400 BC
                              ON ANCIENT MEDICINE
                                 by Hippocrates
                          Translated by Francis Adams

 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.
 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.
 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.
 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.
 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.
 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.
 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?
 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.
 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 mare 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.
 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.
 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.
 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.
 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.
 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.
 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.
 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
straightway 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?
 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.
 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.
 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.
 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.
 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.
 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, some stretched, some long,
some dense, some rare and succulent, some spongy and of 
loose texture.
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.
 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.
 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.

                           -THE END-


                                     400 BC
                          ON AIRS, WATERS, AND PLACES
                                 by Hippocrates
                          Translated by Francis Adams
                    ON AIRS WATERS AND PLACES

  WHOEVER wishes to investigate medicine properly, should proceed
thus: in the first place to consider the seasons of the year, and what
effects each of them produces for they are not at all alike, but
differ much from themselves in regard to their changes. Then the
winds, the hot and the cold, especially such as are common to all
countries, and then such as are peculiar to each locality. We must
also consider the qualities of the waters, for as they differ from one
another in taste and weight, so also do they differ much in their
qualities. In the same manner, when one comes into a city to which
he is a stranger, he ought to consider its situation, how it lies as
to the winds and the rising of the sun; for its influence is not the
same whether it lies to the north or the south, to the rising or to
the setting sun. These things one ought to consider most
attentively, and concerning the waters which the inhabitants use,
whether they be marshy and soft, or hard, and running from elevated
and rocky situations, and then if saltish and unfit for cooking; and
the ground, whether it be naked and deficient in water, or wooded
and well watered, and whether it lies in a hollow, confined situation,
or is elevated and cold; and the mode in which the inhabitants live,
and what are their pursuits, whether they are fond of drinking and
eating to excess, and given to indolence, or are fond of exercise
and labor, and not given to excess in eating and drinking.
  2. From these things he must proceed to investigate everything else.
For if one knows all these things well, or at least the greater part
of them, he cannot miss knowing, when he comes into a strange city,
either the diseases peculiar to the place, or the particular nature of
common diseases, so that he will not be in doubt as to the treatment
of the diseases, or commit mistakes, as is likely to be the case
provided one had not previously considered these matters. And in
particular, as the season and the year advances, he can tell what
epidemic diseases will attack the city, either in summer or in winter,
and what each individual will be in danger of experiencing from the
change of regimen. For knowing the changes of the seasons, the risings
and settings of the stars, how each of them takes place, he will be
able to know beforehand what sort of a year is going to ensue.
Having made these investigations, and knowing beforehand the
seasons, such a one must be acquainted with each particular, and
must succeed in the preservation of health, and be by no means
unsuccessful in the practice of his art. And if it shall be thought
that these things belong rather to meteorology, it will be admitted,
on second thoughts, that astronomy contributes not a little, but a
very great deal, indeed, to medicine. For with the seasons the
digestive organs of men undergo a change.
  3. But how of the aforementioned things should be investigated and
explained, I will now declare in a clear manner. A city that is
exposed to hot winds (these are between the wintry rising, and the
wintry setting of the sun), and to which these are peculiar, but which
is sheltered from the north winds; in such a city the waters will be
plenteous and saltish, and as they run from an elevated source, they
are necessarily hot in summer, and cold in winter; the heads of the
inhabitants are of a humid and pituitous constitution, and their
bellies subject to frequent disorders, owing to the phlegm running
down from the head; the forms of their bodies, for the most part,
are rather flabby; they do not eat nor drink much; drinking wine in
particular, and more especially if carried to intoxication, is
oppressive to them; and the following diseases are peculiar to the
district: in the first place, the women are sickly and subject to
excessive menstruation; then many are unfruitful from disease, and not
from nature, and they have frequent miscarriages; infants are
subject to attacks of convulsions and asthma, which they consider to
be connected with infancy, and hold to be a sacred disease (epilepsy).
The men are subject to attacks of dysentery, diarrhea, hepialus,
chronic fevers in winter, of epinyctis, frequently, and of hemorrhoids
about the anus. Pleurisies, peripneumonies, ardent fevers, and
whatever diseases are reckoned acute, do not often occur, for such
diseases are not apt to prevail where the bowels are loose.
Ophthalmies occur of a humid character, but not of a serious nature,
and of short duration, unless they attack epidemically from the change
of the seasons. And when they pass their fiftieth year, defluxions
supervening from the brain, render them paralytic when exposed
suddently to strokes of the sun, or to cold. These diseases are
endemic to them, and, moreover, if any epidemic disease connected with
the change of the seasons, prevail, they are also liable to it.
  4. But the following is the condition of cities which have the
opposite exposure, namely, to cold winds, between the summer
settings and the summer risings of the sun, and to which these winds
are peculiar, and which are sheltered from the south and the hot
breezes. In the first place the waters are, for the most part, hard
cold. The men must necessarily be well braced and slender, and they
must have the discharges downwards of the alimentary canal hard, and
of difficult evacuation, while those upwards are more fluid, and
rather bilious than pituitous. Their heads are sound and hard, and
they are liable to burstings (of vessels?) for the most part. The
diseases which prevail epidemically with them, are pleurisies, and
those which are called acute diseases. This must be the case when
the bowels are bound; and from any causes, many become affected with
suppurations in the lungs, the cause of which is the tension of the
body, and hardness of the bowels; for their dryness and the coldness
of the water dispose them to ruptures (of vessels?). Such
constitutions must be given to excess of eating, but not of
drinking; for it is not possible to be gourmands and drunkards at
the same time. Ophthalmies, too, at length supervene; these being of a
hard and violent nature, and soon ending in rupture of the eyes;
persons under thirty years of age are liable to severe bleedings at
the nose in summer; attacks of epilepsy are rare but severe. Such
people are likely to be rather long-lived; their ulcers are not
attended with serious discharges, nor of a malignant character; in
disposition they are rather ferocious than gentle. The diseases I have
mentioned are peculiar to the men, and besides they are liable to
any common complaint which may be prevailing from the changes of the
seasons. But the women, in the first place, are of a hard
constitution, from the waters being hard, indigestible, and cold;
and their menstrual discharges are not regular, but in small quantity,
and painful. Then they have difficult parturition, but are not very
subject to abortions. And when they do bring forth children, they
are unable to nurse them; for the hardness and indigestable nature
of the water puts away their milk. Phthisis frequently supervenes
after childbirth, for the efforts of it frequently bring on ruptures
and strains. Children while still little are subject to dropsies in
the testicle, which disappear as they grow older; in such a town
they are late in attaining manhood. It is, as I have now stated,
with regard to hot and cold winds and cities thus exposed.
  5. Cities that are exposed to winds between the summer and the
winter risings of the sun, and those the opposite to them, have the
following characters:- Those which lie to the rising of the sun are
all likely to be more healthy than such as are turned to the North, or
those exposed to the hot winds, even if there should not be a
furlong between them. In the first place, both the heat and cold are
more moderate. Then such waters as flow to the rising sun, must
necessarily be clear, fragrant, soft, and delightful to drink, in such
a city. For the sun in rising and shining upon them purifies them,
by dispelling the vapors which generally prevail in the morning. The
persons of the inhabitants are, for the most part, well colored and
blooming, unless some disease counteract. The inhabitants have clear
voices, and in temper and intellect are superior to those which are
exposed to the north, and all the productions of the country in like
manner are better. A city so situated resembles the spring as to
moderation between heat and cold, and the diseases are few in
number, and of a feeble kind, and bear a resemblance to the diseases
which prevail in regions exposed to hot winds. The women there are
very prolific, and have easy deliveries. Thus it is with regard to
them.
  6. But such cities as lie to the west, and which are sheltered
from winds blowing from the east, and which the hot winds and the cold
winds of the north scarcely touch, must necessarily be in a very
unhealthy situation: in the first place the waters are not clear,
the cause of which is, because the mist prevails commonly in the
morning, and it is mixed up with the water and destroys its clearness,
for the sun does not shine upon the water until he be considerably
raised above the horizon. And in summer, cold breezes from the east
blow and dews fall; and in the latter part of the day the setting
sun particularly scorches the inhabitants, and therefore they are pale
and enfeebled, and are partly subject to all the aforesaid diseases,
but no one is peculiar to them. Their voices are rough and hoarse
owing to the state of the air, which in such a situation is
generally impure and unwholesome, for they have not the northern winds
to purify it; and these winds they have are of a very humid character,
such being the nature of the evening breezes. Such a situation of a
city bears a great resemblance to autumn as regards the changes of the
day, inasmuch as the difference between morning and evening is
great. So it is with regard to the winds that are conducive to health,
or the contrary.
  7. And I wish to give an account of the other kinds of waters,
namely, of such as are wholesome and such as are unwholesome, and what
bad and what good effects may be derived from water; for water
contributes much towards health. Such waters then as are marshy,
stagnant, and belong to lakes, are necessarily hot in summer, thick,
and have a strong smell, since they have no current; but being
constantly supplied by rain-water, and the sun heating them, they
necessarily want their proper color, are unwholesome and form bile; in
winter, they become congealed, cold, and muddy with the snow and
ice, so that they are most apt to engender phlegm, and bring on
hoarseness; those who drink them have large and obstructed spleens,
their bellies are hard, emaciated, and hot; and their shoulders,
collar-bones, and faces are emaciated; for their flesh is melted
down and taken up by the spleen, and hence they are slender; such
persons then are voracious and thirsty; their bellies are very dry
both above and below, so that they require the strongest medicines.
This disease is habitual to them both in summer and in winter, and
in addition they are very subject to dropsies of a most fatal
character; and in summer dysenteries, diarrheas, and protracted
quartan fevers frequently seize them, and these diseases when
prolonged dispose such constitutions to dropsies, and thus prove
fatal. These are the diseases which attack them in summer; but in
winter younger persons are liable to pneumonia, and maniacal
affections; and older persons to ardent fevers, from hardness of the
belly. Women are subject to oedema and leucophlegmasiae; when pregnant
they have difficult deliveries; their infants are large and swelled,
and then during nursing they become wasted and sickly, and the lochial
discharge after parturition does not proceed properly with the
women. The children are particularly subject to hernia, and adults
to varices and ulcers on their legs, so that persons with such
constitutions cannot be long-lived, but before the usual period they
fall into a state of premature old age. And further, the women
appear to be with child, and when the time of parturition arrives, the
fulness of the belly disappears, and this happens from dropsy of the
uterus. Such waters then I reckon bad for every purpose. The next to
them in badness are those which have their fountains in rocks, so that
they must necessarily be hard, or come from a soil which produces
thermal waters, such as those having iron, copper, silver, gold,
sulphur, alum, bitumen, or nitre (soda) in them; for all these are
formed by the force of heat. Good waters cannot proceed from such a
soil, but those that are hard and of a heating nature, difficult to
pass by urine, and of difficult evacuation by the bowels. The best are
those which flow from elevated grounds, and hills of earth; these
are sweet, clear, and can bear a little wine; they are hot in summer
and cold in winter, for such necessarily must be the waters from
deep wells. But those are most to be commended which run to the rising
of the sun, and especially to the summer sun; for such are necessarily
more clear, fragrant, and light. But all such as are salty, crude, and
harsh, are not good for drink. But there are certain constitutions and
diseases with which such waters agree when drunk, as I will explain
presently. Their characters are as follows: the best are such as
have their fountains to the east; the next, those between the summer
risings and settings of the sun, and especially those to the
risings; and third, those between the summer and winter settings;
but the worst are those to the south, and the parts between the winter
rising and setting, and those to the south are very bad, but those
to the north are better. They are to be used as follows: whoever is in
good health and strength need not mind, but may always drink
whatever is at hand. But whoever wishes to drink the most suitable for
any disease, may accomplish his purpose by attending to the
following directions: To persons whose bellies are hard and easily
burnt up, the sweetest, the lightest, and the most limpid waters
will be proper; but those persons whose bellies are soft, loose, and
pituitous, should choose the hardest, those kinds that are most crude,
and the saltiest, for thus will they be most readily dried up; for
such waters as are adapted for boiling, and are of a very solvent
nature, naturally loosen readily and melt down the bowels; but such as
are intractable, hard, and by no means proper for boiling, these
rather bind and dry up the bowels. People have deceived themselves
with regard to salt waters, from inexperience, for they think these
waters purgative, whereas they are the very reverse; for such waters
are crude, and ill adapted for boiling, so that the belly is more
likely to be bound up than loosened by them. And thus it is with
regard to the waters of springs.
  8. I will now tell how it is with respect to rain-water, and water
from snow. Rain waters, then, are the lightest, the sweetest, the
thinnest, and the clearest; for originally the sun raises and attracts
the thinnest and lightest part of the water, as is obvious from the
nature of salts; for the saltish part is left behind owing to its
thickness and weight, and forms salts; but the sun attracts the
thinnest part, owing to its lightness, and he abstracts this not
only from the lakes, but also from the sea, and from all things
which contain humidity, and there is humidity in everything; and
from man himself the sun draws off the thinnest and lightest part of
the juices. As a strong proof of this, when a man walks in the sun, or
sits down having a garment on, whatever parts of the body the sun
shines upon do not sweat, for the sun carries off whatever sweat makes
its appearance; but those parts which are covered by the garment, or
anything else, sweat, for the particles of sweat are drawn and
forced out by the sun, and are preserved by the cover so as not to
be dissipated by the sun; but when the person comes into the shade the
whole body equally perspires, because the sun no longer shines upon
it. Wherefore, of all kinds of water, these spoil the soonest; and
rain water has a bad spot smell, because its particles are collected
and mixed together from most objects, so as to spoil the soonest.
And in addition to this, when attracted and raised up, being carried
about and mixed with the air, whatever part of it is turbid and
darkish is separated and removed from the other, and becomes cloud and
mist, but the most attenuated and lightest part is left, and becomes
sweet, being heated and concocted by the sun, for all other things
when concocted become sweet. While dissipated then and not in a
state of consistence it is carried aloft. But when collected and
condensed by contrary winds, it falls down wherever it happens to be
most condensed. For this is likely to happen when the clouds being
carried along and moving with a wind which does not allow them to
rest, suddenly encounters another wind and other clouds from the
opposite direction: there it is first condensed, and what is behind is
carried up to the spot, and thus it thickens, blackens, and is
conglomerated, and by its weight it falls down and becomes rain. Such,
to all appearance, are the best of waters, but they require to be
boiled and strained; for otherwise they have a bad smell, and occasion
hoarseness and thickness of the voice to those who drink them. Those
from snow and ice are all bad, for when once congealed, they never
again recover their former nature; for whatever is clear, light, and
sweet in them, is separated and disappears; but the most turbid and
weightiest part is left behind. You may ascertain this in the
following manner: If in winter you will pour water by measure into a
vessel and expose it to the open air until it is all frozen, and
then on the following day bring it into a warm situation where the ice
will thaw, if you will measure the water again when dissolved you will
find it much less in quantity. This is a proof that the lightest and
thinnest part is dissipated and dried up by the congelation, and not
the heaviest and thickest, for that is impossible: wherefore I hold
that waters from snow and ice, and those allied to them, are the worst
of any for all purposes whatever. Such are the characters of
rain-water, and those from ice and snow.
  9. Men become affected with the stone, and are seized with
diseases of the kidneys, strangury, sciatica, and become ruptured,
when they drink all sorts of waters, and those from great rivers
into which other rivulets run, or from a lake into which many
streams of all sorts flow, and such as are brought from a considerable
distance. For it is impossible that such waters can resemble one
another, but one kind is sweet, another saltish and aluminous, and
some flow from thermal springs; and these being all mixed up
together disagree, and the strongest part always prevails; but the
same kind is not always the strongest, but sometimes one and sometimes
another, according to the winds, for the north wind imparts strength
to this water, and the south to that, and so also with regard to the
others. There must be deposits of mud and sand in the vessels from
such waters, and the aforesaid diseases must be engendered by them
when drunk, but why not to all I will now explain. When the bowels are
loose and in a healthy state, and when the bladder is not hot, nor the
neck of the bladder very contracted, all such persons pass water
freely, and no concretion forms in the bladder; but those in whom
the belly is hot, the bladder must be in the same condition; and
when preternaturally heated, its neck becomes inflamed; and when these
things happen, the bladder does not expel the urine, but raises its
heat excessively. And the thinnest part of it is secreted, and the
purest part is passed off in the form of urine, but the thickest and
most turbid part is condensed and concreted, at first in small
quantity, but afterwards in greater; for being rolled about in the
urine, whatever is of a thick consistence it assimilates to itself,
and thus it increases and becomes indurated. And when such persons
make water, the stone forced down by the urine falls into the neck
of the bladder and stops the urine, and occasions intense pain; so
that calculous children rub their privy parts and tear at them, as
supposing that the obstruction to the urine is situated there. As a
proof that it is as I say, persons affected with calculus have very
limpid urine, because the thickest and foulest part remains and is
concreted. Thus it generally is in cases of calculus. It forms also in
children from milk, when it is not wholesome, but very hot and
bilious, for it heats the bowels and bladder, so that the urine
being also heated undergoes the same change. And I hold that it is
better to give children only the most diluted wine, for such will
least burn up and dry the veins. Calculi do not form so readily in
women, for in them the urethra is short and wide, so that in them
the urine is easily expelled; neither do they rub the pudendum with
their hands, nor handle the passage like males; for the urethra in
women opens direct into the pudendum, which is not the case with
men, neither in them is the urethra so wide, and they drink more
than children do. Thus, or nearly so, is it with regard to them.
  10. And respecting the seasons, one may judge whether the year
will prove sickly or healthy from the following observations:- If
the appearances connected with the rising and setting stars be as they
should be; if there be rains in autumn; if the winter be mild, neither
very tepid nor unseasonably cold, and if in spring the rains be
seasonable, and so also in summer, the year is likely to prove
healthy. But if the winter be dry and northerly, and the spring
showery and southerly, the summer will necessarily be of a febrile
character, and give rise to ophthalmies and dysenteries. For when
suffocating heat sets in all of a sudden, while the earth is moistened
by the vernal showers, and by the south wind, the heat is
necessarily doubled from the earth, which is thus soaked by rain and
heated by a burning sun, while, at the same time, men's bellies are
not in an orderly state, nor the brain properly dried; for it is
impossible, after such a spring, but that the body and its flesh
must be loaded with humors, so that very acute fevers will attack all,
but especially those of a phlegmatic constitution. Dysenteries are
also likely to occur to women and those of a very humid temperament.
And if at the rising of the Dogstar rain and wintery storms supervene,
and if the etesian winds blow, there is reason to hope that these
diseases will cease, and that the autumn will be healthy; but if
not, it is likely to be a fatal season to children and women, but
least of all to old men; and that convalescents will pass into
quartans, and from quartans into dropsies; but if the winter be
southerly, showery and mild, but the spring northerly, dry, and of a
wintry character, in the first place women who happen to be with
child, and whose accouchement should take place in spring, are apt
to miscarry; and such as bring forth, have feeble and sickly children,
so that they either die presently or are tender, feeble, and sickly,
if they live. Such is the case with the women. The others are
subject to dysenteries and dry ophthalmies, and some have catarrhs
beginning in the head and descending to the lungs. Men of a phlegmatic
temperament are likely to have dysenteries; and women, also, from
the humidity of their nature, the phlegm descending downwards from the
brain; those who are bilious, too, have dry ophthalmies from the
heat and dryness of their flesh; the aged, too, have catarrhs from
their flabbiness and melting of the veins, so that some of them die
suddenly and some become paralytic on the right side or the left.
For when, the winter being southerly and the body hot, the blood and
veins are not properly constringed; a spring that is northerly, dry,
and cold, having come on, the brain when it should have been
expanded and purged, by the coryza and hoarseness is then
constringed and contracted, so that the summer and the heat
occurring suddenly, and a change supervening, these diseases fall out.
And such cities as lie well to the sun and winds, and use good waters,
feel these changes less, but such as use marshy and pooly waters,
and lie well both as regards the winds and the sun, these all feel
it more. And if the summer be dry, those diseases soon cease, but if
rainy, they are protracted; and there is danger of any sore that there
is becoming phagedenic from any cause; and lienteries and dropsies
supervene at the conclusion of diseases; for the bowels are not
readily dried up. And if the summer be rainy and southerly, and next
the autumn, the winter must, of necessity, be sickly, and ardent
fevers are likely to attack those that are phlegmatic, and more
elderly than forty years, and pleurisies and peripneumonies those that
are bilious. But if the summer is parched and northerly, but the
autumn rainy and southerly, headache and sphacelus of the brain are
likely to occur; and in addition hoarseness, coryza, coughs, and in
some cases, consumption. But if the season is northerly and without
water, there being no rain, neither after the Dogstar nor Arcturus;
this state agrees best with those who are naturally phlegmatic, with
those who are of a humid temperament, and with women; but it is most
inimical to the bilious; for they become much parched up, and
ophthalmies of a dry nature supervene, fevers both acute and
chronic, and in some cases melancholy; for the most humid and watery
part of the bile being consumed, the thickest and most acrid portion
is left, and of the blood likewise, when these diseases came upon
them. But all these are beneficial to the phlegmatic, for they are
thereby dried up, and reach winter not oppressed with humors, but with
them dried up.
  11. Whoever studies and observes these things may be able to foresee
most of the effects which will result from the changes of the seasons;
and one ought to be particularly guarded during the greatest changes
of the seasons, and neither willingly give medicines, nor apply the
cautery to the belly, nor make incisions there until ten or more
days be past. Now, the greatest and most dangerous are the two
solstices, and especially the summer, and also the two equinoxes,
but especially the autumnal. One ought also to be guarded about the
rising of the stars, especially of the Dogstar, then of Arcturus,
and then the setting of the Pleiades; for diseases are especially
apt to prove critical in those days, and some prove fatal, some pass
off, and all others change to another form and another constitution.
So it is with regard to them.
  12. I wish to show, respecting Asia and Europe, how, in all
respects, they differ from one another, and concerning the figure of
the inhabitants, for they are different, and do not at all resemble
one another. To treat of all would be a long story, but I will tell
you how I think it is with regard to the greatest and most marked
differences. I say, then, that Asia differs very much from Europe as
to the nature of all things, both With regard to the productions of
the earth and the inhabitants, for everything is produced much more
beautiful and large in Asia; the country is milder, and the
dispositions of the inhabitants also are more gentle and affectionate.
The cause of this is the temperature of the seasons, because it lies
in the middle of the risings of the sun towards the east, and
removed from the cold (and heat), for nothing tends to growth and
mildness so much as when the climate has no predominant quality, but a
general equality of temperature prevails. It is not everywhere the
same with regard to Asia, but such parts of the country as lie
intermediate between the heat and the cold, are the best supplied with
fruits and trees, and have the most genial climate, and enjoy the
purest waters, both celestial and terrestrial. For neither are they
much burnt up by the heat, nor dried up by the drought and want of
rain, nor do they suffer from the cold; since they are well watered
from abundant showers and snow, and the fruits of the season, as might
be supposed, grow in abundance, both such as are raised from seed that
has been sown, and such plants as the earth produces of its own
accord, the fruits of which the inhabitants make use of, training them
from their wild state and transplanting them to a suitable soil; the
cattle also which are reared there are vigorous, particularly
prolific, and bring up young of the fairest description; the
inhabitants too, are well fed, most beautiful in shape, of large
stature, and differ little from one another either as to figure or
size; and the country itself, both as regards its constitution and
mildness of the seasons, may be said to bear a close resemblance to
the spring. Manly courage, endurance of suffering, laborious
enterprise, and high spirit, could not be produced in such a state
of things either among the native inhabitants or those of a
different country, for there pleasure necessarily reigns. For this
reason, also, the forms of wild beasts there are much varied. Thus
it is, as I think, with the Egyptians and Libyans.
  13. But concerning those on the right hand of the summer risings
of the sun as far as the Palus Maeotis (for this is the boundary of
Europe and Asia), it is with them as follows: the inhabitants there
differ far more from one another than those I have treated of above,
owing to the differences of the seasons and the nature of the soil.
But with regard to the country itself, matters are the same there as
among all other men; for where the seasons undergo the greatest and
most rapid changes, there the country is the wildest and most unequal;
and you will find the greatest variety of mountains, forests,
plains, and meadows; but where the seasons do not change much there
the country is the most even; and, if one will consider it, so is it
also with regard to the inhabitants; for the nature of some is like to
a country covered with trees and well watered; of some, to a thin soil
deficient in water; of others, to fenny and marshy places; and of some
again, to a plain of bare and parched land. For the seasons which
modify their natural frame of body are varied, and the greater the
varieties of them the greater also will be the differences of their
shapes.
  14. I will pass over the smaller differences among the nations,
but will now treat of such as are great either from nature, or custom;
and, first, concerning the Macrocephali. There is no other race of men
which have heads in the least resembling theirs. At first, usage was
the principal cause of the length of their head, but now nature
cooperates with usage. They think those the most noble who have the
longest heads. It is thus with regard to the usage: immediately
after the child is born, and while its head is still tender, they
fashion it with their hands, and constrain it to assume a lengthened
shape by applying bandages and other suitable contrivances whereby the
spherical form of the head is destroyed, and it is made to increase in
length. Thus, at first, usage operated, so that this constitution
was the result of force: but, in the course of time, it was formed
naturally; so that usage had nothing to do with it; for the semen
comes from all parts of the body, sound from the sound parts, and
unhealthy from the unhealthy parts. If, then, children with bald heads
are born to parents with bald heads; and children with blue eves to
parents who have blue eyes; and if the children of parents having
distorted eyes squint also for the most part; and if the same may be
said of other forms of the body, what is to prevent it from
happening that a child with a long head should be produced by a parent
having a long head? But now these things do not happen as they did
formerly, for the custom no longer prevails owing to their intercourse
with other men. Thus it appears to me to be with regard to them.
  15. As to the inhabitants of Phasis, their country is fenny, warm,
humid, and wooded; copious and severe rains occur there at all
seasons; and the life of the inhabitants is spent among the fens;
for their dwellings are constructed of wood and reeds, and are erected
amidst the waters; they seldom practice walking either to the city
or the market, but sail about, up and down, in canoes constructed
out of single trees, for there are many canals there. They drink the
hot and stagnant waters, both when rendered putrid by the sun, and
when swollen with rains. The Phasis itself is the most stagnant of all
rivers, and runs the smoothest; all the fruits which spring there
are unwholesome, feeble and imperfect growth, owing to the
redundance of water, and on this account they do not ripen, for much
vapor from the waters overspreads the country. For these reasons the
Phasians have shapes different from those of all other men; for they
are large in stature, and of a very gross habit of body, so that not a
joint nor vein is visible; in color they are sallow, as if affected
with jaundice. Of all men they have the roughest voices, from their
breathing an atmosphere which is not clear, but misty and humid;
they are naturally rather languid in supporting bodily fatigue. The
seasons undergo but little change either as to heat or cold; their
winds for the most part are southerly, with the exception of one
peculiar to the country, which sometimes blows strong, is violent
and hot, and is called by them the wind cenchron. The north wind
scarcely reaches them, and when it does blow it is weak and gentle.
Thus it is with regard to the different nature and shape of the
inhabitants of Asia and Europe.
  16. And with regard to the pusillanimity and cowardice of the
inhabitants, the principal reason the Asiatics are more unwarlike
and of gentler disposition than the Europeans is, the nature of the
seasons, which do not undergo any great changes either to heat or
cold, or the like; for there is neither excitement of the
understanding nor any strong change of the body whereby the temper
might be ruffled and they be roused to inconsiderate emotion and
passion, rather than living as they do always in the state. It is
changes of all kinds which arouse understanding of mankind, and do not
allow them to get into a torpid condition. For these reasons, it
appears to me, the Asiatic race is feeble, and further, owing to their
laws; for monarchy prevails in the greater part of Asia, and where men
are not their own masters nor independent, but are the slaves of
others, it is not a matter of consideration with them how they may
acquire military discipline, but how they may seem not to be
warlike, for the dangers are not equally shared, since they must serve
as soldiers, perhaps endure fatigue, and die for their masters, far
from their children, their wives, and other friends; and whatever
noble and manly actions they may perform lead only to the
aggrandizement of their masters, whilst the fruits which they reap are
dangers and death; and, in addition to all this, the lands of such
persons must be laid waste by the enemy and want of culture. Thus,
then, if any one be naturally warlike and courageous, his
disposition will be changed by the institutions. As a strong proof
of all this, such Greeks or barbarians in Asia as are not under a
despotic form of government, but are independent, and enjoy the fruits
of their own labors, are of all others the most warlike; for these
encounter dangers on their own account, bear the prizes of their own
valor, and in like manner endure the punishment of their own
cowardice. And you will find the Asiatics differing from one
another, for some are better and others more dastardly; of these
differences, as I stated before, the changes of the seasons are the
cause. Thus it is with Asia.
  17. In Europe there is a Scythian race, called Sauromatae, which
inhabits the confines of the Palus Maeotis, and is different from
all other races. Their women mount on horseback, use the bow, and
throw the javelin from their horses, and fight with their enemies as
long as they are virgins; and they do not lay aside their virginity
until they kill three of their enemies, nor have any connection with
men until they perform the sacrifices according to law. Whoever
takes to herself a husband, gives up riding on horseback unless the
necessity of a general expedition obliges her. They have no right
breast; for while still of a tender age their mothers heat strongly
a copper instrument constructed for this very purpose, and apply it to
the right breast, which is burnt up, and its development being
arrested, all the strength and fullness are determined to the right
shoulder and arm.
  18. As the other Scythians have a peculiarity of shape, and do not
resemble any other, the same observation applies to the Egyptians,
only that the latter are oppressed by heat and the former by cold.
What is called the Scythian desert is a prairie, rich in meadows,
high-lying, and well watered; for the rivers which carry off the water
from the plains are large. There live those Scythians which are called
Nomades, because they have no houses, but live in wagons. The smallest
of these wagons have four wheels, but some have six; they are
covered in with felt, and they are constructed in the manner of
houses, some having but a single apartment, and some three; they are
proof against rain, snow, and winds. The wagons are drawn by yokes
of oxen, some of two and others of three, and all without horns, for
they have no horns, owing to the cold. In these wagons the women live,
but the men are carried about on horses, and the sheep, oxen, and
horses accompany them; and they remain on any spot as long as there is
provender for their cattle, and when that fails they migrate to some
other place. They eat boiled meat, and drink the milk of mares, and
also eat hippace, which is cheese prepared from the milk of the
mare. Such is their mode of life and their customs.
  19. In respect of the seasons and figure of body, the Scythian race,
like the Egyptian, have a uniformity of resemblance, different from
all other nations; they are by no means prolific, and the wild
beasts which are indigenous there are small in size and few in number,
for the country lies under the Northern Bears, and the Rhiphaean
mountains, whence the north wind blows; the sun comes very near to
them only when in the summer solstice, and warms them but for a
short period, and not strongly; and the winds blowing from the hot
regions of the earth do not reach them, or but seldom, and with little
force; but the winds from the north always blow, congealed, as they
are, by the snow, ice, and much water, for these never leave the
mountains, which are thereby rendered uninhabitable. A thick fog
covers the plains during the day, and amidst it they live, so that
winter may be said to be always present with them; or, if they have
summer, it is only for a few days, and the heat is not very strong.
Their plains are high-lying and naked, not crowned with mountains, but
extending upwards under the Northern Bears. The wild beasts there
are not large, but such as can be sheltered underground; for the
cold of winter and the barrenness of the country prevent their growth,
and because they have no covert nor shelter. The changes of the
seasons, too, are not great nor violent, for, in fact, they change
gradually; and therefore their figures resemble one another, as they
all equally use the same food, and the same clothing summer and
winter, respiring a humid and dense atmosphere, and drinking water
from snow and ice; neither do they make any laborious exertions, for
neither body nor mind is capable of enduring fatigue when the
changes of the seasons are not great. For these reasons their shapes
are gross and fleshy, with ill-marked joints, of a humid
temperament, and deficient in tone: the internal cavities, and
especially those of the intestines, are full of humors; for the
belly cannot possibly be dry in such a country, with such a
constitution and in such a climate; but owing to their fat, and the
absence of hairs from their bodies, their shapes resemble one another,
the males being all alike, and so also with the women; for the seasons
being of a uniform temperature, no corruption or deterioration takes
place in the concretion of the semen, unless from some violent
cause, or from disease.
  20. I Will give you a strong proof of the humidity (laxity?) of
their constitutions. You will find the greater part of the
Scythians, and all the Nomades, with marks of the cautery on their
shoulders, arms, wrists, breasts, hip-joints, and loins, and that
for no other reason but the humidity and flabbiness of their
constitution, for they can neither strain with their bows, nor
launch the javelin from their shoulder owing to their humidity and
atony: but when they are burnt, much of the humidity in their joints
is dried up, and they become better braced, better fed, and their
joints get into a more suitable condition. They are flabby and squat
at first, because, as in Egypt, they are not swathed (?); and then
they pay no attention to horsemanship, so that they may be adepts at
it; and because of their sedentary mode of life; for the males, when
they cannot be carried about on horseback, sit the most of their
time in the wagon, and rarely practise walking, because of their
frequent migrations and shiftings of situation; and as to the women,
it is amazing how flabby and sluggish they are. The Scythian race
are tawny from the cold, and not from the intense heat of the sun, for
the whiteness of the skin is parched by the cold, and becomes tawny.
  21. It is impossible that persons of such a constitution could be
prolific, for, with the man, the sexual desires are not strong,
owing to the laxity of his constitution, the softness and coldness
of his belly, from all which causes it is little likely that a man
should be given to venery; and besides, from being jaded by exercise
on horseback, the men become weak in their desires. On the part of the
men these are the causes; but on that of the women, they are
embonpoint and humidity; for the womb cannot take in the semen, nor is
the menstrual discharge such as it should be, but scanty and at too
long intervals; and the mouth of the womb is shut up by fat and does
not admit the semen; and, moreover, they themselves are indolent and
fat, and their bellies cold and soft. From these causes the Scythian
race is not prolific. Their female servants furnish a strong proof
of this; for they no sooner have connection with a man than they prove
with child, owing to their active course of life and the slenderness
of body.
  22. And, in addition to these, there are many eunuchs among the
Scythians, who perform female work, and speak like women. Such persons
are called effeminates. The inhabitants of the country attribute the
cause of their impotence to a god, and venerate and worship such
persons, every one dreading that the like might befall himself; but to
me it appears that such affections are just as much divine as all
others are, and that no one disease is either more divine or more
human than another, but that all are alike divine, for that each has
its own nature, and that no one arises without a natural cause. But
I will explain how I think that the affection takes its rise. From
continued exercise on horseback they are seized with chronic
defluxions in their joints owing to their legs always hanging down
below their horses; they afterwards become lame and stiff at the
hip-joint, such of them, at least, as are severely attacked with it.
They treat themselves in this way: when the disease is commencing,
they open the vein behind either ear, and when the blood flows, sleep,
from feebleness, seizes them, and afterwards they awaken, some in good
health and others not. To me it appears that the semen is altered by
this treatment, for there are veins behind the ears which, if cut,
induce impotence; now, these veins would appear to me to be cut.
Such persons afterwards, when they go in to women and cannot have
connection with them, at first do not think much about it, but
remain quiet; but when, after making the attempt two, three, or more
times, they succeed no better, fancying they have committed some
offence against the god whom they blame for the affection, they put on
female attire, reproach themselves for effeminacy, play the part of
women, and perform the same work as women do. This the rich among
the Scythians endure, not the basest, but the most noble and powerful,
owing to their riding on horseback; for the poor are less affected, as
they do not ride on horses. And yet, if this disease had been more
divine than the others, it ought not to have befallen the most noble
and the richest of the Scythians alone, but all alike, or rather those
who have little, as not being able to pay honors to the gods, if,
indeed, they delight in being thus rewarded by men, and grant favors
in return; for it is likely that the rich sacrifice more to the
gods, and dedicate more votive offerings, inasmuch as they have
wealth, and worship the gods; whereas the poor, from want, do less
in this way, and, moreover, upbraid the gods for not giving them
wealth, so that those who have few possessions were more likely to
bear the punishments of these offences than the rich. But, as I
formerly said, these affections are divine just as much as others, for
each springs from a natural cause, and this disease arises among the
Scythians from such a cause as I have stated. But it attacks other men
in like manner, for whenever men ride much and very frequently on
horseback, then many are affected with rheums in the joints, sciatica,
and gout, and they are inept at venery. But these complaints befall
the Scythians, and they are the most impotent of men for the aforesaid
causes, and because they always wear breeches, and spend the most of
their time on horseback, so as not to touch their privy parts with the
hands, and from the cold and fatigue they forget the sexual desire,
and do not make the attempt until after they have lost their virility.
Thus it is with the race of the Scythians.
  23. The other races in Europe differ from one another, both as to
stature and shape, owing to the changes of the seasons, which are very
great and frequent, and because the heat is strong, the winters
severe, and there are frequent rains, and again protracted droughts,
and winds, from which many and diversified changes are induced.
These changes are likely to have an effect upon generation in the
coagulation of the semen, as this process cannot be the same in summer
as in winter, nor in rainy as in dry weather; wherefore, I think, that
the figures of Europeans differ more than those of Asiatics; and
they differ very much from one another as to stature in the same city;
for vitiations of the semen occur in its coagulation more frequently
during frequent changes of the seasons, than where they are alike
and equable. And the same may be said of their dispositions, for the
wild, and unsociable, and the passionate occur in such a constitution;
for frequent excitement of the mind induces wildness, and extinguishes
sociableness and mildness of disposition, and therefore I think the
inhabitants of Europe more courageous than those of Asia; for a
climate which is always the same induces indolence, but a changeable
climate, laborious exertions both of body and mind; and from rest
and indolence cowardice is engendered, and from laborious exertions
and pains, courage. On this account the inhabitants of Europe are than
the Asiatics, and also owing to their institutions, because they are
not governed by kings like the latter, for where men are governed by
kings there they must be very cowardly, as I have stated before; for
their souls are enslaved, and they will not willingly, or readily
undergo dangers in order to promote the power of another; but those
that are free undertake dangers on their own account, and not for
the sake of others; they court hazard and go out to meet it, for
they themselves bear off the rewards of victory, and thus their
institutions contribute not a little to their courage.
  Such is the general character of Europe and Asia.
  24. And there are in Europe other tribes, differing from one another
in stature, shape, and courage: the differences are those I formerly
mentioned, and will now explain more clearly. Such as inhabit a
country which is mountainous, rugged, elevated, and well watered,
and where the changes of the seasons are very great, are likely to
have great variety of shapes among them, and to be naturally of an
enterprising and warlike disposition; and such persons are apt to have
no little of the savage and ferocious in their nature; but such as
dwell in places which are low-lying, abounding in meadows and ill
ventilated, and who have a larger proportion of hot than of cold
winds, and who make use of warm waters- these are not likely to be
of large stature nor well proportioned, but are of a broad make,
fleshy, and have black hair; and they are rather of a dark than of a
light complexion, and are less likely to be phlegmatic than bilious;
courage and laborious enterprise are not naturally in them, but may be
engendered in them by means of their institutions. And if there be
rivers in the country which carry off the stagnant and rain water from
it, these may be wholesome and clear; but if there be no rivers, but
the inhabitants drink the waters of fountains, and such as are
stagnant and marshy, they must necessarily have prominent bellies
and enlarged spleens. But such as inhabit a high country, and one that
is level, windy, and well-watered, will be large of stature, and
like to one another; but their minds will be rather unmanly and
gentle. Those who live on thin, ill-watered, and bare soils, and not
well attempered in the changes of the seasons, in such a country
they are likely to be in their persons rather hard and well braced,
rather of a blond than a dark complexion, and in disposition and
passions haughty and self-willed. For, where the changes of the
seasons are most frequent, and where they differ most from one
another, there you will find their forms, dispositions, and nature the
most varied. These are the strongest of the natural causes of
difference, and next the country in which one lives, and the waters;
for, in general, you will find the forms and dispositions of mankind
to correspond with the nature of the country; for where the land is
fertile, soft, and well-watered, and supplied with waters from very
elevated situations, so as to be hot in summer and cold in winter, and
where the seasons are fine, there the men are fleshy, have
ill-formed joints, and are of a humid temperament; they are not
disposed to endure labor, and, for the most part, are base in
spirit; indolence and sluggishness are visible in them, and to the
arts they are dull, and not clever nor acute. When the country is
bare, not fenced, and rugged, blasted by the winter and scorched by
the sun, there you may see the hardy, hardy, slender, with well-shaped
joints, well-braced, and shaggy; sharp, industry and vigilance
accompany such a constitution; in morals and passions they are haughty
and opinionative, inclining rather to the fierce than to the mild; and
you will find them acute and ingenious as regards the arts, and
excelling in military affairs; and likewise all the other
productions of the earth corresponding to the earth itself. Thus it is
with regard to the most opposite natures and shapes; drawing
conclusions from them, you may judge of the rest without any risk of
error.


                            -THE END-
                                     400 BC
                             ON THE SACRED DISEASE
                                 by Hippocrates
                          translated by Francis Adams
                        ON THE SACRED DISEASE

  It is thus with regard to the disease called Sacred: it appears to
me to be nowise more divine nor more sacred than other diseases, but
has a natural cause from the originates like other affections. Men
regard its nature and cause as divine from ignorance and wonder,
because it is not at all like to other diseases. And this notion of
its divinity is kept up by their inability to comprehend it, and the
simplicity of the mode by which it is cured, for men are freed from it
by purifications and incantations. But if it is reckoned divine
because it is wonderful, instead of one there are many diseases
which would be sacred; for, as I will show, there are others no less
wonderful and prodigious, which nobody imagines to be sacred. The
quotidian, tertian, and quartan fevers, seem to me no less sacred
and divine in their origin than this disease, although they are not
reckoned so wonderful. And I see men become mad and demented from no
manifest cause, and at the same time doing many things out of place;
and I have known many persons in sleep groaning and crying out, some
in a state of suffocation, some jumping up and fleeing out of doors,
and deprived of their reason until they awaken, and afterward becoming
well and rational as before, although they be pale and weak; and
this will happen not once but frequently. And there are many and
various things of the like kind, which it would be tedious to state
particularly.

  They who first referred this malady to the gods appear to me to have
been just such persons as the conjurors, purificators, mountebanks,
and charlatans now are, who give themselves out for being
excessively religious, and as knowing more than other people. Such
persons, then, using the divinity as a pretext and screen of their own
inability to of their own inability to afford any assistance, have
given out that the disease is sacred, adding suitable reasons for this
opinion, they have instituted a mode of treatment which is safe for
themselves, namely, by applying purifications and incantations, and
enforcing abstinence from baths and many articles of food which are
unwholesome to men in diseases. Of sea substances, the surmullet,
the blacktail, the mullet, and the eel; for these are the fishes
most to be guarded against. And of fleshes, those of the goat, the
stag, the sow, and the dog: for these are the kinds of flesh which are
aptest to disorder the bowels. Of fowls, the cock, the turtle, and the
bustard, and such others as are reckoned to be particularly strong.
And of potherbs, mint, garlic, and onions; for what is acrid does
not agree with a weak person. And they forbid to have a black robe,
because black is expressive of death; and to sleep on a goat's skin,
or to wear it, and to put one foot upon another, or one hand upon
another; for all these things are held to be hindrances to the cure.
All these they enjoin with reference to its divinity, as if
possessed of more knowledge, and announcing beforehand other causes so
that if the person should recover, theirs would be the honor and
credit; and if he should die, they would have a certain defense, as if
the gods, and not they, were to blame, seeing they had administered
nothing either to eat or drink as medicines, nor had overheated him
with baths, so as to prove the cause of what had happened. But I am of
opinion that (if this were true) none of the Libyans, who live in
the interior, would be free from this disease, since they all sleep on
goats' skins, and live upon goats' flesh; neither have they couch,
robe, nor shoe that is not made of goat's skin, for they have no other
herds but goats and oxen. But if these things, when administered in
food, aggravate the disease, and if it be cured by abstinence from
them, godhead is not the cause at all; nor will purifications be of
any avail, but it is the food which is beneficial and prejudicial, and
the influence of the divinity vanishes.

  Thus, they who try to cure these maladies in this way, appear to
me neither to reckon them sacred nor divine. For when they are removed
by such purifications, and this method of cure, what is to prevent
them from being brought upon men and induced by other devices
similar to these? So that the cause is no longer divine, but human.
For whoever is able, by purifications conjurations, to drive away such
an affection, will be able, by other practices, to excite it; and,
according to this view, its divine nature is entirely done away
with. By such sayings and doings, they profess to be possessed of
superior knowledge, and deceive mankind by enjoining lustrations and
purifications upon them, while their discourse turns upon the divinity
and the godhead. And yet it would appear to me that their discourse
savors not of piety, as they suppose, but rather of impiety, and as if
there were no gods, and that what they hold to be holy and divine,
were impious and unholy. This I will now explain.

  For, if they profess to know how to bring down the moon, darken
the sun, induce storms and fine weather, and rains and droughts, and
make the sea and land unproductive, and so forth, whether they
arrogate this power as being derived from mysteries or any other
knowledge or consideration, they appear to me to practice impiety, and
either to fancy that there are no gods, or, if there are, that they
have no ability to ward off any of the greatest evils. How, then,
are they not enemies to the gods? For if a man by magical arts and
sacrifices will bring down the moon, and darken the sun, and induce
storms, or fine weather, I should not believe that there was
anything divine, but human, in these things, provided the power of the
divine were overpowered by human knowledge and subjected to it. But
perhaps it will be said, these things are not so, but, not
withstanding, men being in want of the means of life, invent many
and various things, and devise many contrivances for all other things,
and for this disease, in every phase of the disease, assigning the
cause to a god. Nor do they remember the same things once, but
frequently. For, if they imitate a goat, or grind their teeth, or if
their right side be convulsed, they say that the mother of the gods is
the cause. But if they speak in a sharper and more intense tone,
they resemble this state to a horse, and say that Poseidon is the
cause. Or if any excrement be passed, which is often the case, owing
to the violence of the disease, the appellation of Enodia is
adhibited; or, if it be passed in smaller and denser masses, like
bird's, it is said to be from Apollo Nomius. But if foam be emitted by
the mouth, and the patient kick with his feet, Ares then gets the
blame. But terrors which happen during the night, and fevers, and
delirium, and jumpings out of bed, and frightful apparitions, and
fleeing away,-all these they hold to be the plots of Hecate, and the
invasions the and use purifications and incantations, and, as
appears to me, make the divinity to be most wicked and most impious.
For they purify those laboring under this disease, with the same sorts
of blood and the other means that are used in the case of those who
are stained with crimes, and of malefactors, or who have been
enchanted by men, or who have done any wicked act; who ought to do the
very reverse, namely, sacrifice and pray, and, bringing gifts to the
temples, supplicate the gods. But now they do none of these things,
but purify; and some of the purifications they conceal in the earth,
and some they throw into the sea, and some they carry to the mountains
where no one can touch or tread upon them. But these they ought to
take to the temples and present to the god, if a god be the cause of
the disease. Neither truly do I count it a worthy opinion to hold that
the body of man is polluted by god, the most impure by the most
holy; for were it defiled, or did it suffer from any other thing, it
would be like to be purified and sanctified rather than polluted by
god. For it is the divinity which purifies and sanctifies the greatest
of offenses and the most wicked, and which proves our protection
from them. And we mark out the boundaries of the temples and the
groves of the gods, so that no one may pass them unless he be pure,
and when we enter them we are sprinkled with holy water, not as
being polluted, but as laying aside any other pollution which we
formerly had. And thus it appears to me to hold, with regard to
purifications.

  But this disease seems to me to be no more divine than others; but
it has its nature such as other diseases have, and a cause whence it
originates, and its nature and cause are divine only just as much as
all others are, and it is curable no less than the others, unless
when, the from of time, it is confirmed, and has became stronger
than the remedies applied. Its origin is hereditary, like that of
other diseases. For if a phlegmatic person be born of a phlegmatic,
and a bilious of a bilious, and a phthisical of a phthisical, and
one having spleen disease, of another having disease of the spleen,
what is to hinder it from happening that where the father and mother
were subject to this disease, certain of their offspring should be
so affected also? As the semen comes from all parts of the body,
healthy particles will come from healthy parts, and unhealthy from
unhealthy parts. And another great proof that it is in nothing more
divine than other diseases is, that it occurs in those who are of a
phlegmatic constitution, but does not attack the bilious. Yet, if it
were more divine than the others, this disease ought to befall all
alike, and make no distinction between the bilious and phlegmatic.

  But the brain is the cause of this affection, as it is of other very
great diseases, and in what manner and from what cause it is formed, I
will now plainly declare. The brain of man, as in all other animals,
is double, and a thin membrane divides it through the middle, and
therefore the pain is not always in the same part of the head; for
sometimes it is situated on either side, and sometimes the whole is
affected; and veins run toward it from all parts of the body, many
of which are small, but two are thick, the one from the liver, and the
other from the spleen. And it is thus with regard to the one from
the liver: a portion of it runs downward through the parts on the
side, near the kidneys and the psoas muscles, to the inner part of the
thigh, and extends to the foot. It is called vena cava. The other runs
upward by the right veins and the lungs, and divides into branches for
the heart and the right arm. The remaining part of it rises upward
across the clavicle to the right side of the neck, and is
superficial so as to be seen; near the ear it is concealed, and
there it divides; its thickest, largest, and most hollow part ends
in the brain; another small vein goes to the right ear, another to the
right eye, and another to the nostril. Such are the distributions of
the hepatic vein. And a vein from the spleen is distributed on the
left side, upward and downward, like that from the liver, but more
slender and feeble.

  By these veins we draw in much breath, since they are the
spiracles of our bodies inhaling air to themselves and distributing it
to the rest of the body, and to the smaller veins, and they and
afterwards exhale it. For the breath cannot be stationary, but it
passes upward and downward, for if stopped and intercepted, the part
where it is stopped becomes powerless. In proof of this, when, in
sitting or lying, the small veins are compressed, so that the breath
from the larger vein does not pass into them, the part is
immediately seized with numbness; and it is so likewise with regard to
the other veins.

  This malady, then, affects phlegmatic people, but not bilious. It
begins to be formed while the foetus is still in utero. For the brain,
like the other organs, is depurated and grows before birth. If,
then, in this purgation it be properly and moderately depurated, and
neither more nor less than what is proper be secreted from it, the
head is thus in the most healthy condition. If the secretion (melting)
the from the brain be greater than natural, the person, when he
grows up, will have his head diseased, and full of noises, and will
neither be able to endure the sun nor cold. Or, if the melting take
place from any one part, either from the eye or ear, or if a vein
has become slender, that part will be deranged in proportion to the
melting. Or, should depuration not take place, but congestion
accumulate in the brain, it necessarily becomes phlegmatic. And such
children as have an eruption of ulcers on the head, on the ears, and
along the rest of the body, with copious discharges of saliva and
mucus,-these, in after life, enjoy best health; for in this way the
phlegm which ought to have been purged off in the womb, is
discharged and cleared away, and persons so purged, for the most part,
are not subject to attacks of this disease. But such as have had their
skin free from eruptions, and have had no discharge of saliva or
mucus, nor have undergone the proper purgation in the womb, these
persons run the risk of being seized with this disease.

  But should the defluxion make its way to the heart, the person is
seized with palpitation and asthma, the chest becomes diseased, and
some also have curvature of the spine. For when a defluxion of cold
phlegm takes place on the lungs and heart, the blood is chilled, and
the veins, being violently chilled, palpitate in the lungs and
heart, and the heart palpitates, so that from this necessity asthma
and orthopnoea supervene. For it does not receive the spirits as
much breath as he needs until the defluxion of phlegm be mastered, and
being heated is distributed to the veins, then it ceases from its
palpitation and difficulty of breathing, and this takes place as
soon as it obtains an abundant supply; and this will be more slowly,
provided the defluxion be more abundant, or if it be less, more
quickly. And if the defluxions be more condensed, the epileptic
attacks will be more frequent, but otherwise if it be rarer. Such
are the symptoms when the defluxion is upon the lungs and heart; but
if it be upon the bowels, the person is attacked with diarrhoea.

  And if, being shut out from all these outlets, its defluxion be
determined to the veins I have formerly mentioned, the patient loses
his speech, and chokes, and foam issues by the mouth, the teeth are
fixed, the hands are contracted, the eyes distorted, he becomes
insensible, and in some cases the bowels are evacuated. And these
symptoms occur sometimes on the left side, sometimes on the right, and
sometimes in both. The cause of everyone of these symptoms I will
now explain. The man becomes speechless when the phlegm, suddenly
descending into the veins, shuts out the air, and does not admit it
either to the brain or to the vena cava, or to the ventricles, but
interrupts the inspiration. For when a person draws in air by the
mouth and nostrils, the breath goes first to the brain, then the
greater part of it to the internal cavity, and part to the lungs,
and part to the veins, and from them it is distributed to the other
parts of the body along the veins; and whatever passes to the
stomach cools, and does nothing more; and so also with regard to the
lungs. But the air which enters the veins is of use (to the body) by
entering the brain and its ventricles, and thus it imparts sensibility
and motion to all the members, so that when the veins are excluded
from the air by the phlegm and do not receive it, the man loses his
speech and intellect, and the hands become powerless, and are
contracted, the blood stopping and not being diffused, as it was wont;
and the eyes are distorted owing to the veins being excluded from
the air; and they palpitate; and froth from the lungs issues by the
mouth. For when the breath does not find entrance to him, he foams and
sputters like a dying person. And the bowels are evacuated in
consequence of the violent suffocation; and the suffocation is
produced when the liver and stomach ascend to the diaphragm, and the
mouth of the stomach is shut up; this takes place when the breath does
not enter by the mouth, as it is wont. The patient kicks with his feet
when the air is shut up in the lungs and cannot find an outlet,
owing to the phlegm; and rushing by the blood upward and downward,
it occasions convulsions and pain, and therefore he kicks with his
feet. All these symptoms he endures when the cold phlegm passes into
the warm blood, for it congeals and stops the blood. And if the
deflexion be copious and thick, it immediately proves fatal to him,
for by its cold it prevails over the blood and congeals it; or, if
it be less, it in the first place obtains the mastery, and stops the
respiration; and then in the course of time, when it is diffused along
the veins and mixed with much warm blood, it is thus overpowered,
the veins receive the air, and the patient recovers his senses.

  Of little children who are seized with this disease, the greater
part die, provided the defluxion be copious and humid, for the veins
being slender cannot admit the phlegm, owing to its thickness and
abundance; but the blood is cooled and congealed, and the child
immediately dies. But if the phlegm be in small quantity, and make a
defluxion into both the veins, or to those on either side, the
children survive, but exhibit notable marks of the disorder; for
either the mouth is drawn aside, or an eye, the neck, or a hand,
wherever a vein being filled with phlegm loses its tone, and is
attenuated, and the part of the body connected with this vein is
necessarily rendered weaker and defective. But for the most it affords
relief for a longer interval; for the child is no longer seized with
these attacks, if once it has contracted this impress of the
disease, in consequence of which the other veins are necessarily
affected, and to a certain degree attenuated, so as just to admit
the air, but no longer to permit the influx of phlegm. However, the
parts are proportionally enfeebled whenever the veins are in an
unhealthy state. When in striplings the defluxion is small and to
the right side, they recover without leaving any marks of the disease,
but there is danger of its becoming habitual, and even increasing if
not treated by suitable remedies. Thus, or very nearly so, is the case
when it attacks children.

  To persons of a more advanced age, it neither proves fatal, nor
produces distortions. For their veins are capacious and are filled
with hot blood; and therefore the phlegm can neither prevail nor
cool the blood, so as to coagulate it, but it is quickly overpowered
and mixed with the blood, and thus the veins receive the air, and
sensibility remains; and, owing to their strength, the aforesaid
symptoms are less likely to seize them. But when this disease
attacks very old people, it therefore proves fatal, or induces
paraplegia, because the veins are empty, and the blood scanty, thin,
and watery. When, therefore, the defluxion is copious, and the
season winter, it proves fatal; for it chokes up the exhalents, and
coagulates the blood if the defluxion be to both sides; but if to
either, it merely induces paraplegia. For the blood being thin,
cold, and scanty, cannot prevail over the but being itself
overpowered, it is coagulated, so that those parts in which the
blood is corrupted, lose their strength.

  The flux is to the right rather than to the left because the veins
there are more capacious and numerous than on the left side, for on
the one side they spring from the liver, and on the other from the
spleen. The defluxion and melting down take place most especially in
the case of children in whom the head is heated either by the sun or
by fire, or if the brain suddenly contract a rigor, and then the
phlegm is excreted. For it is melted down by the heat and diffusion of
the but it is excreted by the congealing and contracting of it, and
thus a defluxion takes place. And in some this is the cause of the
disease, and in others, when the south wind quickly succeeds to
northern breezes, it suddenly unbinds and relaxes the brain, which
is contracted and weak, so that there is an inundation of phlegm,
and thus the defluxion takes place. The defluxion also takes place
in consequence of fear, from any hidden cause, if we are the at any
person's calling aloud, or while crying, when one cannot quickly
recover one's breath, such as often happens to children. When any of
these things occur, the body immediately shivers, the person
becoming speechless cannot draw his breath, but the breath (pneuma)
stops, the brain is contracted, the blood stands still, and thus the
excretion and defluxion of the phlegm take place. In children, these
are the causes of the attack at first. But to old persons winter is
most inimical. For when the head and brain have been heated at a great
fire, and then the person is brought into cold and has a rigor, or
when from cold he comes into warmth, and sits at the fire, he is apt
to suffer in the same way, and thus he is seized in the manner
described above. And there is much danger of the same thing occurring,
if his head be exposed to the sun, but less so in summer, as the
changes are not sudden. When a person has passed the twentieth year of
his life, this disease is not apt to seize him, unless it has become
habitual from childhood, or at least this is rarely or never the case.
For the veins are filled with blood, and the brain consistent and
firm, so that it does not run down into the veins, or if it do, it
does not master the blood, which is copious and hot.

  But when it has gained strength from one's childhood, and become
habitual, such a person usually suffers attacks, and is seized with
them in changes of the winds, especially in south winds, and it is
difficult of removal. For the brain becomes more humid than natural,
and is inundated with phlegm, so that the defluxions become more
frequent, and the phlegm can no longer be the nor the brain be dried
up, but it becomes wet and humid. This you may ascertain in
particular, from beasts of the flock which are seized with this
disease, and more especially goats, for they are most frequently
attacked with it. If you will cut open the head, you will find the
brain humid, full of sweat, and having a bad smell. And in this way
truly you may see that it is not a god that injures the body, but
disease. And so it is with man. For when the disease has prevailed for
a length of time, it is no longer curable, as the brain is corroded by
the phlegm, and melted, and what is melted down becomes water, and
surrounds the brain externally, and overflows it; wherefore they are
more frequently and readily seized with the disease. And therefore the
disease is protracted, because the influx is thin, owing to its
quantity, and is immediately overpowered by the blood and heated all
through.

  But such persons as are habituated to the disease know beforehand
when they are about to be seized and flee from men; if their own house
be at hand, they run home, but if not, to a deserted place, where as
few persons as possible will see them falling, and they immediately
cover themselves up. This they do from shame of the affection, and not
from fear of the divinity, as many suppose. And little children at
first fall down wherever they may happen to be, from inexperience. But
when they have been often seized, and feel its approach beforehand,
they flee to their mothers, or to any other person they are acquainted
with, from terror and dread of the affection, for being still
infants they do not know yet what it is to be ashamed.

  Therefore, they are attacked during changes of the winds, and
especially south winds, then also with north winds, and afterwards
also with the others. These are the strongest winds, and the most
opposed to one another, both as to direction and power. For, the north
wind condenses the air, and separates from it whatever is muddy and
nebulous, and renders it clearer and brighter, and so in like manner
also, all the winds which arise from the sea and other waters; for
they extract the humidity and nebulosity from all objects, and from
men themselves, and therefore it (the north wind) is the most
wholesome of the winds. But the effects of the south are the very
reverse. For in the first place it begins by melting and diffusing the
condensed air, and therefore it does not blow strong at first, but
is gentle at the commencement, because it is not able at once to
overcome the and compacted air, which yet in a while it dissolves.
It produces the same effects upon the land, the sea, the fountains,
the wells, and on every production which contains humidity, and
this, there is in all things, some more, some less. For all these feel
the effects of this wind, and from clear they become cloudy, from
cold, hot; from dry, moist; and whatever ear then vessels are placed
upon the ground, filled with wine or any other fluid, are affected
with the south wind, and undergo a change. And the a change. And the
sun, and the moon, it renders blunter appearance than they naturally
are. When, then, it possesses such powers over things so great and
strong, and the body is made to feel and undergo changes in the
changes of the winds, it necessarily follows that the brain should
be disolved and overpowered with moisture, and that the veins should
become more relaxed by the south winds, and that by the north the
healthiest portion of the brain should become contracted, while the
most morbid and humid is secreted, and overflows externally, and
that catarrhs should thus take place in the changes of these winds.
Thus is this disease formed and prevails from those things which enter
into and go out of the body, and it is not more difficult to
understand or to cure than the others, neither is it more divine
than other diseases.

  Men ought to know that from nothing else but the brain come joys,
delights, laughter and sports, and sorrows, griefs, despondency, and
lamentations. And by this, in an especial manner, we acquire wisdom
and knowledge, and see and hear, and know what are foul and what are
fair, what are bad and what are good, what are sweet, and what
unsavory; some we discriminate by habit, and some we perceive by their
utility. By this we distinguish objects of relish and disrelish,
according to the seasons; and the same things do not always please us.
And by the same organ we become mad and delirious, and fears and
terrors assail us, some by night, and some by day, and dreams and
untimely wanderings, and cares that are not suitable, and ignorance of
present circumstances, desuetude, and unskilfulness. All these
things we endure from the brain, when it is not healthy, but is more
hot, more cold, more moist, or more dry than natural, or when it
suffers any other preternatural and unusual affection. And we become
mad from its humidity. For when it is more moist than natural, it is
necessarily put into motion, and the affection being moved, neither
the sight nor hearing can be at rest, and the tongue speaks in
accordance with the sight and hearing.

  As long as the brain is at rest, the man enjoys his reason, but
the depravement of the brain arises from phlegm and bile, either of
which you may recognize in this manner: Those who are mad from
phlegm are quiet, and do not cry out nor make a noise; but those
from bile are vociferous, malignant, and will not be quiet, but are
always doing something improper. If the madness be constant, these are
the causes thereof. But if terrors and fears assail, they are
connected with derangement of the brain, and derangement is owing to
its being heated. And it is heated by bile when it is determined to
the brain along the bloodvessels running from the trunk; and fear is
present until it returns again to the veins and trunk, when it ceases.
He is grieved and troubled when the brain is unseasonably cooled and
contracted beyond its wont. This it suffers from phlegm, and from
the same affection the patient becomes oblivious. He calls out and
screams at night when the brain is suddenly heated. The bilious endure
this. But the phlegmatic are not heated, except when much blood goes
to the brain, and creates an ebullition. Much blood passes along the
aforesaid veins. But when the man happens to see a frightful dream and
is in fear as if awake, then his face is in a greater glow, and the
eyes are red when the patient is in fear. And the understanding
meditates doing some mischief, and thus it is affected in sleep. But
if, when awakened, he returns to himself, and the blood is again
distributed along the veins, it ceases.

  In these ways I am of the opinion that the brain exercises the
greatest power in the man. This is the interpreter to us of those
things which emanate from the air, when the brain happens to be in a
sound state. But the air supplies sense to it. And the eyes, the ears,
the tongue and the feet, administer such things as the brain
cogitates. For in as much as it is supplied with air, does it impart
sense to the body. It is the brain which is the messenger to the
understanding. For when the man draws the breath into himself, it
passes first to the brain, and thus the air is distributed to the rest
of the body, leaving in the brain its acme, and whatever has sense and
understanding. For if it passed first to the body and last to the
brain, then having left in the flesh and veins the judgment, when it
reached the brain it would be hot, and not at all pure, but mixed with
the humidity from flesh and blood, so as to be no longer pure.

  Wherefore, I say, that it is the brain which interprets the
understanding. But the diaphragm has obtained its name (frenes) from
accident and usage, and not from reality or nature, for I know no
power which it possesses, either as to sense or understanding,
except that when the man is affected with unexpected joy or sorrow, it
throbs and produces palpitations, owing to its thinness, and as having
no belly to receive anything good or bad that may present themselves
to it, but it is thrown into commotion by both these, from its natural
weakness. It then perceives beforehand none of those things which
occur in the body, but has received its name vaguely and without any
proper reason, like the parts about the heart, which are called
auricles, but which contribute nothing towards hearing. Some say
that we think with the heart, and that this is the part which is
grieved, and experiences care. But it is not so; only it contracts
like the diaphragm, and still more so for the same causes. For veins
from all parts of the body run to it, and it has valves, so as to as
to perceive if any pain or pleasurable emotion befall the man. For
when grieved the body necessarily shudders, and is contracted, and
from excessive joy it is affected in like manner. Wherefore the
heart and the diaphragm are particularly sensitive, they have
nothing to do, however, with the operations of the understanding,
but of all but of all these the brain is the cause. Since, then, the
brain, as being the primary seat of sense and of the spirits,
perceives whatever occurs in the body, if any change more powerful
than usual take place in the air, owing to the seasons, the brain
becomes changed by the state of the air. For, on this account, the
brain first perceives, because, I say, all the most acute, most
powerful, and most deadly diseases, and those which are most difficult
to be understood by the inexperienced, fall upon the brain.

  And the disease called the Sacred arises from causes as the
others, namely, those things which enter and quit the body, such as
cold, the sun, and the winds, which are ever changing and are never at
rest. And these things are divine, so that there is no necessity for
making a distinction, and holding this disease to be more divine
than the others, but all are divine, and all human. And each has its
own peculiar nature and power, and none is of an ambiguous nature,
or irremediable. And the most of them are curable by the same means as
those by which any other thing is food to one, and injurious to
another. Thus, then, the physician should understand and distinguish
the season of each, so that at one time he may attend to the
nourishment and increase, and at another to abstraction and
diminution. And in this disease as in all others, he must strive not
to feed the disease, but endeavor to wear it out by administering
whatever is most opposed to each disease, and not that which favors
and is allied to it. For by that which is allied to it, it gains vigor
and increase, but it wears out and disappears under the use of that
which is opposed to it. But whoever is acquainted with such a change
in men, and can render a man humid and dry, hot and cold by regimen,
could also cure this disease, if he recognizes the proper season for
administering his remedies, without minding purifications, spells, and
all other illiberal practices of a like kind.
                                    THE END
                                     400 BC
                                    THE LAW
                                 by Hippocrates
                          translated by Francis Adams

  Medicine is of all the Arts the most noble; but, not withstanding,
owing to the ignorance of those who practice it, and of those who,
inconsiderately, form a judgment of them, it is at present far
behind all the other arts. Their mistake appears to me to arise
principally from this, that in the cities there is no punishment
connected with the practice of medicine (and with it alone) except
disgrace, and that does not hurt those who are familiar with it.
Such persons are like the figures which are introduced in tragedies,
for as they have the shape, and dress, and personal appearance of an
actor, but are not actors, so also physicians are many in title but
very few in reality.

  2. Whoever is to acquire a competent knowledge of medicine, ought to
be possessed of the following advantages: a natural disposition;
instruction; a favorable position for the study; early tuition; love
of labor; leisure. First of all, a natural talent is required; for,
when Nature opposes, everything else is in vain; but when Nature leads
the way to what is most excellent, instruction in the art takes place,
which the student must try to appropriate to himself by reflection,
becoming an early pupil in a place well adapted for instruction. He
must also bring to the task a love of labor and perseverance, so
that the instruction taking root may bring forth proper and abundant
fruits.

  3. Instruction in medicine is like the culture of the productions of
the earth. For our natural disposition is, as it were, the soil; the
tenets of our teacher are, as it were, the seed; instruction in
youth is like the planting of the seed in the ground at the proper
season; the place where the instruction is communicated is like the
food imparted to vegetables by the atmosphere; diligent study is
like the cultivation of the fields; and it is time which imparts
strength to all things and brings them to maturity.

  4. Having brought all these requisites to the study of medicine, and
having acquired a true knowledge of it, we shall thus, in traveling
through the cities, be esteemed physicians not only in name but in
reality. But inexperience is a bad treasure, and a bad fund to those
who possess it, whether in opinion or reality, being devoid of
self-reliance and contentedness, and the nurse both of timidity and
audacity. For timidity betrays a want of powers, and audacity a want
of skill. There are, indeed, two things, knowledge and opinion, of
which the one makes its possessor really to know, the other to be
ignorant.

  5. Those things which are sacred, are to be imparted only to
sacred persons; and it is not lawful to import them to the profane
until they have been initiated in the mysteries of the science.
                             THE END
                                     400 BC
                                    THE OATH
                                 by Hippocrates
                          Translated by Francis Adams

  I SWEAR by Apollo the physician, and Aesculapius, and Health, and
All-heal, and all the gods and goddesses, that, according to my
ability and judgment, I will keep this Oath and this stipulation- to
reckon him who taught me this Art equally dear to me as my parents, to
share my substance with him, and relieve his necessities if
required; to look upon his offspring in the same footing as my own
brothers, and to teach them this art, if they shall wish to learn
it, without fee or stipulation; and that by precept, lecture, and
every other mode of instruction, I will impart a knowledge of the Art
to my own sons, and those of my teachers, and to disciples bound by
a stipulation and oath according to the law of medicine, but to none
others. I will follow that system of regimen which, according to my
ability and judgment, I consider for the benefit of my patients, and
abstain from whatever is deleterious and mischievous. I will give no
deadly medicine to any one if asked, nor suggest any such counsel; and
in like manner I will not give to a woman a pessary to produce
abortion. With purity and with holiness I will pass my life and
practice my Art. I will not cut persons laboring under the stone,
but will leave this to be done by men who are practitioners of this
work. Into whatever houses I enter, I will go into them for the
benefit of the sick, and will abstain from every voluntary act of
mischief and corruption; and, further from the seduction of females or
males, of freemen and slaves. Whatever, in connection with my
professional practice or not, in connection with it, I see or hear, in
the life of men, which ought not to be spoken of abroad, I will not
divulge, as reckoning that all such should be kept secret. While I
continue to keep this Oath unviolated, may it be granted to me to
enjoy life and the practice of the art, respected by all men, in all
times! But should I trespass and violate this Oath, may the reverse be
my lot!


                                -THE END-
                                     400 BC
                            THE BOOK OF PROGNOSTICS
                                 by Hippocrates
                          Translated by Francis Adams
                    THE BOOK OF PROGNOSTICS

  IT APPEARS to me a most excellent thing for the physician to
cultivate Prognosis; for by foreseeing and foretelling, in the
presence of the sick, the present, the past, and the future, and
explaining the omissions which patients have been guilty of, he will
be the more readily believed to be acquainted with the circumstances
of the sick; so that men will have confidence to intrust themselves to
such a physician. And he will manage the cure best who has foreseen
what is to happen from the present state of matters. For it is
impossible to make all the sick well; this, indeed, would have been
better than to be able to foretell what is going to happen; but
since men die, some even before calling the physician, from the
violence of the disease, and some die immediately after calling him,
having lived, perhaps, only one day or a little longer, and before the
physician could bring his art to counteract the disease; it
therefore becomes necessary to know the nature of such affections, how
far they are above the powers of the constitution; and, moreover, if
there be anything divine in the diseases, and to learn a foreknowledge
of this also. Thus a man will be the more esteemed to be a good
physician, for he will be the better able to treat those aright who
can be saved, having long anticipated everything; and by seeing and
announcing beforehand those who will live and those who will die, he
will thus escape censure.
  2. He should observe thus in acute diseases: first, the
countenance of the patient, if it be like those of persons in
health, and more so, if like itself, for this is the best of all;
whereas the most opposite to it is the worst, such as the following; a
sharp nose, hollow eyes, collapsed temples; the ears cold, contracted,
and their lobes turned out: the skin about the forehead being rough,
distended, and parched; the color of the whole face being green,
black, livid, or lead-colored. If the countenance be such at the
commencement of the disease, and if this cannot be accounted for
from the other symptoms, inquiry must be made whether the patient
has long wanted sleep; whether his bowels have been very loose; and
whether he has suffered from want of food; and if any of these
causes be confessed to, the danger is to be reckoned so far less;
and it becomes obvious, in the course of a day and a night, whether or
not the appearance of the countenance proceeded from these causes. But
if none of these be said to exist, if the symptoms do not subside in
the aforesaid time, it is to be known for certain that death is at
hand. And, also, if the disease be in a more advanced stage either
on the third or fourth day, and the countenance be such, the same
inquiries as formerly directed are to be made, and the other
symptoms are to be noted, those in the whole countenance, those on the
body, and those in the eyes; for if they shun the light, or weep
involuntarily, or squint, or if the one be less than the other, or
if the white of them be red, livid, or has black veins in it; if there
be a gum upon the eyes, if they are restless, protruding, or are
become very hollow; and if the countenance be squalid and dark, or the
color of the whole face be changed- all these are to be reckoned bad
and fatal symptoms. The physician should also observe the appearance
of the eyes from below the eyelids in sleep; for when a portion of the
white appears, owing to the eyelids not being closed together, and
when this is not connected with diarrhea or purgation from medicine,
or when the patient does not sleep thus from habit, it is to be
reckoned an unfavorable and very deadly symptom; but if the eyelid
be contracted, livid, or pale, or also the lip, or nose, along with
some of the other symptoms, one may know for certain that death is
close at hand. It is a mortal symptom, also, when the lips are
relaxed, pendent, cold, and blanched.
  3. It is well when the patient is found by his physician reclining
upon either his right or his left side, having his hands, neck, and
legs slightly bent, and the whole body lying in a relaxed state, for
thus the most of persons in health recline, and these are the best
of postures which most resemble those of healthy persons. But to lie
upon one's back, with the hands, neck, and the legs extended, is far
less favorable. And if the patient incline forward, and sink down to
the foot of the bed, it is a still more dangerous symptom; but if he
be found with his feet naked and not sufficiently warm, and the hands,
neck, and legs tossed about in a disorderly manner and naked, it is
bad, for it indicates aberration of intellect. It is a deadly symptom,
also, when the patient sleeps constantly with his mouth open, having
his legs strongly bent and plaited together, while he lies upon his
back; and to lie upon one's belly, when not habitual to the patient to
sleep thus while in good health, indicates delirium, or pain in the
abdominal regions. And for the patient to wish to sit erect at the
acme of a disease is a bad symptom in all acute diseases, but
particularly so in pneumonia. To grind the teeth in fevers, when
such has not been the custom of the patient from childhood,
indicates madness and death, both which dangers are to be announced
beforehand as likely to happen; and if a person in delirium do this it
is a very deadly symptom. And if the patient had an ulcer
previously, or if one has occurred in the course of the disease, it is
to be observed; for if the man be about to die the sore will become
livid and dry, or yellow and dry before death.
  4. Respecting the movement of the hands I have these observations to
make: When in acute fevers, pneumonia, phrenitis, or headache, the
hands are waved before the face, hunting through empty space, as if
gathering bits of straw, picking the nap from the coverlet, or tearing
chaff from the wall- all such symptoms are bad and deadly.
  5. Respiration, when frequent, indicates pain or inflanunation in
the parts above the diaphragm: a large respiration performed at a
great interval announces delirium; but a cold respiration at nose or
mouth is a very fatal symptom. Free respiration is to be looked upon
as contributing much to the safety of the patient in all acute
diseases, such as fevers, and those complaints which come to a
crisis in forty days.
   6. Those sweats are the best in all acute diseases which occur on
the critical days, and completely carry off the fever. Those are
favorable, too, which taking place over the whole body, show that
the man is bearing the disease better. But those that do not produce
this effect are not beneficial. The worst are cold sweats, confined to
the head, face, and neck; these in an acute fever prognosticate death,
or in a milder one, a prolongation of the disease; and sweats which
occur over the whole body, with the characters of those confined to
the neck, are in like manner bad. Sweats attended with a miliary
eruption, and taking place about the neck, are bad; sweats in the form
of drops and of vapour are good. One ought to know the entire
character of sweats, for some are connected with prostration of
strength in the body, and some with intensity of the inflammation.
  7. That state of the hypochondrium is best when it is free from
pain, soft, and of equal size on the right side and the left. But if
inflamed, or painful, or distended; or when the right and left sides
are of disproportionate sizes;- all these appearances are to be
dreaded. And if there be also pulsation in the hypochondrium, it
indicates perturbation or delirium; and the physician should examine
the eyes of such persons; for if their pupils be in rapid motion, such
persons may be expected to go mad. A swelling in the hypochondrium,
that is hard and painful, is very bad, provided it occupy the whole
hypochondrium; but if it be on either side, it is less dangerous
when on the left. Such swellings at the commencement of the disease
prognosticate speedy death; but if the fever has passed twenty days,
and the swelling has not subsided, it turns to a suppuration. A
discharge of blood from the nose occurs to such in the first period,
and proves very useful; but inquiry should be made if they have
headache or indistinct vision; for if there be such, the disease
will be determined thither. The discharge of blood is rather to be
expected in those who are younger than thirty-five years. Such
swellings as are soft, free from pain, and yield to the finger,
occasion more protracted crises, and are less dangerous than the
others. But if the fever continue beyond sixty days, without any
subsidence of the swelling, it indicates that empyema is about to take
place; and a swelling in any other part of the cavity will terminate
in like manner. Such, then, as are painful, hard, and large,
indicate danger of speedy death; but such as are soft, free of pain,
and yield when pressed with the finger, are more chronic than these.
Swellings in the belly less frequently form abscesses than those in
the hypochondrium; and seldomest of all, those below the navel are
converted into suppuration; but you may rather expect a hemorrhage
from the upper parts. But the suppuration of all protracted
swellings about these parts is to be anticipated. The collections of
matter there are to be thus judged of: such as are determined outwards
are the best when they are small, when they protrude very much, and
swell to a point; such as are large and broad, and which do not
swell out to a sharp point, are the worst. Of such as break
internally, the best are those which have no external communication,
but are covered and indolent; and when the whole place is free from
discoloration. That pus is best which is white, homogeneous, smooth,
and not at all fetid; the contrary to this is the worst.
  8. All dropsies arising from acute diseases are bad; for they do not
remove the fever, and are very painful and fatal. The most of them
commence from the flanks and loins, but some from the liver; in
those which derive their origin from the flanks and loins the feet
swell, protracted diarrhoeas supervene, which neither remove the pains
in the flanks and loins, nor soften the belly, but in dropsies which
are connected with the liver there is a tickling cough, with
scarcely any perceptible expectoration, and the feet swell; there
are no evacuations from the bowels, unless such as are hard and
forced; and there are swellings about the belly, sometimes on the
one side and sometimes on the other, and these increase and diminish
by turns.
  9. It is a bad symptom when the head, hands, and feet are cold,
while the belly and sides are hot; but it is a very good symptom
when the whole body is equally hot. The patient ought to be able to
turn round easily, and to be agile when raised up; but if he appear
heavy in the rest of his body as well as in his hands and feet, it
is more dangerous; and if, in addition to the weight, his nails and
fingers become livid, immediate death may be anticipated; and if the
hands and feet be black it is less dangerous than if they be livid,
but the other symptoms must be attended, to; for if he appear to
bear the illness well, and if certain of the salutary symptoms
appear along with these there may be hope that the disease will turn
to a deposition, so that the man may recover; but the blackened
parts of the body will drop off. When the testicles and members are
retracted upwards, they indicate strong pains and danger of death.
  10. With regard to sleep- as is usual with us in health, the patient
should wake during the day and sleep during the night. If this rule be
anywise altered it is so far worse: but there will be little harm
provided he sleep in the morning for the third part of the day; such
sleep as takes place after this time is more unfavorable; but the
worst of all is to get no sleep either night or day; for it follows
from this symptom that the insomnolency is connected with sorrow and
pains, or that he is about to become delirious.
  11. The excrement is best which is soft and consistent, is passed at
the hour which was customary to the patient when in health, in
quantity proportionate to the ingests; for when the passages are such,
the lower belly is in a healthy state. But if the discharges be fluid,
it is favorable that they are not accompanied with a noise, nor are
frequent, nor in great quantity; for the man being oppressed by
frequently getting up, must be deprived of sleep; and if the
evacuations be both frequent and large, there is danger of his falling
into deliquium animi. But in proportion to the ingesta he should
have evacuations twice or thrice in the day, once at night and more
copiously in the morning, as is customary with a person in health. The
faeces should become thicker when the disease is tending to a
crisis; they ought to be yellowish and not very fetid. It is favorable
that round worms be passed with the discharges when the disease is
tending to a crisis. The belly, too, through the whole disease, should
be soft and moderately distended; but excrements that are very watery,
or white, or green, or very red, or frothy, are all bad. It is also
bad when the discharge is small, and viscid, and white, and
greenish, and smooth; but still more deadly appearances are the black,
or fatty, or livid, or verdigris-green, or fetid. Such as are of
varied characters indicate greater duration of the complaint, but
are no less dangerous; such as those which resemble scrapings, those
which are bilious, those resembling leeks, and the black; these
being sometimes passed together, and sometimes singly. It is best when
wind passes without noise, but it is better that flatulence should
pass even thus than that it should be retained; and when it does
pass thus, it indicates either that the man is in pain or in delirium,
unless he gives vent to the wind spontaneously. Pains in the
hypochondria, and swellings, if recent, and not accompanied with
inflammation, are relieved by borborygmi supervening in the
hypochondrium, more especially if it pass off with faeces, urine,
and wind; but even although not, it will do good by passing along, and
it also does good by descending to the lower part of the belly.
  12. The urine is best when the sediment is white, smooth, and
consistent during the whole time, until the disease come to a
crisis, for it indicates freedom from danger, and an illness of
short duration; but if deficient, and if it be sometimes passed clear,
and sometimes with a white and smooth sediment, the disease will be
more protracted, and not so void of danger. But if the urine be
reddish, and the sediment consistent and smooth, the affection, in
this case, will be more protracted than the former, but still not
fatal. But farinaceous sediments in the urine are bad, and still worse
are the leafy; the white and thin are very bad, but the furfuraceous
are still worse than these. Clouds carried about in the urine are good
when white, but bad if black. When the urine is yellow and thin, it
indicates that the disease is unconcocted; and if it (the disease)
should be protracted, there maybe danger lest the patient should not
hold out until the urine be concocted. But the most deadly of all
kinds of urine are the fetid, watery, black, and thick; in adult men
and women the black is of all kinds of urine the worst, but in
children, the watery. In those who pass thin and crude urine for a
length of time, if they have otherwise symptoms of convalescence, an
abscess may be expected to form in the parts below the diaphragm.
And fatty substances floating on the surface are to be dreaded, for
they are indications of melting. And one should consider respecting
the kinds of urine, which have clouds, whether they tend upwards or
downwards, and upwards or downwards, and the colors which they have
and such as fall downwards, with the colors as described, are to be
reckoned good and commended; but such as are carried upwards, with the
colors as described, are to be held as bad, and are to be
distrusted. But you must not allow yourself to be deceived if such
urine be passed while the bladder is diseased; for then it is a
symptom of the state, not of the general system, but of a particular
viscus.
  13. That vomiting is of most service which consists of phlegm and
bile mixed together, and neither very thick nor in great quantity; but
those vomitings which are more unmixed are worse. But if that which is
vomited be of the color of leeks or livid, or black, whatever of these
colors it be, it is to be reckoned bad; but if the same man vomit
all these colors, it is to be reckoned a very fatal symptom. But of
all the vomitings, the livid indicates the danger of death, provided
it be of a fetid smell. But all the smells which are somewhat putrid
and fetid, are bad in all vomitings.
  14. The expectoration in all pains about the lungs and sides, should
be quickly and easily brought up, and a certain degree of yellowness
should appear strongly mixed up with the sputum. But if brought up
long after the commencement of the pain, and of a yellow or ruddy
color, or if it occasions much cough, or be not strongly mixed, it
is worse; for that which is intensely yellow is dangerous, but the
white, and viscid, and round, do no good. But that which is very green
and frothy is bad; but if so intense as to appear black, it is still
more dangerous than these; it is dangerous than these; it is bad, if
nothing is expectorated, and the lungs discharge nothing, but are
gorged with matters which boil (as it were) in the air-passages. It is
bad when coryza and sneezing either precede or follow affections of
the lungs, but in all other affections, even the most deadly, sneezing
is a salutary symptom. A yellow spittle mixed up with not much blood
in cases of pneumonia, is salutary and very beneficial if spit up at
the commencement of the disease, but if on the seventh day, or still
later, it is less favorable. And all sputa are bad which do not remove
the pain. But the worst is the black, as has been described. Of all
others the sputa which remove the pain are the best.
  15. When the pains in these regions do not cease, either with the
discharge of the sputa, nor with alvine evacuations, nor from
venesection, purging with medicine, nor a suitable regimen, it is to
be held that they will terminate in suppurations. Of empyemata such as
are spit up while the sputum is still bilious, are very fatal, whether
the bilious portion be expectorated separate, or along with the other;
but more especially if the empyema begin to advance after this
sputum on the seventh day of the disease. It is to be expected that
a person with such an expectoration shall die on the fourteenth day,
unless something favorable supervene. The following are favorable
symptoms: to support the disease easily, to have free respiration,
to be free from pain, to have the sputa readily brought up, the
whole body to appear equally warm and soft, to have no thirst, the
urine, and faeces, sleep, and sweats to be all favorable, as described
before; when all these symptoms concur, the patient certainly will not
die; but if some of these be present and some not, he will not survive
longer than the fourteenth day. The bad symptoms are the opposite of
these, namely, to bear the disease with difficulty, respiration
large and dense, the pain not ceasing, the sputum scarcely coughed up,
strong thirst, to have the body unequally affected by the febrile
heat, the belly and sides intensely hot, the forehead, hands, and feet
cold; the urine, and excrements, the sleep, and sweats, all bad,
agreeably to the characters described above; if such a combination
of symptoms accompany the expectoration, the man will certainly die
before the fourteenth day, and either on the ninth or eleventh. Thus
then one may conclude regarding this expectoration, that it is very
deadly, and that the patient will not survive until the fourteenth
day. It is by balancing the concomitant symptoms whether good or
bad, that one is to form a prognosis; for thus it will most probably
prove to be a true one. Most other suppurations burst, some on the
twentieth, some on the thirtieth, some on the fortieth, and some as
late as the sixtieth day.
  16. One should estimate when the commencement of the suppuration
will take place, by calculating from the day on which the patient
was first seized with fever, or if he had a rigor, and if he says,
that there is a weight in the place where he had pain formerly, for
these symptoms occur in the commencement of suppurations. One then may
expect the rupture of the abscesses to take place from these times
according to the periods formerly stated. But if the empyema be only
on either side, one should turn him and inquire if he has pain on
the other side; and if the one side be hotter than the other, and when
laid upon the sound side, one should inquire if he has the feeling
of a weight hanging from above, for if so, the empyema will be upon
the opposite side to that on which the weight was felt.
  17. Empyema may be recognized in all cases by the following
symptoms: In the first place, the fever does not go off, but is slight
during the day, and increases at night, and copious sweats
supervene, there is a desire to cough, and the patients expectorate
nothing worth mentioning, the eyes become hollow, the cheeks have
red spots on them, the nails of the hands are bent, the fingers are
hot especially their extremities, there are swellings in the feet,
they have no desire of food, and small blisters (phlyctaenae) occur
over the body. These symptoms attend chronic empyemata, and may be
much trusted to; and such as are of short standing are indicated by
the same, provided they be accompanied by those signs which occur at
the commencement, and if at the same time the patient has some
difficulty of breathing. Whether they will break earlier or later
may be determined by these symptoms; if there be pain at the
commencement, and if the dyspnoea, cough, and ptyalism be severe,
the rupture may be expected in the course of twenty days or still
earlier; but if the pain be more mild, and all the other symptoms in
proportion, you may expect from these the rupture to be later; but
pain, dyspnoea, and ptyalism, must take place before the rupture of
the abscess. Those patients recover most readily whom the fever leaves
the same day that the abscess bursts,- when they recover their
appetite speedily, and are freed from the thirst,- when the alvine
discharges are small and consistent, the matter white, smooth, uniform
in color, and free of phlegm, and if brought up without pain or strong
coughing. Those die whom the fever does not leave, or when appearing
to leave them it returns with an exacerbation; when they have
thirst, but no desire of food, and there are watery discharges from
the bowels; when the expectoration is green or livid, or pituitous and
frothy; if all these occur they die, but if certain of these
symptoms supervene, and others not, some patients die and some
recover, after a long interval. But from all the symptoms taken
together one should form a judgment, and so in all other cases.
  18. When abscesses form about the ears, after peripneumonic
affections, or depositions of matter take place in the inferior
extremities and end in fistula, such persons recover. The following
observations are to be made upon them: if the fever persist, and the
pain do not cease, if the expectoration be not normal, and if the
alvine discharges be neither bilious, nor free and unmixed; and if the
urine be neither copious nor have its proper sediment, but if, on
the other hand, all the other salutary symptoms be present, in such
cases abscesses may be expected to take place. They form in the
inferior parts when there is a collection of phlegm about the
hypochondria; and in the upper when the continue soft and free of
pain, and when dyspnoea having been present for a certain time, ceases
without any obvious cause. All deposits which take place in the legs
after severe and dangerous attacks of pneumonia, are salutary, but the
best are those which occur at the time when the sputa undergo a
change; for if the swelling and pain take place while the sputa are
changing from yellow and becoming of a purulent character, and are
expectorated freely, under these circumstances the man will recover
most favorably and the abscess becoming free of pain, will soon cease;
but if the expectoration is not free, and the urine does not appear to
have the proper sediment, there is danger lest the limb should be
maimed, or that the case otherwise should give trouble. But if the
abscesses disappear and go back, while expectoration does not take
place, and fever prevails, it is a bad symptom; for there is danger
that the man may get into a state of delirium and die. Of persons
having empyema after peripneumonic affections, those that are advanced
in life run the greatest risk of dying; but in the other kinds of
empyema younger persons rather die. In cases of empyema treated by the
cautery or incision, when the matter is pure, white, and not fetid,
the patient recovers; but if of a bloody and dirty character, he dies.
  19. Pains accompanied with fever which occur about the loins and
lower parts, if they attack the diaphragm, and leave the parts
below, are very fatal. Wherefore one ought to pay attention to the
other symptoms, since if any unfavorable one supervene, the case is
hopeless; but if while the disease is determined to the diaphragm, the
other symptoms are not bad, there is great reason to expect that it
will end in empyema. When the bladder is hard and painful, it is an
extremely bad and mortal symptom, more especially in cases attended
with continued fever; for the pains proceeding from the bladder
alone are to kill the patient; and at such a time the bowels are not
moved, or the discharges are hard and forced. But urine of a
purulent character, and having a white and smooth sediment, relieves
the patient. But if no amendment takes place in the characters of
the urine, nor the bladder become soft, and the fever is of the
continual type, it may be expected that the patient will die in the
first stages of the complaint. This form attacks children more
especially, from their seventh to their fifteenth year.
  20. Fevers come to a crisis on the same days as to number on which
men recover and die. For the mildest class of fevers, and those
originating with the most favorable symptoms, cease on the fourth
day or earlier; and the most malignant, and those setting in with
the most dangerous symptoms, prove fatal on the fourth day or earlier.
The first class of them as to violence ends thus: the second is
protracted to the seventh day, the third to the eleventh, the fourth
to the fourteenth, the fifth to the seventeenth, and the sixth to
the twentieth. Thus these periods from the most acute disease ascend
by fours up to twenty. But none of these can be truly calculated by
whole days, for neither the year nor the months can be numbered by
entire days. After these in the same manner, according to the same
progression, the first period is of thirty-four days, the second of
forty days, and the third of sixty days. In the commencement of
these it is very difficult to determine those which will come to a
crisis after a long interval; for these beginnings are very similar,
but one should pay attention from the first day, and observe further
at every additional tetrad, and then one cannot miss seeing how the
disease will terminate. The constitution of quartans is agreeable to
the same order. Those which will come to a crisis in the shortest
space of time, are the easiest to be judged of; for the differences of
them are greatest from the commencement, thus those who are going to
recover breathe freely, and do not suffer pain, they sleep during
the night, and have the other salutary symptoms, whereas those that
are to die have difficult respiration, are delirious, troubled with
insomnolency, and have other bad symptoms. Matters being thus, one may
conjecture, according to the time, and each additional period of the
diseases, as they proceed to a crisis. And in women, after
parturition, the crises proceed agreeably to the same ratio.
  21. Strong and continued headaches with fever, if any of the
deadly symptoms be joined to them, are very fatal. But if without such
symptoms the pain be prolonged beyond twenty days, a discharge of
blood from the nose or some abscess in the inferior parts may be
anticipated; but while the pain is recent, we may expect in like
manner a discharge of blood from the nose, or a suppuration,
especially if the pain be seated above the temples and forehead; but
the hemorrhage is rather to be looked for in persons younger than
thirty years, and the suppuration in more elderly persons.
  22. Acute pain of the ear, with continual and strong fever, is to be
dreaded; for there is danger that the man may become delirious and
die. Since, then, this is a hazardous spot, one ought to pay
particular attention to all these symptoms from the commencement.
Younger persons die of this disease on the seventh day, or still
earlier, but old persons much later; for the fevers and delirium
less frequently supervene upon them, and on that account the ears
previously come to a suppuration, but at these periods of life,
relapses of the disease coming on generally prove fatal. Younger
persons die before the ear suppurates; only if white matter run from
the ear, there may be hope that a younger person will recover,
provided any other favorable symptom be combined.
  23. Ulceration of the throat with fever, is a serious affection, and
if any other of the symptoms formerly described as being bad, be
present, the physician ought to announce that his patient is in
danger. Those quinsies are most dangerous, and most quickly prove
fatal, which make no appearance in the fauces, nor in the neck, but
occasion very great pain and difficulty of breathing; these induce
suffocation on the first day, or on the second, the third, or the
fourth. Such as, in like manner, are attended with pain, are swelled
up, and have redness (erythema) in the throat, are indeed very
fatal, but more protracted than the former, provided the redness be
great. Those cases in which both the throat and the neck are red,
are more protracted, and certain persons recover from them, especially
if the neck and breast be affected with erythema, and the erysipelas
be not determined inwardly. If neither the erysipelas disappear on the
critical day, nor any abscess form outwardly, nor any pus be spit
up, and if the patient fancy himself well, and be free from pain,
death, or a relapse of the erythema is to be apprehended. It is much
less hazardous when the swelling and redness are determined outwardly;
but if determined to the lungs, they superinduce delirium, and
frequently some of these cases terminate in empyema. It is very
dangerous to cut off or scarify enlarged uvulae while they and red and
large, for inflammations and hemorrhages supervene; but one should try
to reduce such swellings by some other means at this season. When
the whole of it is converted into an abscess, which is called Uva,
or when the extremity of the variety called Columella is larger and
round, but the upper part thinner, at this time it will be safe to
operate. But it will be better to open the bowels gently before
proceeding to the operation, if time will permit, and the patient be
not in danger of being suffocated.
  24. When the fevers cease without any symptoms of resolution
occurring, and not on the critical days, in such cases a relapse may
be anticipated. When any of the fevers is protracted, although the man
exhibits symptoms of recovery, and there is no longer pain from any
inflammation, nor from any other visible cause, in such a case a
deposit, with swelling and pain, may be expected in some one of the
joints, and not improbably in those below. Such deposits occur more
readily and in less time to persons under thirty years of age; and one
should immediately suspect the formation of such a deposit, if the
fever be protracted beyond twenty days; but to aged persons these less
seldom happen, and not until the fever be much longer protracted. Such
a deposit may be expected, when the fever is of a continual type,
and that it will pass into a quartan, if it become intermittent, and
its paroxysms come on in an irregular manner, and if in this form it
approach autumn. As deposits form most readily in persons below thirty
years of age, so quartans most commonly occur to persons beyond that
age. It is proper to know that deposits occur most readily in
winter, that then they are most protracted, but are less given to
return. Whoever, in a fever that is not of a fatal character, says
that he has pain in his head, and that something dark appears to be
before his eyes, and that he has pain at the stomach, will be seized
with vomiting of bile; but if rigor also attack him, and the
inferior parts of the hypochondrium are cold, vomiting is still nearer
at hand; and if he eat or drink anything at such a season, it will
be quickly vomited. In these cases, when the pain commences on the
first day, they are particularly oppressed on the fourth and the
fifth; and they are relieved on the seventh, but the greater part of
them begin to have pain on the third day, and are most especially
tossed on the fifth, but are relieved on the ninth or eleventh; but in
those who begin to have pains on the fifth day, and other matters
proceed properly with them, the disease comes to a crisis on the
fourteenth day. But when in such a fever persons affected with
headache, instead of having a dark appearance before their eyes,
have dimness of vision, or flashes of light appear before their
eyes, and instead of pain at the pit of the stomach, they have in
their hypochondrium a fullness stretching either to the right or
left side, without either pain or inflammation, a hemorrhage from
the nose is to be expected in such a case, rather than a vomiting. But
it is in young persons particularly that the hemorrhage is to be
expected, for in persons beyond the age of thirty-five, vomitings
are rather to be anticipated. Convulsions occur to children if acute
fever be present, and the belly be they cannot sleep, are agitated,
and moan, and change color, and become green, livid, or ruddy. These
complaints occur most readily to children which are very young up to
their seventh year; older children and adults are not equally liable
to be seized with convulsions in fevers, unless some of the
strongest and worst symptoms precede, such as those which occur in
frenzy. One must judge of children as of others, which will die and
which recover, from the whole of the symptoms, as they have been
specially described. These things I say respecting acute diseases, and
the affections which spring from them.
  25. He who would correctly beforehand those that will recover, and
those that will die, and in what cases the disease will be
protracted for many days, and in what cases for a shorter time, must
be able to form a judgment from having made himself acquainted with
all the symptoms, and estimating their powers in comparison with one
another, as has been described, with regard to the others, and the
urine and sputa, as when the patient coughs up pus and pus and bile
together. One ought also to consider promptly the influx of epidemical
diseases and the constitution of the season. One should likewise be
well acquainted with the particular signs and the other symptoms,
and not be ignorant how that, in every year, and at every season,
bad symptoms prognosticate ill, and favorable symptoms good, since the
aforesaid symptoms appear to have held true in Libya, in Delos, and in
Scythia, from which it may be known that, in the same regions, there
is no difficulty in attaining a knowledge of many more things than
these; if having learned them, one knows also how to judge and
reason correctly of them. But you should not complain because the name
of any disease may happen not to be described here, for you may know
all such as come to a crisis in the aforementioned times, by the
same symptoms.

                           -THE END-