wild beasts and of animals generally is not more harmful, as compared with that of men in health.The text here is very uncertain; I have combined that of Littré with that of Kéhlewein so as to give a good sense: The diet of men in health is as injurious to the sick as the diet of wild beasts is to men in health. Take a man sick of a disease which is neither severe and desperate nor yet altogether mild, but likely to be pronounced under wrong treatment, and suppose that he resolved to eat bread, and meat, or any other food that is beneficial to men in health, not much of it, but far less than he could have taken had he been well; take again a man in health, with a constitution neither altogether weak nor altogether strong, and suppose he were to eat one of the foods that would be beneficial and strength-giving to an ox or a horse, vetches or barley or something similar, not much of it, but far less than he could take. If the man in health did this he would suffer no less pain and danger than that sick man who took bread or barley-cake at a time when he ought not. All this goes to prove that this art of medicine, if research be continued on the same method, can all be discovered.

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If the matter were simple, as in these instances, and both sick and well were hurt by too strong foods, benefited and nourished by weaker foods, there would be no difficulty. For recourse to weaker food must have secured a great degree of safety. But as it is, if a man takes insufficient food, the mistake is as great as that of excess, and harms the man just as much. For abstinence has upon the human constitution a most powerful effect, to enervate, to weaken and to kill. Depletion produces many other evils, different from those of repletion, but just as severe. Wherefore the greater complexity of these ills requires a more exact method of treatment. For it is necessary to aim at some measure. But no measure, neither number nor weight, by reference to which knowledge can be made exact, can be found except bodily feeling. Wherefore it is laborious to make knowledge so exact that only small mistakes are made here and there. And that physician who makes only small mistakes would win my hearty praise. Perfectly exact truth is but rarely to be seen. For most physicians seem to me to be in the same case as bad pilots; the mistakes of the latter are unnoticed so long as they are steering in a calm, but, when a great storm overtakes them with a violent gale, all men realise clearly then that it is their ignorance and blundering which have lost the ship. So also when bad physicians, who comprise the great majority, treat men who are suffering from no serious complaint, so that the greatest blunders would not affect them seriously—such illnesses occur very often, being far more common than serious disease—they are not shown up in their true colours to laymen if their errors are confined to such cases; but when they meet with a severe, violent and dangerous illness, then it is that their errors and want of skill are manifest to all. The punishment of the impostor, whether sailor or doctor, is not postponed, but follows speedily.

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That the discomforts a man feels after unseasonable abstinence are no less than those of unseasonable repletion, it were well to learn by a reference to men in health. For some of them benefit by taking one meal only each day, and because of this benefit they make a rule of having only one meal; others again, because of the same reason, that they are benefited thereby, take lunch also. Moreover some have adopted one or other of these two practices for the sake of pleasure or for some other chance reason. For the great majority of men can follow indifferently either the one habit or the other, and can take lunch or only one daily meal. Others again, if they were to do anything outside what is beneficial, would not get off easily, but if they change their respective ways for a single day, nay, for a part of a single day, they suffer excessive discomfort. Some, who lunch although lunch does not suit them, forthwith become heavy and sluggish in body and in mind, a prey to yawning, drowsiness and thirst; while, if they go on to eat dinner as well, flatulence follows with colic and violent diarrhœa. Many have found such action to result in a serious illness, even if the quantity of food they take twice a day be no greater than that which they have grown accustomed to digest once a day. On the other hand, if a man who has grown accustomed, and has found it beneficial, to take lunch, should miss taking it, he suffers, as soon as the lunch-hour is passed, from prostrating weakness, trembling and faintness. Hollowness of the eyes follows; urine becomes paler and hotter, and the mouth bitter; his bowels seem to hang; there come dizziness, depression and listlessness. Besides all this, when he attempts to dine, he has the following troubles: his food is less pleasant, and he cannot digest what formerly he used to dine on when he had lunch. The mere food, descending into the bowels with colic and noise, burns them, and disturbed sleep follows, accompanied by wild and troubled dreams. Many such sufferers also have found these symptoms the beginning of an illness.

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It is necessary to inquire into the cause why such symptoms come to these men. The one who had grown accustomed to one meal suffered, I think, because he did not wait sufficient time, until his digestive organs had completely digested and assimilated the food taken the day before, and until they had become empty and quiet, but had taken fresh food while the organs were still in a state of hot turmoil and ferment. Such organs digest much more slowly than others, and need longer rest and quiet. The man accustomed to take lunch, since no fresh nourishment was given him as soon as his body needed nourishment, when the previous meal was digested and there was nothing to sustain him, naturally wastes and pines away through want. For I put down to want all the symptoms which I have said such a man shows. And I assert furthermore that all other men besides, who when in good health fast for two or three days, will show the same symptoms as I have said those exhibit who do not take their lunch.

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Such constitutions, I contend, that rapidly and severely feel the effects of errors, are weaker than the others. A weak man is but one step removed from a sickly man, but a sickly man is weaker still, and is more apt to suffer distress whenever he misses the due season. And, while the art can admit of such nice exactness, it is difficult always to attain perfect accuracy. But many departments of medicine have reached such a pitch of exactness, and I will speak about them later. I declare, however, that we ought not to reject the ancient art as non-existent, or on the ground that its method of inquiry is faulty, just because it has not attained exactness in every detail, but much rather, because it has been able by reasoning to rise from deep ignorance to approximately perfect accuracy, I think we ought to admire the discoveries as the work, not of chance, but of inquiry rightly and correctly conducted.

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But I want to return to the theory of those who prosecute their researches in the art after the novel fashion, building on a postulate. For if there be such a thing as heat, or cold, or dryness, or moistness, which injures a man, it necessarily follows that the scientific healer will counteract cold with hot, hot with cold, moist with dry and dry with moist. Now suppose we have a man whose constitution is not strong, but weaker than the average. Let this man’s food be wheat straight from the threshing-floor, unworked and uncooked, and raw meat, and let his drink be water. The use of this diet will assuredly cause him much severe suffering; he will experience pains and physical weakness, his digestion will be ruined and he will not be able to live long. Well, what remedy should be prepared for a man in this condition ? Heat or cold or dryness or moistness ? One of these, plainly; for, according to the theory of the new school, if the injury was caused by one of the opposites, the other opposite ought to be a specific. Of course the most obvious as well as the most reliable medicine would be to abandon his old diet, and to give him bread instead of wheat, boiled meat instead of raw meat, and besides these things, a little wine to drink. This change must restore him to his health, unless indeed it has been entirely ruined by long continuance of the diet. What then shall we say ? That he was suffering from cold, and that the taking of these hot things benefited him ? Or shall we say the opposite ? I think that I have nonplussed my opponent. For is it the heat of the wheat, or the cold, or the dryness, or the moistness, that the baker took away from it ? For a thing which has been exposed to fire and to water, and has been made by many other things, each of which has its own individual propertyOr power. and nature, has lost some of its qualities and has been mixed and combined with others.

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Of course I know also that it makes a difference to a man’s body whether bread be of bolted or of unbolted flour, whether it be of winnowed or of unwinnowed wheat, whether it be kneaded with much water or with little, whether it be thoroughly kneaded or unkneaded, whether it be thoroughly baked or underbaked, and there are countless other differences. Barley-cake varies in just the same way. The propertiesOr powers. too of each variety are powerful, and no one is like to any other. But how could he who has not considered these truths, or who considers them without learning, know anything about human ailments ? For each of these differences produces in a human being an effect and a change of one sort or another, and upon these differences is based all the dieting of a man, whether he be in health, recovering from an illness, or suffering from one. Accordingly there could surely be nothing more useful or more necessary to know than these things, and how the first discoverers, pursuing their inquiries excellently and with suitable application of reason to the nature of man, made their discoveries, and thought the art worthy to be ascribed to a god, as in fact is the usual belief. For they did not consider that the dry or the moist or the hot or the cold or anything else of the kind injures a man, or that he has need of any such thing, but they considered that it is the strength of each thing, that which, being too powerful for the human constitution, it cannot assimilate, which causes harm, and this they sought to take away. The strongest part of the sweet is the sweetest, of the bitter the most bitter, of the acid the most acid, and each of all the component parts of man has its extreme. For these they saw are component parts of man, and that they are injurious to him; for there is in man salt and bitter, sweet and acid, astringent and insipid,Or flat, the opposite of sharp. and a vast number of other things, possessing properties of all sorts, both in number and in strength. These, when mixed and compounded with one another are neither apparent nor do they hurt a man; but when one of them is separated off, and stands alone, then it is apparent and hurts a man. Moreover, of the foods that are unsuitable for us and hurt a man when taken, each one of them is either bitter, or salt, or acid, or something else uncompounded and strong, and for this reason we are disordered by them, just as we are by the secretions separated off in the body. But all things that a man eats or drinks are plainly altogether free from such an uncompounded and potent humour, e.g. bread, cake, and suchlike, which men are accustomed constantly to use in great quantity, except the highly seasoned delicacies which gratify his appetite and greed. And from such foods, when plentifully partaken of by a man, there arises no disorder at all or isolation of the powersOr properties. resident in the body, but strength, growth and nourishment in great measure arise from them, for no other reason except that they are well compounded, and have nothing undiluted and strong, but form a single, simple whole.

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I am at a loss to understand how those who maintain the other view, and abandon the old method to rest the art on a postulate, treat their patients on the lines of their postulate. For they have not discovered, I think, an absolute hot or cold, dry or moist, that participates in no other form. But I think that they have at their disposal the same foods and the same drinks as we all use, and to one they add the attribute of being hot, to another, cold, to another, dry, to another, moist, since it would be futile to order a patient to take something hot, as he would at once ask, What hot thing? So that they must either talk nonsense or have recourse to one of these known substances. And if one hot thing happens to be astringent, and another hot thing insipid, and a third hot thing causes flatulence (for there are many various kinds of hot things, possessing many opposite powers), surely it will make a difference whether he administers the hot astringent thing, or the hot insipid thing, or that which is cold and astringent at the same time (for there is such a thing), or the cold insipid thing. For I am sure that each of these pairs produces exactly the opposite of that produced by the other, not only in a man, but in a leathern or wooden vessel, and in many other things less sensitive than man. For it is not the heat which possesses the great power, but the astringent and the insipid, and the other qualities I have mentioned, both in man and out of man, whether eaten or drunk, whether applied externally as ointment or as plaster.

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And I believe that of all the powersOr properties. none hold less sway in the body than cold and heat. My reasons are these. So long as the hot and cold in the body are mixed up together, they cause no pain. For the hot is tempered and moderated by the cold, and the cold by the hot. But when either is entirely separated from the other, then it causes pain. And at that season, when cold comes upon a man and causes him some pain, for that very reason internal heat first is present quickly and spontaneously, without needing any help or preparation. The result is the same, whether men be diseased or in health. For instance, if a man in health will cool his body in winter, either by a cold bath or in any other way, the more he cools it (provided that his body is not entirely frozen) the more he becomes hotter than before when he puts his clothes on and enters his shelter. Again, if he will make himself thoroughly hot by means of either a hot bath of a large fire, and afterwards wear the same clothes and stay in the same place as he did when chilled, he feels far colder and besides more shivery than before. Or if a man fan himself because of the stifling heat and make coolness for himself, on ceasing to do this in this way he will feel ten times the stifling heat felt by one who does nothing of the sort.

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Now the following is much stronger evidence still. All who go afoot through snow or great cold, and become over-chilled in feet, hands or head, suffer at night very severely from burning and tingling when they come into a warm place and wrap up; in some cases blisters arise like those caused by burning in fire. But it is not until they are warmed that they experience these symptoms. So ready is cold to pass into heat and heat into cold. I could give a multitude of other proofs. But in the case of sick folk, is it not those who have suffered from shivering in whom breaks out the most acute fever? And not only is it not powerful, but after a while does it not subside, generally without doing harm all the time it remains, hot as it is? And passing through all the body it ends in most cases in the feet, where the shivering and chill were most violent and lasted unusually long. Again, when the fever disappears with the breaking out of the perspiration, it cools the patient so that he is far colder than if he had never been attacked at all. What important or serious consequence, therefore, could come from that thing on which quickly supervenes in this way its exact opposite, spontaneously annulling its effect?Or power. Or what need has it of elaborate treatment?

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An opponent may retort, But patients whose fever comes from ardent fevers,καῦσος was almost certainly a form of remittent malaria. See my Malaria and Greek History (index). pneumonia, or other virulent disease, do not quickly get rid of their feverishness, and in these cases the heat and cold no longer alternate. Now I consider that herein lies my strongest evidence that men are not feverish merely through heat, and that it could not be the sole cause of the harm; the truth being that one and the same thing is both bitter and hot, or acid and hot, or salt and hot, with numerous other combinations, and cold again combines with other powers.Or properties. It is these things which cause the harm. Heat, too, is present, but merely as a concomitant, having the strength of the directing factor which is aggravated and increases with the other factor, but having no powerOr effect. greater than that which properly belongs to it.

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That this is so is plain if we consider the following pieces of evidence. First we have the more obvious symptoms, which all of us often experience and will continue so to do. In the first place, those of us who suffer from cold in the head, with discharge from the nostrils, generally find this discharge more acrid than that which previously formed there and daily passed from the nostrils; it makes the nose swell, and inflames it to an extremely fiery heat, as is shown if you put your hand upon it.Or, with the MSS. reading, And if you keep putting your hand to it, and the catarrh last a long time, etc. And if the disease be present for an unusually long time, the part actually becomes ulcered, although it is without flesh and hard. But in some way the heat of the nostril ceases, not when the discharge takes place and the inflammation is present, but when the running becomes thicker and less acrid, being matured and more mixed than it was before, then it is that the heat finally ceases. But in cases where the evil obviously comes from cold alone, unaccompanied by anything else, there is always the same change, heat following chill and chill heat, and these supervene at once, and need no coction. In all other instances, where acrid and unmixed humours come into play, I am confident that the cause is the same, and that restoration results from coction and mixture.

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Again, such discharges as settle in the eyes, possessing powerful, acrid humours of all sorts, ulcerate the eyelids, and in some cases eat into the parts on to which they run, the cheeks and under the eyes; and they rupture and eat through the covering of the eyeball. But pains, burning and intense inflammation prevail until the discharges are concocted and become thicker, so that rheum is formed from them. This coction is the result of mixture, compounding and digestion. Secondly, the discharges that settle in the throat, giving rise to soreness, angina, erysipelas and pneumonia, all these at first emit salt, watery and acrid humours, whereby the diseases are strengthened. But when they become thicker and more matured, and throw off all trace of their acridness, then the fevers too subside with the other symptoms that distress the patient. We must surely consider the cause of each complaint to be those things the presence of which of necessity produces a complaint of a specific kind, which ceases when they change into another combination. All conditions, then, resulting from heat or cold pure and simple, with no other powerOr quality. as a factor, must cease when heat changes into cold or cold into heat. This change takes place in the manner I have described above. Moreover, all other complaints to which man is liable arise from powers.Or qualities. Thus, when there is an out-pouring of the bitter principle, which we call yellow bile, great nausea, burning and weakness prevail. When the patient gets rid of it, sometimes by purgation, either spontaneous or by medicine, if the purging be seasonable he manifestly gets rid both of the pains and of the heat. But so long as these bitter particles are undissolved, undigested and uncompounded, by no possible means can the pains and fevers be stayed. And those who are attacked by pungent and acrid acids suffer greatly from frenzy, from gnawings of the bowels and chest, and from restlessness.Or distress. No relief from these symptoms is secured until the acidity is purged away, or calmed down and mixed with the other humours. But coction, alteration, thinning or thickening into the form of humours through other forms of all sorts (wherefrom crises also and fixing their periods derive great importance in cases of illness)—to all these things surely heat and cold are not in the least liable. For neither could either ferment or thicken. †For what shall we call it? Combinations of humours that exhibit a powerOr property. that varies with the various factors.There are many reasons for supposing that this sentence is either (a) in its wrong place, or (b) an interpolation. It seems quite irrelevant, and αὐτῶν should grammatically refer to τὸ θερμὸν and τὸ ψυχρόν, but there is not a crasis of these, but only of χυμοί. Hot and cold mixed produce only hot or cold, not a crasis. The sentence might be more relevantly placed at the end of Chapter XVIII, as an explanation of the process ἀποκαθίστασθαι πεφθέντα καὶ κρηθέντα. But transposition will not remove the other difficulties of the sentence. What is αὐτό? Health or disease? If health, then there is but one crasis producing it, not many, having various properties. If disease, then it cannot be a crasis at all, but ἀκρασία. Finally, ἄλλην πρὸς ἄλληλα is dubious Greek. The whole sentence looks like an interpolation, though it is hard to say why it was introduced. The scribe of M seems to have felt the difficulties, for he wrote κρῆσις, πλὴν for ἄλλην, and ἔχουσα.† Since the hot will give up its heat only when mixed with the cold, and the cold can be neutralized only by the hot. But all other components of man become milder and better the greater the number of other components with which they are mixed. A man is in the best possible condition when there is complete coction and rest, with no particular powerOr property. displayed. About this I think that I have given a full explanation.

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Certain physicians and philosophers assert that nobody can know medicine who is ignorant what a man is; he who would treat patients properly must, they say, learn this. But the question they raise is one for philosophy; it is the province of those who, like Empedocles, have written on natural science,About nature, how the universe was born and grew out of primal elements. We might almost trauslate φὐσις by evolution. what man is from the beginning, how he came into being at the first, and from what elements he was originally constructed. But my view is, first, that all that philosophers or physicians have said or written on natural science no more pertains to medicine than to painting.Or, perhaps, pertains even less to medicine than to literature. I also hold that clear knowledge about natural science can be acquired from medicine and from no other source, and that one can attain this knowledge when medicine itself has been properly comprehended, but till then it is quite impossible—I mean to possess this information, what man is, by what causes he is made, and similar points accurately. Since this at least I think a physician must know, and be at great pains to know, about natural science, if he is going to perform aught of his duty, what man is in relation to foods and drinks, and to habits generally, and what will be the effects of each on each individual. It is not sufficient to learn simply that cheese is a bad food, as it gives a pain to one who eats a surfeit of it; we must know what the pain is, the reasons for it, and which constituent of man is harmfully affected. For there are many other bad foods and bad drinks, which affect a man in different ways. I would therefore have the point put thus:—Undiluted wine, drunk in large quantity, produces a certain effect upon a man. All who know this would realise that this is a power of wine, and that wine itself is to blame,See Appendix on p. 64. and we know through what parts of a man it chiefly exerts this power. Such nicety of truth I wish to be manifest in all other instances. To take my former example, cheese does not harm all men alike; some can eat their fill of it without the slightest hurt, nay, those it agrees with are wonderfully strengthened thereby. Others come off badly. So the constitutions of these men differ, and the difference lies in the constituent of the body which is hostile to cheese, and is roused and stirred to action under its influence. Those in whom a humour of such a kind is present in greater quantity, and with greater control over the body, naturally suffer more severely. But if cheese were bad for the human constitution without exception, it would have hurt all. He who knows the above truths will not fall into the following errors.

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In convalescence from illness, and also in protracted illnesses, many disturbances occur, some spontaneously and some from things casually administered. I am aware that most physicians, like laymen, if the patient has done anything unusual near the day of the disturbance—taken a bath or a walk, or eaten strange food, these things being all beneficial—nevertheless assign the cause to one of them, and, while ignorant of the real cause, stop what may have been of the greatest value. Instead of so doing they ought to know what will be the result of a bath unseasonably taken or of fatigue. For the trouble caused by each of these things is also peculiar to each, and so with surfeit or such and such food. Whoever therefore fails to know how each of these particulars affects a man will be able neither to discover their consequences nor to use them properly.

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I hold that it is also necessary to know which diseased states arise from powers and which from structures. What I mean is roughly that a power is an intensity and strength of the humours, while structures are the conformations to be found in the human body, some of which are hollow, taperingOr contracting. from wide to narrow; some are expanded, some hard and round, some broad and suspended, some stretched, some long, some close in texture, some loose in texture and fleshy, some spongy and porous. Now which structure is best adapted to draw and attract to itself fluid from the rest of the body, the hollow and expanded, the hard and round, or the hollow and tapering? I take it that the best adapted is the broad hollow that tapers. One should learn this thoroughly from unenclosed objectsi. e. objects that are not concealed, as are the internal organs. that can be seen. For example, if you open the mouth wide you will draw in no fluid; but if you protrude and contract it, compressing the lips, and then insert a tube, you can easily draw up any liquid you wish. Again, cupping instruments, which are broad and tapering, are so constructed on purpose to draw and attract blood from the flesh. There are many other instruments of a similar nature. Of the parts within the human frame, the bladder, the head, and the womb are of this structure. These obviously attract powerfully, and are always full of a fluid from without. Hollow and expanded parts are especially adapted for receiving fluid that has flowed into them, but are not so suited for attraction. Round solids will neither attract fluid nor receive it when it has flowed into them, for it would slip round and find no place on which to rest. Spongy, porous parts, like the spleen, lungs and breasts, will drink up readily what is in contact with them, and these parts especially harden and enlarge on the addition of fluid. They will not be evacuated every day, as are bowels, where the fluid is inside, while the bowels themselves contain it externally; but when one of these parts drinks up the fluid and takes it to itself, the porous hollows, even the small ones, are every-where filled, and the soft, porous part becomes hard and close, and neither digests nor discharges. This happens because of the nature of its structure. When wind and flatulence are produced in the body, the rumbling noise naturally occurs in the hollow, broad parts, such as the bowels and the chest. For when the flatulence does not fill a part so as to be at rest, but moves and changes its position, it cannot be but that thereby noise and perceptible movements take place. In soft, fleshy parts occur numbness and obstructions, such as happen in apoplexy. And when flatulence meets a broad, resisting body, and rushes on it, and this happens by nature to be neither strong so as to endure its violence without harm, nor soft and porous so as to give way and admit it, but tender, fleshy, full of blood, and close, like the liver, because it is close and broad it resists without yielding, while the flatulence being checked increases and becomes stronger, dashing violently against the obstacle. But owing to its tenderness and the blood it contains, the part cannot be free from pain, and this is why the sharpest and most frequent pains occur in this region, and abscesses and tumours are very common. Violent pain, but much less severe, is also felt under the diaphragm. For the diaphragm is an extended, broad and resisting substance, of a stronger and more sinewy texture, and so there is less pain. But here too occur pains and tumours.

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There are many other structural forms, both internal and external, which differ widely from one another with regard to the experiences of a patient and of a healthy subject, such as whether the head be large or small, the neck thin or thick, long or short, the bowels long or round, the chest and ribs broad or narrow, and there are very many other things, the differences between which must all be known, so that knowledge of the causes of each thing may ensure that the proper precautions are taken.

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As I have said before, we must examine the powers of humours, and what the effect of each is upon man, and how they are related to one another. Let me give an example. If a humour that is sweet assumes another form, not by admixture, but by a self-caused change, what will it first become, bitter, or salt, or astringent, or acid? I think acid. Therefore where sweet humour is the least suitable of all, acid humour is the next least suitable to be administered.Because:— +

(1) Health is a crasis of all the humours, none being in excess;

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(2) Sweet humour passes readily into acid;

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(3) Therefore, when sweet is the least suitable as a remedy (there being an excess of it already), acid (which is likely to be reinforced from the sweet) is the next least suitable.

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Kéhlewein’s text makes sense only if we transpose ὀξύς and γλυκύς. If you want ὀξὺς χυμός for crasis you can get it best by adding ὀξύς, next best by adding γλυκύς, which naturally turns into ὀξύς.

If a man can in this way conduct with success inquiries outside the human body, he will always be able to select the very best treatment. And the best is always that which is farthest removed from the unsuitable.

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+APPENDIX ON CHAPTER XX, p. 54. +

οἰνος ἄκρητος πολλὸς ποθεὶς διατίθησί πως τὸν ἄνθρωπον· καὶ πάντες ἄν αἱ εἰδότες τοῦτο γνοίησαν, ὅτι αὕτη δύναμις οἲνου καὶ αὺτὸς αἴτιος.

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So A; other MSS. have ἀσθενέα after ἄνθρωπον, ἰδόντες for οἱ εἰδότες, ἡ after αὕτη and ἐστιν after αὐτός.

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This passage contradicts the general argument, which is that in medicine statements about foods must not be made ἁπλῶς. Cheese is not bad food; it is only bad in certain conditions, and in certain ways, and at certain times. In these circumstances cheese has a δύναμις which does not belong to cheese in itself, but is latent until certain conditions call it forth. The error, says the writer, is not made in the case of wine. Everybody knows that in itself wine is not bad; it is drinking to excess, or at wrong times, which is mischievous.

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Now the reading of A (in fact any MS. reading) makes the writer say that wine itself is to blame (αὐτὸς αἴτιος)—an obvious contradiction of the general argument. My colleague the Rev. H. J. Chaytor most ingeniously suggests that αὐτός refers not to wine but to the man. He would therefore translate this δύναμις of wine and the man himself are to blame. But not only is it more natural for αὐτός to refer to wine, but the writer’s whole point is that in and by itself no food is αἴτιος. A food is a cause only in certain conditions, or, rather, certain conditions call forth certain δυνάμεις.

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I think, therefore, that the right reading is ὅτι τοιαύτη δύναμις οἵνου καὶ οὐκ αὐτὸς αἵτιος. Such and such a δύναμις of wine (i. e. a δύναμις caused by excess of wine acting upon the human φύσιις) is to blame and not mere wine by itself. ὅτι τοιαύτη might easily turn into ὅτι αὕτη, and the omission of οὐ by scribes is not uncommon.

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There is an attractive vigour about the reading ἰδόντες for οἱ εἰδότες, and it may be correct. Anybody can see at a glance that in the case of wine it is excess, etc., and not merely wine itself which is to blame.

 diff --git a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng3.xml b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng3.xml new file mode 100644 index 000000000..8641715f4 --- /dev/null +++ b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng3.xml @@ -0,0 +1,133 @@ + + + + + + + On Ancient Medicine + Hippocrates + Francis Adams + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + + National Library of Medicine History of Medicine Division + + + Cultural Heritage Language Technologies + Kansas City Missouri + February 20, 2003 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0627.tlg001.perseus-eng3.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + + + + + + The Genuine Works of Hippocrates + Hippocrates + Francis Adams + + New York + William Wood and Company + 1886 + + 1 + + Internet Archive + + + + + + + + +

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Whoever having undertaken to speak or write on Medicine, have first laid down for themselves some hypothesis to their argument, such as hot, or cold, or moist, or dry, or whatever else they choose (thus reducing their subject within a narrow compass, and supposing only one or two original causes of diseases or of death among mankind), are all clearly mistaken in much that they say; and this is the more reprehensible as relating to an art which all men avail themselves of on the most important occasions, and the good operators and practitioners in which they hold in especial honor. For there are practitioners, some bad and some far otherwise, which, if there had been no such thing as Medicine, and if nothing had been investigated or found out in it, would not have been the case, but all would have been equally unskilled and ignorant of it, and everything concerning the sick would have been directed by chance. But now it is not so; for, as in all the other arts, those who practise them differ much from one another in dexterity and knowledge, so is it in like manner with Medicine. Wherefore I have not thought that it stood in need of an empty hypothesis, like those subjects which are occult and dubious, in attempting to handle which it is necessary to use some hypothesis; as, for example, with regard to things above us and things below the earth; if any one should treat of these and undertake to declare how they are constituted, the reader or hearer could not find out, whether what is delivered be true or false; for there is nothing which can be referred to in order to discover the truth.

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But all these requisites belong of old to Medicine, and an origin and way have been found out, by which many and elegant discoveries have been made, during a length of time, and others will yet be found out, if a person possessed of the proper ability, and knowing those discoveries which have been made, should proceed from them to prosecute his investigations. But whoever, rejecting and despising all these, attempts to pursue another course and form of inquiry, and says he has discovered anything, is deceived himself and deceives others, for the thing is impossible. And for what reason it is impossible, I will now endeavor to explain, by stating and showing what the art really is. From this it will be manifest that discoveries cannot possibly be made in any other way. And most especially, it appears to me, that whoever treats of this art should treat of things which are familiar to the common people. For of nothing else will such a one have to inquire or treat, but of the diseases under which the common people have labored, which diseases and the causes of their origin and departure, their increase and decline, illiterate persons cannot easily find out themselves, but still it is easy for them to understand these things when discovered and expounded by others. For it is nothing more than that every one is put in mind of what had occurred to himself. But whoever does not reach the capacity of the illiterate vulgar and fails to make them listen to him, misses his mark. Wherefore, then, there is no necessity for any hypothesis.

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For the art of Medicine would not have been invented at first, nor would it have been made a subject of investigation (for there would have been no need of it), if when men are indisposed, the same food and other articles of regimen which they eat and drink when in good health were proper for them, and if no others were preferable to these. But now necessity itself made medicine to be sought out and discovered by men, since the same things when administered to the sick, which agreed with them when in good health, neither did nor do agree with them. But to go still further back, I hold that the diet and food which people in health now use would not have been discovered, provided it had suited with man to eat and drink in like manner as the ox, the horse, and all other animals, except man, do of the productions of the earth, such as fruits, weeds, and grass; for from such things these animals grow, live free of disease, and require no other kind of food. And, at first, I am of opinion that man used the same sort of food, and that the present articles of diet had been discovered and invented only after a long lapse of time, for when they suffered much and severely from strong and brutish diet, swallowing things which were raw, unmixed, and possessing great strength, they became exposed to strong pains and diseases, and to early deaths. It is likely, indeed, that from habit they would suffer less from these things then than we would now, but still they would suffer severely even then; and it is likely that the greater number, and those who had weaker constitutions, would all perish; whereas the stronger would hold out for a longer time, as even nowadays some, in consequence of using strong articles of food, get off with little trouble, but others with much pain and suffering. From this necessity it appears to me that they would search out the food befitting their nature, and thus discover that which we now use: and that from wheat, by macerating it, stripping it of its hull, grinding it all down, sifting, toasting, and baking it, they formed bread; and from barley they formed cake (maza), performing many operations in regard to it; they boiled, they roasted, they mixed, they diluted those things which are strong and of intense qualities with weaker things, fashioning them to the nature and powers of man, and considering that the stronger things Nature would not be able to manage if administered, and that from such things pains, diseases, and death would arise, but such as Nature could manage, that from them food, growth, and health, would arise. To such a discovery and investigation what more suitable name could one give than that of Medicine? since it was discovered for the health of man, for his nourishment and safety, as a substitute for that kind of diet by which pains, diseases, and deaths were occasioned.

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And if this is not held to be an art, I do not object. For it is not suitable to call any one an artist of that which no one is ignorant of, but which all know from usage and necessity. But still the discovery is a great one, and requiring much art and investigation. Wherefore those who devote themselves to gymnastics and training, are always making some new discovery, by pursuing the same line of inquiry, where, by eating and drinking certain things, they are improved and grow stronger than they were.

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Let us inquire then regarding what is admitted to be Medicine; namely, that which was invented for the sake of the sick, which possesses a name and practitioners, whether it also seeks to accomplish the same objects, and whence it derived its origin. To me, then, it appears, as I said at the commencement, that nobody would have sought for medicine at all, provided the same kinds of diet had suited with men in sickness as in good health. Wherefore, even yet, such races of men as make no use of medicine, namely, barbarians, and even certain of the Greeks, live in the same way when sick as when in health; that is to say, they take what suits their appetite, and neither abstain from, nor restrict themselves in anything for which they have a desire. But those who have cultivated and invented medicine, having the same object in view as those of whom I formerly spoke, in the first place, I suppose, diminished the quantity of the articles of food which they used, and this alone would be sufficient for certain of the sick, and be manifestly beneficial to them, although not to all, for there would be some so affected as not to be able to manage even small quantities of their usual food, and as such persons would seem to require something weaker, they invented soups, by mixing a few strong things with much water, and thus abstracting that which was strong in them by dilution and boiling. But such as could not manage even soups, laid them aside, and had recourse to drinks, and so regulated them as to mixture and quantity, that they were administered neither stronger nor weaker than what was required.

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But this ought to be well known, that soups do not agree with certain persons in their diseases, but, on the contrary, when administered both the fevers and the pains are exacerbated, and it becomes obvious that what was given has proved food and increase to the disease, but a wasting and weakness to the body. But whatever persons so affected partook of solid food, or cake, or bread, even in small quantity, would be ten times and more decidedly injured than those who had taken soups, for no other reason than from the strength of the food in reference to the affection; and to whomsoever it is proper to take soups and not eat solid food, such a one will be much more injured if he eat much than if he eat little, but even little food will be injurious to him. But all the causes of the sufferance refer themselves to this rule, that the strongest things most especially and decidedly hurt man, whether in health or in disease.

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What other object, then, had he in view who is called a physician, and is admitted to be a practitioner of the art, who found out the regimen and diet befitting the sick, than he who originally found out and prepared for all mankind that kind of food which we all now use, in place of the former savage and brutish mode of living? To me it appears that the mode is the same, and the discovery of a similar nature. The one sought to abstract those things which the constitution of man cannot digest, because of their wildness and intemperature, and the other those things which are beyond the powers of the affection in which any one may happen to be laid up. Now, how does the one differ from the other, except that the latter admits of greater variety, and requires more application, whereas the former was the commencement of the process?

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And if one would compare the diet of sick persons with that of persons in health, he will find it not more injurious than that of healthy persons in comparison with that of wild beasts and of other animals. For, suppose a man laboring under one of those diseases which are neither serious and unsupportable, nor yet altogether mild, but such as that, upon making any mistake in diet, it will become apparent, as if he should eat bread and flesh, or any other of those articles which prove beneficial to healthy persons, and that, too, not in great quantity, but much less than he could have taken when in good health; and that another man in good health, having a constitution neither very feeble, nor yet strong, eats of those things which are wholesome and strengthening to an ox or a horse, such as vetches, barley, and the like, and that, too, not in great quantity, but much less than he could take; the healthy person who did so would be subjected to no less disturbance and danger than the sick person who took bread or cake unseasonably. All these things are proofs that Medicine is to be prosecuted and discovered by the same method as the other.

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And if it were simply, as is laid down, that such things as are stronger prove injurious, but such as are weaker prove beneficial and nourishing, both to sick and healthy persons, it were an easy matter, for then the safest rule would be to circumscribe the diet to the lowest point. But then it is no less mistake, nor one that injuries a man less, provided a deficient diet, or one consisting of weaker things than what are proper, be administered. For, in the constitution of man, abstinence may enervate, weaken, and kill. And there are many other ills, different from those of repletion, but no less dreadful, arising from deficiency of food; wherefore the practice in those cases is more varied, and requires greater accuracy. For one must aim at attaining a certain measure, and yet this measure admits neither weight nor calculation of any kind, by which it may be accurately determined, unless it be the sensation of the body; wherefore it is a task to learn this accurately, so as not to commit small blunders either on the one side or the other, and in fact I would give great praise to the physician whose mistakes are small, for perfect accuracy is seldom to be seen, since many physicians seem to me to be in the same plight as bad pilots, who, if they commit mistakes while conducting the ship in a calm do not expose themselves, but when a storm and violent hurricane overtake them, they then, from their ignorance and mistakes, are discovered to be what they are, by all men, namely, in losing their ship. And thus bad and commonplace physicians, when they treat men who have no serious illness, in which case one may commit great mistakes without producing any formidable mischief (and such complaints occur much more frequently to men than dangerous ones): under these circumstances, when they commit mistakes, they do not expose themselves to ordinary men; but when they fall in with a great, a strong, and a dangerous disease, then their mistakes and want of skill are made apparent to all. Their punishment is not far off, but is swift in overtaking both the one and the other.He means both the pilot and physician.

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And that no less mischief happens to a man from unseasonable depletion than from repletion, may be clearly seen upon reverting to the consideration of persons in health. For, to some, with whom it agrees to take only one meal in the day, and they have arranged it so accordingly; whilst others, for the same reason, also take dinner, and this they do because they find it good for them, and not like those persons who, for pleasure or from any casual circumstance, adopt the one or the other custom and to the bulk of mankind it is of little consequence which of these rules they observe, that is to say, whether they make it a practice to take one or two meals. But there are certain persons who cannot readily change their diet with impunity; and if they make any alteration in it for one day, or even for a part of a day, are greatly injured thereby. Such persons, provided they take dinner when it is not their wont, immediately become heavy and inactive, both in body and mind, and are weighed down with yawning, slumbering, and thirst; and if they take supper in addition, they are seized with flatulence, tormina, and diarrhea, and to many this has been the commencement of a serious disease, when they have merely taken twice in a day the same food which they have been in the custom of taking once. And thus, also, if one who has been accustomed to dine, and this rule agrees with him, should not dine at the accustomed hour, he will straightway feel great loss of strength, trembling, and want of spirits, the eyes of such a person will become more pallid, his urine thick and hot, his mouth bitter; his bowels will seem, as it were, to hang loose; he will suffer from vertigo, lowness of spirit, and inactivity,- such are the effects; and if he should attempt to take at supper the same food which he was wont to partake of at dinner, it will appear insipid, and he will not be able to take it off; and these things, passing downwards with tormina and rumbling, burn up his bowels; he experiences insomnolency or troubled and disturbed dreams; and to many of them these symptoms are the commencement of some disease.

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But let us inquire what are the causes of these things which happened to them. To him, then, who was accustomed to take only one meal in the day, they happened because he did not wait the proper time, until his bowels had completely derived benefit from and had digested the articles taken at the preceding meal, and until his belly had become soft, and got into a state of rest, but he gave it a new supply while in a state of heat and fermentation, for such bellies digest much more slowly, and require more rest and ease. And as to him who had been accustomed to dinner, since, as soon as the body required food, and when the former meal was consumed, and he wanted refreshment, no new supply was furnished to it, he wastes and is consumed from want of food. For all the symptoms which I describe as befalling to this man I refer to want of food. And I also say that all men who, when in a state of health, remain for two or three days without food, experience the same unpleasant symptoms as those which I described in the case of him who had omitted to take dinner.

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Wherefore, I say, that such constitutions as suffer quickly and strongly from errors in diet, are weaker than others that do not; and that a weak person is in a state very nearly approaching to one in disease; but a person in disease is the weaker, and it is, therefore, more likely that he should suffer if he encounters anything that is unseasonable. It is difficult, seeing that there is no such accuracy in the Art, to hit always upon what is most expedient, and yet many cases occur in medicine which would require this accuracy, as we shall explain. But on that account, I say, we ought not to reject the ancient Art, as if it were not, and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well and properly made, and not from chance.

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But I wish the discourse to revert to the new method of those who prosecute their inquiries in the Art by hypothesis. For if hot, or cold, or moist, or dry, be that which proves injurious to man, and if the person who would treat him properly must apply cold to the hot, hot to the cold, moist to the dry, and dry to the moist- let me be presented with a man, not indeed one of a strong constitution, but one of the weaker, and let him eat wheat, such as it is supplied from the thrashing-floor, raw and unprepared, with raw meat, and let him drink water. By using such a diet I know that he will suffer much and severely, for he will experience pains, his body will become weak, and his bowels deranged, and he will not subsist long. What remedy, then, is to be provided for one so situated? Hot? or cold? or moist? or dry? For it is clear that it must be one or other of these. For, according to this principle, if it is one of the which is injuring the patient, it is to be removed by its contrary. But the surest and most obvious remedy is to change the diet which the person used, and instead of wheat to give bread, and instead of raw flesh, boiled, and to drink wine in addition to these; for by making these changes it is impossible but that he must get better, unless completely disorganized by time and diet. What, then, shall we say? whether that, as he suffered from cold, these hot things being applied were of use to him, or the contrary? I should think this question must prove a puzzler to whomsoever it is put. For whether did he who prepared bread out of wheat remove the hot, the cold, the moist, or the dry principle in it?- for the bread is consigned both to fire and to water, and is wrought with many things, each of which has its peculiar property and nature, some of which it loses, and with others it is diluted and mixed.

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And this I know, moreover, that to the human body it makes a great difference whether the bread be fine or coarse; of wheat with or without the hull, whether mixed with much or little water, strongly wrought or scarcely at all, baked or raw- and a multitude of similar differences; and so, in like manner, with the cake (maza); the powers of each, too, are great, and the one nowise like the other. Whoever pays no attention to these things, or, paying attention, does not comprehend them, how can he understand the diseases which befall a man? For, by every one of these things, a man is affected and changed this way or that, and the whole of his life is subjected to them, whether in health, convalescence, or disease. Nothing else, then, can be more important or more necessary to know than these things. So that the first inventors, pursuing their investigations properly, and by a suitable train of reasoning, according to the nature of man, made their discoveries, and thought the Art worthy of being ascribed to a god, as is the established belief. For they did not suppose that the dry or the moist, the hot or the cold, or any of these are either injurious to man, or that man stands in need of them, but whatever in each was strong, and more than a match for a man’s constitution, whatever he could not manage, that they held to be hurtful, and sought to remove. Now, of the sweet, the strongest is that which is intensely sweet; of the bitter, that which is intensely bitter; of the acid, that which is intensely acid; and of all things that which is extreme, for these things they saw both existing in man, and proving injurious to him. For there is in man the bitter and the salt, the sweet and the acid, the sour and the insipid, and a multitude of other things having all sorts of powers both as regards quantity and strength. These, when all mixed and mingled up with one another, are not apparent, neither do they hurt a man; but when any of them is separate, and stands by itself, then it becomes perceptible, and hurts a man. And thus, of articles of food, those which are unsuitable and hurtful to man when administered, every one is either bitter, or intensely so, or saltish or acid, or something else intense and strong, and therefore we are disordered by them in like manner as we are by the secretions in the body. But all those things which a man eats and drinks are devoid of any such intense and well-marked quality, such as bread, cake, and many other things of a similar nature which man is accustomed to use for food, with the exception of condiments and confectioneries, which are made to gratify the palate and for luxury. And from those things, when received into the body abundantly, there is no disorder nor dissolution of the powers belonging to the body; but strength, growth, and nourishment result from them, and this for no other reason than because they are well mixed, have nothing in them of an immoderate character, nor anything strong, but the whole forms one simple and not strong substance.

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I cannot think in what manner they who advance this doctrine, and transfer Art from the cause I have described to hypothesis, will cure men according to the principle which they have laid down. For, as far as I know, neither the hot nor the cold, nor the dry, nor the moist, has ever been found unmixed with any other quality; but I suppose they use the same articles of meat and drink as all we other men do. But to this substance they give the attribute of being hot, to that cold, to that dry, and to that moist. Since it would be absurd to advise the patient to take something hot, for he would straightway ask what it is? so that he must either play the fool, or have recourse to some one of the well known substances; and if this hot thing happen to be sour, and that hot thing insipid, and this hot thing has the power of raising a disturbance in the body (and there are many other kinds of heat, possessing many opposite powers), he will be obliged to administer some one of them, either the hot and the sour, or the hot and the insipid, or that which, at the same time, is cold and sour (for there is such a substance), or the cold and the insipid. For, as I think, the very opposite effects will result from either of these, not only in man, but also in a bladder, a vessel of wood, and in many other things possessed of far less sensibility than man; for it is not the heat which is possessed of great efficacy, but the sour and the insipid, and other qualities as described by me, both in man and out of man, and that whether eaten or drunk, rubbed in externally, and otherwise applied.

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But I think that of all the qualities heat and cold exercise the least operation in the body, for these reasons: as long time as hot and cold are mixed up with one another they do not give trouble, for the cold is attempered and rendered more moderate by the hot, and the hot by the cold; but when the one is wholly separate from the other, then it gives pain; and at that season when cold is applied it creates some pain to a man, but quickly, for that very reason, heat spontaneously arises in him without requiring any aid or preparation. And these things operate thus both upon men in health and in disease. For example, if a person in health wishes to cool his body during winter, and bathes either in cold water or in any other way, the more he does this, unless his body be fairly congealed, when he resumes his clothes and comes into a place of shelter, his body becomes more heated than before. And thus, too, if a person wish to be warmed thoroughly either by means of a hot bath or strong fire, and straight-way having the same clothing on, takes up his abode again in the place he was in when he became congealed, he will appear much colder, and more disposed to chills than before. And if a person fan himself on account of a suffocating heat, and having procured refrigeration for himself in this manner, cease doing so, the heat and suffocation will be ten times greater in his case than in that of a person who does nothing of the kind. And, to give a more striking example, persons travelling in the snow, or otherwise in rigorous weather, and contracting great cold in their feet, their hands, or their head, what do they not suffer from inflammation and tingling when they put on warm clothing and get into a hot place? In some instances, blisters arise as if from burning with fire, and they do not suffer from any of those unpleasant symptoms until they become heated. So readily does either of these pass into the other; and I could mention many other examples. And with regard to the sick, is it not in those who experience a rigor that the most acute fever is apt to break out? And yet not so strongly neither, but that it ceases in a short time, and, for the most part, without having occasioned much mischief; and while it remains, it is hot, and passing over the whole body, ends for the most part in the feet, where the chills and cold were most intense and lasted longest; and, when sweat supervenes, and the fever passes off, the patient is much colder than if he had not taken the fever at all. Why then should that which so quickly passes into the opposite extreme, and loses its own powers spontaneously, be reckoned a mighty and serious affair? And what necessity is there for any great remedy for it?

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One might here say- but persons in ardent fevers, pneumonia, and other formidable diseases, do not quickly get rid of the heat, nor experience these rapid alterations of heat and cold. And I reckon this very circumstance the strongest proof that it is not from heat simply that men get into the febrile state, neither is it the sole cause of the mischief, but that this species of heat is bitter, and that acid, and the other saltish, and many other varieties; and again there is cold combined with other qualities. These are what proves injurious; heat, it is true, is present also, possessed of strength as being that which conducts, is exacerbated and increased along with the other, but has no power greater than what is peculiar to itself.

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With regard to these symptoms, in the first place those are most obvious of which we have all often had experience. Thus, then, in such of us as have a coryza and defluxion from the nostrils, this discharge is much more acrid than that which formerly was formed in and ran from them daily; and it occasions swelling of the nose, and it inflames, being of a hot and extremely ardent nature, as you may know, if you apply your hand to the place; and, if the disease remains long, the part becomes ulcerated although destitute of flesh and hard; and the heat in the nose ceases, not when the defluxion takes place and the inflammation is present, but when the running becomes thicker and less acrid, and more mixed with the former secretion, then it is that the heat ceases. But in all those cases in which this decidedly proceeds from cold alone, without the concourse of any other quality, there is a change from cold to hot, and from hot to cold, and these quickly supervene, and require no coction. But all the others being connected, as I have said, with acrimony and intemperance of humors, pass off in this way by being mixed and concocted.

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But such defluxions as are determined to the eyes being possessed of strong and varied acrimonies, ulcerate the eyelids, and in some cases corrode the and parts below the eyes upon which they flow, and even occasion rupture and erosion of the tunic which surrounds the eyeball. But pain, heat, and extreme burning prevail until the defluxions are concocted and become thicker, and concretions form about the eyes, and the coction takes place from the fluids being mixed up, diluted, and digested together. And in defluxions upon the throat, from which are formed hoarseness, cynanche, crysipelas, and pneumonia, all these have at first saltish, watery, and acrid discharges, and with these the diseases gain strength. But when the discharges become thicker, more concocted, and are freed from all acrimony, then, indeed, the fevers pass away, and the other symptoms which annoyed the patient; for we must account those things the cause of each complaint, which, being present in a certain fashion, the complaint exists, but it ceases when they change to another combination. But those which originate from pure heat or cold, and do not participate in any other quality, will then cease when they undergo a change from cold to hot, and from hot to cold; and they change in the manner I have described before. Wherefore, all the other complaints to which man is subject arise from powers (qualities?). Thus, when there is an overflow of the bitter principle, which we call yellow bile, what anxiety, burning heat, and loss of strength prevail! but if relieved from it, either by being purged spontaneously, or by means of a medicine seasonably administered, the patient is decidedly relieved of the pains and heat; but while these things float on the stomach, unconcocted and undigested, no contrivance could make the pains and fever cease; and when there are acidities of an acrid and aeruginous character, what varieties of frenzy, gnawing pains in the bowels and chest, and inquietude, prevail! and these do not cease until the acidities be purged away, or are calmed down and mixed with other fluids. The coction, change, attenuation, and thickening into the form of humors, take place through many and various forms; therefore the crises and calculations of time are of great importance in such matters; but to all such changes hot and cold are but little exposed, for these are neither liable to putrefaction nor thickening. What then shall we say of the change? that it is a combination (crasis) of these humors having different powers toward one another. But the hot does not loose its heat when mixed with any other thing except the cold; nor again, the cold, except when mixed with the hot. But all other things connected with man become the more mild and better in proportion as they are mixed with the more things besides. But a man is in the best possible state when they are concocted and at rest, exhibiting no one peculiar quality; but I think I have said enough in explanation of them.

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Certain sophists and physicians say that it is not possible for any one to know medicine who does not know what man is [and how he was made and how constructed], and that whoever would cure men properly, must learn this in the first place. But this saying rather appertains to philosophy, as Empedocles and certain others have described what man in his origin is, and how he first was made and constructed. But I think whatever such has been said or written by sophist or physician concerning nature has less connection with the art of medicine than with the art of painting. And I think that one cannot know anything certain respecting nature from any other quarter than from medicine; and that this knowledge is to be attained when one comprehends the whole subject of medicine properly, but not until then; and I say that this history shows what man is, by what causes he was made, and other things accurately. Wherefore it appears to me necessary to every physician to be skilled in nature, and strive to know, if he would wish to perform his duties, what man is in relation to the articles of food and drink, and to his other occupations, and what are the effects of each of them to every one. And it is not enough to know simply that cheese is a bad article of food, as disagreeing with whoever eats of it to satiety, but what sort of disturbance it creates, and wherefore, and with what principle in man it disagrees; for there are many other articles of food and drink naturally bad which affect man in a different manner. Thus, to illustrate my meaning by an example, undiluted wine drunk in large quantity renders a man feeble; and everybody seeing this knows that such is the power of wine, and the cause thereof; and we know, moreover, on what parts of a man’s body it principally exerts its action; and I wish the same certainty to appear in other cases. For cheese (since we used it as an example) does not prove equally injurious to all men, for there are some who can take it to satiety without being hurt by it in the least, but, on the contrary, it is wonderful what strength it imparts to those it agrees with; but there are some who do not bear it well, their constitutions are different, and they differ in this respect, that what in their body is incompatible with cheese, is roused and put in commotion by such a thing; and those in whose bodies such a humor happens to prevail in greater quantity and intensity, are likely to suffer the more from it. But if the thing had been pernicious to of man, it would have hurt all. Whoever knows these things will not suffer from it.

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During convalescence from diseases, and also in protracted diseases, many disorders occur, some spontaneously, and some from certain things accidentally administered. I know that the common herd of physicians, like the vulgar, if there happen to have been any innovation made about that day, such as the bath being used, a walk taken, or any unusual food eaten, all which were better done than otherwise, attribute notwithstanding the cause of these disorders, to some of these things, being ignorant of the true cause but proscribing what may have been very proper. Now this ought not to be so; but one should know the effects of a bath or a walk unseasonably applied; for thus there will never be any mischief from these things, nor from any other thing, nor from repletion, nor from such and such an article of food. Whoever does not know what effect these things produce upon a man, cannot know the consequences which result from them, nor how to apply them.

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And it appears to me that one ought also to know what diseases arise in man from the powers, and what from the structures. What do I mean by this? By powers, I mean intense and strong juices; and by structures, whatever conformations there are in man. For some are hollow, and from broad contracted into narrow; some expanded, some hard and round, some broad and suspended,Meaning probably the diaphragm, with its membranes. some stretched, some long, some dense, some rare and succulent,Meaning the mammae, according to Heurnius. some spongy and of loose texture.Such as the spleen and lungs. Now, then, which of these figures is the best calculated to suck to itself and attract humidity from another body? Whether what is hollow and expanded, or what is solid and round, or what is hollow, and from broad, gradually turning narrow? I think such as from hollow and broad are contracted into narrow: this may be ascertained otherwise from obvious facts: thus, if you gape wide with the mouth you cannot draw in any liquid; but by protruding, contracting, and compressing the lips, and still more by using a tube, you can readily draw in whatever you wish. And thus, too, the instruments which are used for cupping are broad below and gradually become narrow, and are so constructed in order to suck and draw in from the fleshy parts. The nature and construction of the parts within a man are of a like nature; the bladder, the head, the uterus in woman; these parts clearly attract, and are always filled with a juice which is foreign to them. Those parts which are hollow and expanded are most likely to receive any humidity flowing into them, but cannot attract it in like manner. Those parts which are solid and round could not attract a humidity, nor receive it when it flows to them, for it would glide past, and find no place of rest on them. But spongy and rare parts, such as the spleen, the lungs, and the breasts, drink up especially the juices around them, and become hardened and enlarged by the accession of juices. Such things happen to these organs especially. For it is not with the spleen as with the stomach, in which there is a liquid, which it contains and evacuates every day; but when it (the spleen) drinks up and receives a fluid into itself, the hollow and lax parts of it are filled, even the small interstices; and, instead of being rare and soft, it becomes hard and dense, and it can neither digest nor discharge its contents: these things it suffers, owing to the nature of its structure. Those things which engender flatulence or tormina in the body, naturally do so in the hollow and broad parts of the body, such as the stomach and chest, where they produce rumbling noises; for when they do not fill the parts so as to be stationary, but have changes of place and movements, there must necessarily be noise and apparent movements from them. But such parts as are fleshy and soft, in these there occur torpor and obstructions, such as happen in apoplexy. But when it (the flatus?) encounters a broad and resisting structure, and rushes against such a part, and this happens when it is by nature not strong so as to be able to withstand it without suffering injury; nor soft and rare, so as to receive or yield to it, but tender, juicy, full of blood, and dense, like the liver, owing to its density and broadness, it resists and does not yield. But flatus, when it obtains admission, increases and becomes stronger, and rushes toward any resisting object; but owing to its tenderness, and the quantity of blood which it (the liver) contains, it cannot be without uneasiness; and for these reasons the most acute and frequent pains occur in the region of it, along with suppurations and chronic tumors (phymata). These symptoms also occur in the site of the diaphragm, but much less frequently; for the diaphragm is a broad, expanded, and resisting substance, of a nervous (tendinous?) and strong nature, and therefore less susceptible of pain; and yet pains and chronic abscesses do occur about it.

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There are both within and without the body many other kinds of structure, which differ much from one another as to sufferings both in health and disease; such as whether the head be small or large; the neck slender or thick, long or short; the belly long or round; the chest and ribs broad or narrow; and many others besides, all which you ought to be acquainted with, and their differences; so that knowing the causes of each, you may make the more accurate observations.

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And, as has been formerly stated, one ought to be acquainted with the powers of juices, and what action each of them has upon man, and their alliances towards one another. What I say is this: if a sweet juice change to another kind, not from any admixture, but because it has undergone a mutation within itself; what does it first become?- bitter? salt? austere? or acid? I think acid. And hence, an acid juice is the most improper of all things that can be administered in cases in which a sweet juice is the most proper. Thus, if one should succeed in his investigations of external things, he would be the better able always to select the best; for that is best which is farthest removed from that which is unwholesome.

+ + diff --git a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng4.xml b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng4.xml new file mode 100644 index 000000000..1f6f73d81 --- /dev/null +++ b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-eng4.xml @@ -0,0 +1,151 @@ + + + + + + + Ancient Medicine + Hippocrates + William Henry Samuel Jones + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + + National Library of Medicine History of Medicine Division + + + + Cultural Heritage Language Technologies + Kansas City Missouri + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0627.tlg001.perseus-eng4.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + + + + + + Hippocrates + Hippocrates + William Henry Samuel Jones + + London + William Heinemann Ltd. + Cambridge, MA + Harvard University Press + 1923 + + 1 + + Loeb Classical Library + Internet Archive + + + + + + + +

Data Entry

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This pointer pattern extracts section.

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All who, on attempting to speak or to write on medicine, have assumed for themselves a postulate as a basis for their discussion—heat, cold, moisture, dryness, or anything else that they may fancy—who narrow down the causal principle of diseases and of death among men, and make it the same in all cases, postulating one thing or two, all these obviously blunder in many points even of their statements,Or, reading καινοῖσι κτλ., of their novelties. but they are most open to censure because they blunder in what is an art, and one which all men use on the most important occasions, and give the greatest honours to the good craftsmen and practitioners in it. Some practitioners are poor, others very excellent; this would not be the case if an art of medicine did not exist at all, and had not been the subject of any research and discovery, but all would be equally inexperienced and unlearned therein, and the treatment of the sick would be in all respects haphazard. But it is not so; just as in all other arts the workers vary much in skill and in knowledge,Or manual skill and intelligence. so also is it in the case of medicine. Wherefore I have deemed that it has no need of an empty postulate,Or, reading χαινῆς, a novel postulate. But the writer’s objection is not that the postulate is novel, but that it is a postulate. A postulate, he says, is empty in a sphere where accurate and verifiable knowledge is possible. Only in regions where science cannot penetrate are ὑποθέσεις legitimate. For this reason I read κενῆς. as do insoluble mysteries, about which any exponent must use a postulate, for example, things in the sky or below the earth. If a man were to learn and declare the state of these, neither to the speaker himself nor to his audience would it be clear whether his statements were true or not. For there is no test the application of which would give certainty.

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But medicine has long had all its means to hand, and has discovered both a principle and a method, through which the discoveries made during a long period are many and excellent, while full discovery will be made, if the inquirer be competent, conduct his researches with knowledge of the discoveries already made, and make them his starting-point. But anyone who, casting aside and rejecting all these means, attempts to conduct research in any other way or after another fashion, and asserts that he has found out anything, is and has been the victim of deception.Or, with the reading suggested, both deceives and is deceived. His assertion is impossible; the causes of its impossibility I will endeavour to expound by a statement and exposition of what the art is.Or, reading ὅτι ἔστιν, that the art really is an art, really exists. In this way it will be manifest that by any other means discoveries are impossible. But it is particularly necessary, in my opinion, for one who discusses this art to discuss things familiar to ordinary folk. For the subject of inquiry and discussion is simply and solely the sufferings of these same ordinary folk when they are sick or in pain. Now to learn by themselves how their own sufferings come about and cease, and the reasons why they get worse or better, is not an easy task for ordinary folk; but when these things have been discovered and are set forth by another, it is simple. For merely an effort of memory is required of each man when he listens to a statement of his experiences. But if you miss being understood by laymen, and fail to put your hearers in this condition, you will miss reality. Therefore for this reason also medicine has no need of any postulate.

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For the art of medicine would never have been discovered to begin with, nor would any medical research have been conducted—for there would have been no need for medicine—if sick men had profited by the same mode of living and regimen as the food, drink and mode of living of men in health, and if there had been no other things for the sick better than these. But the fact is that sheer necessity has caused men to seek and to find medicine, because sick men did not, and do not, profit by the same regimen as do men in health. To trace the matter yet further back, I hold that not even the mode of living and nourishment enjoyed at the present time by men in health would have been discovered, had a man been satisfied with the same food and drink as satisfy an ox, a horse, and every animal save man, for example the products of the earth—fruits, wood and grass. For on these they are nourished, grow, and live without pain, having no need at all of any other kind of living. Yet I am of opinion that to begin with man also used this sort of nourishment. Our present ways of living have, I think, been discovered and elaborated during a long period of time. For many and terrible were the sufferings of men from strong and brutish living when they partook of crude foods, uncompounded and possessing great powersOr strong qualities.—the same in fact as men would suffer at the present day, falling into violent pains and diseases quickly followed by death. Formerly indeed they probably suffered less, because they were used to it, but they suffered severely even then. The majority naturally perished, having too weak a constitution, while the stronger resisted longer, just as at the present time some men easily deal with strong foods, while others do so only with many severe pains. For this reason the ancients too seem to me to have sought for nourishment that harmonised with their constitution, and to have discovered that which we use now. So from wheat, after steeping it, winnowing, grinding and sifting, kneading, baking, they produced bread, and from barley they produced cake. Experimenting with food they boiled or baked, after mixing, many other things, combining the strong and uncompounded with the weaker components so as to adapt all to the constitution and power of man, thinking that from foods which, being too strong, the human constitution cannot assimilate when eaten, will come pain, disease, and death, while from such as can be assimilated will come nourishment, growth and health. To this discovery and research what juster or more appropriate name could be given than medicine, seeing that it has been discovered with a view to the health, saving and nourishment of man, in the place of that mode of living from which came the pain, disease and death?

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That it is not commonly considered an art is not unnatural, for it is inappropriate to call anyone an artist in a craft in which none are laymen, but all possess knowledge through being compelled to use it. Nevertheless the discovery was a great one, implying much investigation and art. At any rate even at the present day those who study gymnastics and athletic exercises are constantly making some fresh discovery by investigating on the same method what food and what drink are best assimilated and make a man grow stronger.

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Let us consider also whether the acknowledged art of medicine, that was discovered for the treatment of the sick and has both a name and artists, has the same object as the other art,I.e. that of dieting in health. See Chapter VII. and what its origin was. In my opinion, as I said at the beginning, nobody would have even sought for medicine, if the same ways of life had suited both the sick and those in health. At any rate even at the present day such as do not use medical science, foreigners and some Greeks, live as do those in health, just as they please, and would neither forgo nor restrict the satisfaction of any of their desires. But those who sought for and discovered medicine, having the same intention as the men I discussed above, in the first place, I think, lessened the bulk of the foods, and, without altering their character, greatly diminished their quantity. But they found that this treatment was sufficient only occasionally, and although clearly beneficial with some patients, it was not so in all cases, as some were in such a condition that they could not assimilate even small quantities of food. As such patients were thought to need weaker nutriment, slops were invented by mixing with much water small quantities of strong foods, and by taking away from their strength by compounding and boiling. Those that were not able to assimilate them were refused even these slops, and were reduced to taking liquids, these moreover being so regulated in composition and quantity as to be moderate, and nothing was administered that was either more or less, or less compounded, than it ought to be.

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It must be clearly understood that some are not benefited in disease by slops, but when they take them, their fever and pain grow manifestly worse, and it is plain that what is taken proves nourishment and increase to the disease, but wears away and enfeebles the body. Any men who in this condition take dry food, barley-cake or bread, even though it be very little, will be hurt ten times more, and more obviously, than if they take slops, simply and solely because the food is too strong for their condition; and a man to whom slops are beneficial, but not solid food, will suffer much more harm if he eat more than if he eat little, though he will feel pain even if he eat little. Now all the causes of the pain can be reduced to one, namely, it is the strongest foods that hurt a man most and most obviously, whether he be well or ill.

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What difference then can be seen between the purpose of him we call physician, who is an acknowledged handicraftsman, the discoverer of the mode of life and of the nourishment suitable for the sick, and his who discovered and prepared originally nourishment for all men, which we now use, instead of the old savage and brutish mode of living ? My own view is that their reasoning was identical and the discovery one and the same. The one sought to do away with those things which, when taken, the constitution of man in health could not assimilate because of their brutish and uncompounded character, the other those things which the temporary condition of an individual prevented him from assimilating. How do the two pursuits differ, except in their scopeOr appearance. The two pursuits are really one, but they appear to a superficial observer to differ. and in that the latter is more complex and requires the greater application, while the former is the starting point and came first in time ?

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A consideration of the diet of the sick, as compared with that of men in health, would show that the diet of wild beasts and of animals generally is not more harmful, as compared with that of men in health.The text here is very uncertain; I have combined that of Littré with that of Kéhlewein so as to give a good sense: The diet of men in health is as injurious to the sick as the diet of wild beasts is to men in health. Take a man sick of a disease which is neither severe and desperate nor yet altogether mild, but likely to be pronounced under wrong treatment, and suppose that he resolved to eat bread, and meat, or any other food that is beneficial to men in health, not much of it, but far less than he could have taken had he been well; take again a man in health, with a constitution neither altogether weak nor altogether strong, and suppose he were to eat one of the foods that would be beneficial and strength-giving to an ox or a horse, vetches or barley or something similar, not much of it, but far less than he could take. If the man in health did this he would suffer no less pain and danger than that sick man who took bread or barley-cake at a time when he ought not. All this goes to prove that this art of medicine, if research be continued on the same method, can all be discovered.

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If the matter were simple, as in these instances, and both sick and well were hurt by too strong foods, benefited and nourished by weaker foods, there would be no difficulty. For recourse to weaker food must have secured a great degree of safety. But as it is, if a man takes insufficient food, the mistake is as great as that of excess, and harms the man just as much. For abstinence has upon the human constitution a most powerful effect, to enervate, to weaken and to kill. Depletion produces many other evils, different from those of repletion, but just as severe. Wherefore the greater complexity of these ills requires a more exact method of treatment. For it is necessary to aim at some measure. But no measure, neither number nor weight, by reference to which knowledge can be made exact, can be found except bodily feeling. Wherefore it is laborious to make knowledge so exact that only small mistakes are made here and there. And that physician who makes only small mistakes would win my hearty praise. Perfectly exact truth is but rarely to be seen. For most physicians seem to me to be in the same case as bad pilots; the mistakes of the latter are unnoticed so long as they are steering in a calm, but, when a great storm overtakes them with a violent gale, all men realise clearly then that it is their ignorance and blundering which have lost the ship. So also when bad physicians, who comprise the great majority, treat men who are suffering from no serious complaint, so that the greatest blunders would not affect them seriously—such illnesses occur very often, being far more common than serious disease—they are not shown up in their true colours to laymen if their errors are confined to such cases; but when they meet with a severe, violent and dangerous illness, then it is that their errors and want of skill are manifest to all. The punishment of the impostor, whether sailor or doctor, is not postponed, but follows speedily.

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That the discomforts a man feels after unseasonable abstinence are no less than those of unseasonable repletion, it were well to learn by a reference to men in health. For some of them benefit by taking one meal only each day, and because of this benefit they make a rule of having only one meal; others again, because of the same reason, that they are benefited thereby, take lunch also. Moreover some have adopted one or other of these two practices for the sake of pleasure or for some other chance reason. For the great majority of men can follow indifferently either the one habit or the other, and can take lunch or only one daily meal. Others again, if they were to do anything outside what is beneficial, would not get off easily, but if they change their respective ways for a single day, nay, for a part of a single day, they suffer excessive discomfort. Some, who lunch although lunch does not suit them, forthwith become heavy and sluggish in body and in mind, a prey to yawning, drowsiness and thirst; while, if they go on to eat dinner as well, flatulence follows with colic and violent diarrhœa. Many have found such action to result in a serious illness, even if the quantity of food they take twice a day be no greater than that which they have grown accustomed to digest once a day. On the other hand, if a man who has grown accustomed, and has found it beneficial, to take lunch, should miss taking it, he suffers, as soon as the lunch-hour is passed, from prostrating weakness, trembling and faintness. Hollowness of the eyes follows; urine becomes paler and hotter, and the mouth bitter; his bowels seem to hang; there come dizziness, depression and listlessness. Besides all this, when he attempts to dine, he has the following troubles: his food is less pleasant, and he cannot digest what formerly he used to dine on when he had lunch. The mere food, descending into the bowels with colic and noise, burns them, and disturbed sleep follows, accompanied by wild and troubled dreams. Many such sufferers also have found these symptoms the beginning of an illness.

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It is necessary to inquire into the cause why such symptoms come to these men. The one who had grown accustomed to one meal suffered, I think, because he did not wait sufficient time, until his digestive organs had completely digested and assimilated the food taken the day before, and until they had become empty and quiet, but had taken fresh food while the organs were still in a state of hot turmoil and ferment. Such organs digest much more slowly than others, and need longer rest and quiet. The man accustomed to take lunch, since no fresh nourishment was given him as soon as his body needed nourishment, when the previous meal was digested and there was nothing to sustain him, naturally wastes and pines away through want. For I put down to want all the symptoms which I have said such a man shows. And I assert furthermore that all other men besides, who when in good health fast for two or three days, will show the same symptoms as I have said those exhibit who do not take their lunch.

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Such constitutions, I contend, that rapidly and severely feel the effects of errors, are weaker than the others. A weak man is but one step removed from a sickly man, but a sickly man is weaker still, and is more apt to suffer distress whenever he misses the due season. And, while the art can admit of such nice exactness, it is difficult always to attain perfect accuracy. But many departments of medicine have reached such a pitch of exactness, and I will speak about them later. I declare, however, that we ought not to reject the ancient art as non-existent, or on the ground that its method of inquiry is faulty, just because it has not attained exactness in every detail, but much rather, because it has been able by reasoning to rise from deep ignorance to approximately perfect accuracy, I think we ought to admire the discoveries as the work, not of chance, but of inquiry rightly and correctly conducted.

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But I want to return to the theory of those who prosecute their researches in the art after the novel fashion, building on a postulate. For if there be such a thing as heat, or cold, or dryness, or moistness, which injures a man, it necessarily follows that the scientific healer will counteract cold with hot, hot with cold, moist with dry and dry with moist. Now suppose we have a man whose constitution is not strong, but weaker than the average. Let this man’s food be wheat straight from the threshing-floor, unworked and uncooked, and raw meat, and let his drink be water. The use of this diet will assuredly cause him much severe suffering; he will experience pains and physical weakness, his digestion will be ruined and he will not be able to live long. Well, what remedy should be prepared for a man in this condition ? Heat or cold or dryness or moistness ? One of these, plainly; for, according to the theory of the new school, if the injury was caused by one of the opposites, the other opposite ought to be a specific. Of course the most obvious as well as the most reliable medicine would be to abandon his old diet, and to give him bread instead of wheat, boiled meat instead of raw meat, and besides these things, a little wine to drink. This change must restore him to his health, unless indeed it has been entirely ruined by long continuance of the diet. What then shall we say ? That he was suffering from cold, and that the taking of these hot things benefited him ? Or shall we say the opposite ? I think that I have nonplussed my opponent. For is it the heat of the wheat, or the cold, or the dryness, or the moistness, that the baker took away from it ? For a thing which has been exposed to fire and to water, and has been made by many other things, each of which has its own individual propertyOr power. and nature, has lost some of its qualities and has been mixed and combined with others.

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Of course I know also that it makes a difference to a man’s body whether bread be of bolted or of unbolted flour, whether it be of winnowed or of unwinnowed wheat, whether it be kneaded with much water or with little, whether it be thoroughly kneaded or unkneaded, whether it be thoroughly baked or underbaked, and there are countless other differences. Barley-cake varies in just the same way. The propertiesOr powers. too of each variety are powerful, and no one is like to any other. But how could he who has not considered these truths, or who considers them without learning, know anything about human ailments ? For each of these differences produces in a human being an effect and a change of one sort or another, and upon these differences is based all the dieting of a man, whether he be in health, recovering from an illness, or suffering from one. Accordingly there could surely be nothing more useful or more necessary to know than these things, and how the first discoverers, pursuing their inquiries excellently and with suitable application of reason to the nature of man, made their discoveries, and thought the art worthy to be ascribed to a god, as in fact is the usual belief. For they did not consider that the dry or the moist or the hot or the cold or anything else of the kind injures a man, or that he has need of any such thing, but they considered that it is the strength of each thing, that which, being too powerful for the human constitution, it cannot assimilate, which causes harm, and this they sought to take away. The strongest part of the sweet is the sweetest, of the bitter the most bitter, of the acid the most acid, and each of all the component parts of man has its extreme. For these they saw are component parts of man, and that they are injurious to him; for there is in man salt and bitter, sweet and acid, astringent and insipid,Or flat, the opposite of sharp. and a vast number of other things, possessing properties of all sorts, both in number and in strength. These, when mixed and compounded with one another are neither apparent nor do they hurt a man; but when one of them is separated off, and stands alone, then it is apparent and hurts a man. Moreover, of the foods that are unsuitable for us and hurt a man when taken, each one of them is either bitter, or salt, or acid, or something else uncompounded and strong, and for this reason we are disordered by them, just as we are by the secretions separated off in the body. But all things that a man eats or drinks are plainly altogether free from such an uncompounded and potent humour, e.g. bread, cake, and suchlike, which men are accustomed constantly to use in great quantity, except the highly seasoned delicacies which gratify his appetite and greed. And from such foods, when plentifully partaken of by a man, there arises no disorder at all or isolation of the powersOr properties. resident in the body, but strength, growth and nourishment in great measure arise from them, for no other reason except that they are well compounded, and have nothing undiluted and strong, but form a single, simple whole.

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I am at a loss to understand how those who maintain the other view, and abandon the old method to rest the art on a postulate, treat their patients on the lines of their postulate. For they have not discovered, I think, an absolute hot or cold, dry or moist, that participates in no other form. But I think that they have at their disposal the same foods and the same drinks as we all use, and to one they add the attribute of being hot, to another, cold, to another, dry, to another, moist, since it would be futile to order a patient to take something hot, as he would at once ask, What hot thing? So that they must either talk nonsense or have recourse to one of these known substances. And if one hot thing happens to be astringent, and another hot thing insipid, and a third hot thing causes flatulence (for there are many various kinds of hot things, possessing many opposite powers), surely it will make a difference whether he administers the hot astringent thing, or the hot insipid thing, or that which is cold and astringent at the same time (for there is such a thing), or the cold insipid thing. For I am sure that each of these pairs produces exactly the opposite of that produced by the other, not only in a man, but in a leathern or wooden vessel, and in many other things less sensitive than man. For it is not the heat which possesses the great power, but the astringent and the insipid, and the other qualities I have mentioned, both in man and out of man, whether eaten or drunk, whether applied externally as ointment or as plaster.

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And I believe that of all the powersOr properties. none hold less sway in the body than cold and heat. My reasons are these. So long as the hot and cold in the body are mixed up together, they cause no pain. For the hot is tempered and moderated by the cold, and the cold by the hot. But when either is entirely separated from the other, then it causes pain. And at that season, when cold comes upon a man and causes him some pain, for that very reason internal heat first is present quickly and spontaneously, without needing any help or preparation. The result is the same, whether men be diseased or in health. For instance, if a man in health will cool his body in winter, either by a cold bath or in any other way, the more he cools it (provided that his body is not entirely frozen) the more he becomes hotter than before when he puts his clothes on and enters his shelter. Again, if he will make himself thoroughly hot by means of either a hot bath of a large fire, and afterwards wear the same clothes and stay in the same place as he did when chilled, he feels far colder and besides more shivery than before. Or if a man fan himself because of the stifling heat and make coolness for himself, on ceasing to do this in this way he will feel ten times the stifling heat felt by one who does nothing of the sort.

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Now the following is much stronger evidence still. All who go afoot through snow or great cold, and become over-chilled in feet, hands or head, suffer at night very severely from burning and tingling when they come into a warm place and wrap up; in some cases blisters arise like those caused by burning in fire. But it is not until they are warmed that they experience these symptoms. So ready is cold to pass into heat and heat into cold. I could give a multitude of other proofs. But in the case of sick folk, is it not those who have suffered from shivering in whom breaks out the most acute fever? And not only is it not powerful, but after a while does it not subside, generally without doing harm all the time it remains, hot as it is? And passing through all the body it ends in most cases in the feet, where the shivering and chill were most violent and lasted unusually long. Again, when the fever disappears with the breaking out of the perspiration, it cools the patient so that he is far colder than if he had never been attacked at all. What important or serious consequence, therefore, could come from that thing on which quickly supervenes in this way its exact opposite, spontaneously annulling its effect?Or power. Or what need has it of elaborate treatment?

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An opponent may retort, But patients whose fever comes from ardent fevers,καῦσος was almost certainly a form of remittent malaria. See my Malaria and Greek History (index). pneumonia, or other virulent disease, do not quickly get rid of their feverishness, and in these cases the heat and cold no longer alternate. Now I consider that herein lies my strongest evidence that men are not feverish merely through heat, and that it could not be the sole cause of the harm; the truth being that one and the same thing is both bitter and hot, or acid and hot, or salt and hot, with numerous other combinations, and cold again combines with other powers.Or properties. It is these things which cause the harm. Heat, too, is present, but merely as a concomitant, having the strength of the directing factor which is aggravated and increases with the other factor, but having no powerOr effect. greater than that which properly belongs to it.

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That this is so is plain if we consider the following pieces of evidence. First we have the more obvious symptoms, which all of us often experience and will continue so to do. In the first place, those of us who suffer from cold in the head, with discharge from the nostrils, generally find this discharge more acrid than that which previously formed there and daily passed from the nostrils; it makes the nose swell, and inflames it to an extremely fiery heat, as is shown if you put your hand upon it.Or, with the MSS. reading, And if you keep putting your hand to it, and the catarrh last a long time, etc. And if the disease be present for an unusually long time, the part actually becomes ulcered, although it is without flesh and hard. But in some way the heat of the nostril ceases, not when the discharge takes place and the inflammation is present, but when the running becomes thicker and less acrid, being matured and more mixed than it was before, then it is that the heat finally ceases. But in cases where the evil obviously comes from cold alone, unaccompanied by anything else, there is always the same change, heat following chill and chill heat, and these supervene at once, and need no coction. In all other instances, where acrid and unmixed humours come into play, I am confident that the cause is the same, and that restoration results from coction and mixture.

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Again, such discharges as settle in the eyes, possessing powerful, acrid humours of all sorts, ulcerate the eyelids, and in some cases eat into the parts on to which they run, the cheeks and under the eyes; and they rupture and eat through the covering of the eyeball. But pains, burning and intense inflammation prevail until the discharges are concocted and become thicker, so that rheum is formed from them. This coction is the result of mixture, compounding and digestion. Secondly, the discharges that settle in the throat, giving rise to soreness, angina, erysipelas and pneumonia, all these at first emit salt, watery and acrid humours, whereby the diseases are strengthened. But when they become thicker and more matured, and throw off all trace of their acridness, then the fevers too subside with the other symptoms that distress the patient. We must surely consider the cause of each complaint to be those things the presence of which of necessity produces a complaint of a specific kind, which ceases when they change into another combination. All conditions, then, resulting from heat or cold pure and simple, with no other powerOr quality. as a factor, must cease when heat changes into cold or cold into heat. This change takes place in the manner I have described above. Moreover, all other complaints to which man is liable arise from powers.Or qualities. Thus, when there is an out-pouring of the bitter principle, which we call yellow bile, great nausea, burning and weakness prevail. When the patient gets rid of it, sometimes by purgation, either spontaneous or by medicine, if the purging be seasonable he manifestly gets rid both of the pains and of the heat. But so long as these bitter particles are undissolved, undigested and uncompounded, by no possible means can the pains and fevers be stayed. And those who are attacked by pungent and acrid acids suffer greatly from frenzy, from gnawings of the bowels and chest, and from restlessness.Or distress. No relief from these symptoms is secured until the acidity is purged away, or calmed down and mixed with the other humours. But coction, alteration, thinning or thickening into the form of humours through other forms of all sorts (wherefrom crises also and fixing their periods derive great importance in cases of illness)—to all these things surely heat and cold are not in the least liable. For neither could either ferment or thicken. †For what shall we call it? Combinations of humours that exhibit a powerOr property. that varies with the various factors.There are many reasons for supposing that this sentence is either (a) in its wrong place, or (b) an interpolation. It seems quite irrelevant, and αὐτῶν should grammatically refer to τὸ θερμὸν and τὸ ψυχρόν, but there is not a crasis of these, but only of χυμοί. Hot and cold mixed produce only hot or cold, not a crasis. The sentence might be more relevantly placed at the end of Chapter XVIII, as an explanation of the process ἀποκαθίστασθαι πεφθέντα καὶ κρηθέντα. But transposition will not remove the other difficulties of the sentence. What is αὐτό? Health or disease? If health, then there is but one crasis producing it, not many, having various properties. If disease, then it cannot be a crasis at all, but ἀκρασία. Finally, ἄλλην πρὸς ἄλληλα is dubious Greek. The whole sentence looks like an interpolation, though it is hard to say why it was introduced. The scribe of M seems to have felt the difficulties, for he wrote κρῆσις, πλὴν for ἄλλην, and ἔχουσα.† Since the hot will give up its heat only when mixed with the cold, and the cold can be neutralized only by the hot. But all other components of man become milder and better the greater the number of other components with which they are mixed. A man is in the best possible condition when there is complete coction and rest, with no particular powerOr property. displayed. About this I think that I have given a full explanation.

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Certain physicians and philosophers assert that nobody can know medicine who is ignorant what a man is; he who would treat patients properly must, they say, learn this. But the question they raise is one for philosophy; it is the province of those who, like Empedocles, have written on natural science,About nature, how the universe was born and grew out of primal elements. We might almost trauslate φὐσις by evolution. what man is from the beginning, how he came into being at the first, and from what elements he was originally constructed. But my view is, first, that all that philosophers or physicians have said or written on natural science no more pertains to medicine than to painting.Or, perhaps, pertains even less to medicine than to literature. I also hold that clear knowledge about natural science can be acquired from medicine and from no other source, and that one can attain this knowledge when medicine itself has been properly comprehended, but till then it is quite impossible—I mean to possess this information, what man is, by what causes he is made, and similar points accurately. Since this at least I think a physician must know, and be at great pains to know, about natural science, if he is going to perform aught of his duty, what man is in relation to foods and drinks, and to habits generally, and what will be the effects of each on each individual. It is not sufficient to learn simply that cheese is a bad food, as it gives a pain to one who eats a surfeit of it; we must know what the pain is, the reasons for it, and which constituent of man is harmfully affected. For there are many other bad foods and bad drinks, which affect a man in different ways. I would therefore have the point put thus:—Undiluted wine, drunk in large quantity, produces a certain effect upon a man. All who know this would realise that this is a power of wine, and that wine itself is to blame,See Appendix on p. 64. and we know through what parts of a man it chiefly exerts this power. Such nicety of truth I wish to be manifest in all other instances. To take my former example, cheese does not harm all men alike; some can eat their fill of it without the slightest hurt, nay, those it agrees with are wonderfully strengthened thereby. Others come off badly. So the constitutions of these men differ, and the difference lies in the constituent of the body which is hostile to cheese, and is roused and stirred to action under its influence. Those in whom a humour of such a kind is present in greater quantity, and with greater control over the body, naturally suffer more severely. But if cheese were bad for the human constitution without exception, it would have hurt all. He who knows the above truths will not fall into the following errors.

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In convalescence from illness, and also in protracted illnesses, many disturbances occur, some spontaneously and some from things casually administered. I am aware that most physicians, like laymen, if the patient has done anything unusual near the day of the disturbance—taken a bath or a walk, or eaten strange food, these things being all beneficial—nevertheless assign the cause to one of them, and, while ignorant of the real cause, stop what may have been of the greatest value. Instead of so doing they ought to know what will be the result of a bath unseasonably taken or of fatigue. For the trouble caused by each of these things is also peculiar to each, and so with surfeit or such and such food. Whoever therefore fails to know how each of these particulars affects a man will be able neither to discover their consequences nor to use them properly.

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I hold that it is also necessary to know which diseased states arise from powers and which from structures. What I mean is roughly that a power is an intensity and strength of the humours, while structures are the conformations to be found in the human body, some of which are hollow, taperingOr contracting. from wide to narrow; some are expanded, some hard and round, some broad and suspended, some stretched, some long, some close in texture, some loose in texture and fleshy, some spongy and porous. Now which structure is best adapted to draw and attract to itself fluid from the rest of the body, the hollow and expanded, the hard and round, or the hollow and tapering? I take it that the best adapted is the broad hollow that tapers. One should learn this thoroughly from unenclosed objectsi. e. objects that are not concealed, as are the internal organs. that can be seen. For example, if you open the mouth wide you will draw in no fluid; but if you protrude and contract it, compressing the lips, and then insert a tube, you can easily draw up any liquid you wish. Again, cupping instruments, which are broad and tapering, are so constructed on purpose to draw and attract blood from the flesh. There are many other instruments of a similar nature. Of the parts within the human frame, the bladder, the head, and the womb are of this structure. These obviously attract powerfully, and are always full of a fluid from without. Hollow and expanded parts are especially adapted for receiving fluid that has flowed into them, but are not so suited for attraction. Round solids will neither attract fluid nor receive it when it has flowed into them, for it would slip round and find no place on which to rest. Spongy, porous parts, like the spleen, lungs and breasts, will drink up readily what is in contact with them, and these parts especially harden and enlarge on the addition of fluid. They will not be evacuated every day, as are bowels, where the fluid is inside, while the bowels themselves contain it externally; but when one of these parts drinks up the fluid and takes it to itself, the porous hollows, even the small ones, are every-where filled, and the soft, porous part becomes hard and close, and neither digests nor discharges. This happens because of the nature of its structure. When wind and flatulence are produced in the body, the rumbling noise naturally occurs in the hollow, broad parts, such as the bowels and the chest. For when the flatulence does not fill a part so as to be at rest, but moves and changes its position, it cannot be but that thereby noise and perceptible movements take place. In soft, fleshy parts occur numbness and obstructions, such as happen in apoplexy. And when flatulence meets a broad, resisting body, and rushes on it, and this happens by nature to be neither strong so as to endure its violence without harm, nor soft and porous so as to give way and admit it, but tender, fleshy, full of blood, and close, like the liver, because it is close and broad it resists without yielding, while the flatulence being checked increases and becomes stronger, dashing violently against the obstacle. But owing to its tenderness and the blood it contains, the part cannot be free from pain, and this is why the sharpest and most frequent pains occur in this region, and abscesses and tumours are very common. Violent pain, but much less severe, is also felt under the diaphragm. For the diaphragm is an extended, broad and resisting substance, of a stronger and more sinewy texture, and so there is less pain. But here too occur pains and tumours.

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There are many other structural forms, both internal and external, which differ widely from one another with regard to the experiences of a patient and of a healthy subject, such as whether the head be large or small, the neck thin or thick, long or short, the bowels long or round, the chest and ribs broad or narrow, and there are very many other things, the differences between which must all be known, so that knowledge of the causes of each thing may ensure that the proper precautions are taken.

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As I have said before, we must examine the powers of humours, and what the effect of each is upon man, and how they are related to one another. Let me give an example. If a humour that is sweet assumes another form, not by admixture, but by a self-caused change, what will it first become, bitter, or salt, or astringent, or acid? I think acid. Therefore where sweet humour is the least suitable of all, acid humour is the next least suitable to be administered.Because:— +

(1) Health is a crasis of all the humours, none being in excess;

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(2) Sweet humour passes readily into acid;

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(3) Therefore, when sweet is the least suitable as a remedy (there being an excess of it already), acid (which is likely to be reinforced from the sweet) is the next least suitable.

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Kéhlewein’s text makes sense only if we transpose ὀξύς and γλυκύς. If you want ὀξὺς χυμός for crasis you can get it best by adding ὀξύς, next best by adding γλυκύς, which naturally turns into ὀξύς.

If a man can in this way conduct with success inquiries outside the human body, he will always be able to select the very best treatment. And the best is always that which is farthest removed from the unsuitable.

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+APPENDIX ON CHAPTER XX, p. 54. +

οἰνος ἄκρητος πολλὸς ποθεὶς διατίθησί πως τὸν ἄνθρωπον· καὶ πάντες ἄν αἱ εἰδότες τοῦτο γνοίησαν, ὅτι αὕτη δύναμις οἲνου καὶ αὺτὸς αἴτιος.

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So A; other MSS. have ἀσθενέα after ἄνθρωπον, ἰδόντες for οἱ εἰδότες, ἡ after αὕτη and ἐστιν after αὐτός.

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This passage contradicts the general argument, which is that in medicine statements about foods must not be made ἁπλῶς. Cheese is not bad food; it is only bad in certain conditions, and in certain ways, and at certain times. In these circumstances cheese has a δύναμις which does not belong to cheese in itself, but is latent until certain conditions call it forth. The error, says the writer, is not made in the case of wine. Everybody knows that in itself wine is not bad; it is drinking to excess, or at wrong times, which is mischievous.

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Now the reading of A (in fact any MS. reading) makes the writer say that wine itself is to blame (αὐτὸς αἴτιος)—an obvious contradiction of the general argument. My colleague the Rev. H. J. Chaytor most ingeniously suggests that αὐτός refers not to wine but to the man. He would therefore translate this δύναμις of wine and the man himself are to blame. But not only is it more natural for αὐτός to refer to wine, but the writer’s whole point is that in and by itself no food is αἴτιος. A food is a cause only in certain conditions, or, rather, certain conditions call forth certain δυνάμεις.

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I think, therefore, that the right reading is ὅτι τοιαύτη δύναμις οἵνου καὶ οὐκ αὐτὸς αἵτιος. Such and such a δύναμις of wine (i. e. a δύναμις caused by excess of wine acting upon the human φύσιις) is to blame and not mere wine by itself. ὅτι τοιαύτη might easily turn into ὅτι αὕτη, and the omission of οὐ by scribes is not uncommon.

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There is an attractive vigour about the reading ἰδόντες for οἱ εἰδότες, and it may be correct. Anybody can see at a glance that in the case of wine it is excess, etc., and not merely wine itself which is to blame.

+ + diff --git a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-grc2.xml b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-grc2.xml index 13f76759e..108586963 100644 --- a/data/tlg0627/tlg001/tlg0627.tlg001.perseus-grc2.xml +++ b/data/tlg0627/tlg001/tlg0627.tlg001.perseus-grc2.xml @@ -44,7 +44,7 @@ William Heinemann Ltd. Cambridge, MA Harvard University Press -1923 +1923 1