De prisca medicina

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Again, such discharges as settle in the eyes, possessing powerful, acrid humours of all sorts, ulcerate the eyelids, and in some cases eat into the parts on to which they run, the cheeks and under the eyes; and they rupture and eat through the covering of the eyeball. But pains, burning and intense inflammation prevail until the discharges are concocted and become thicker, so that rheum is formed from them. This coction is the result of mixture, compounding and digestion. Secondly, the discharges that settle in the throat, giving rise to soreness, angina, erysipelas and pneumonia, all these at first emit salt, watery and acrid humours, whereby the diseases are strengthened. But when they become thicker and more matured, and throw off all trace of their acridness, then the fevers too subside with the other symptoms that distress the patient. We must surely consider the cause of each complaint to be those things the presence of which of necessity produces a complaint of a specific kind, which ceases when they change into another combination. All conditions, then, resulting from heat or cold pure and simple, with no other power as a factor, must cease when heat changes into cold or cold into heat. This change takes place in the manner I have described above. Moreover, all other complaints to which man is liable arise from powers. Thus, when there is an out-pouring of the bitter principle, which we call yellow bile, great nausea, burning and weakness prevail. When the patient gets rid of it, sometimes by purgation, either spontaneous or by medicine, if the purging be seasonable he manifestly gets rid both of the pains and of the heat. But so long as these bitter particles are undissolved, undigested and uncompounded, by no possible means can the pains and fevers be stayed. And those who are attacked by pungent and acrid acids suffer greatly from frenzy, from gnawings of the bowels and chest, and from restlessness. No relief from these symptoms is secured until the acidity is purged away, or calmed down and mixed with the other humours. But coction, alteration, thinning or thickening into the form of humours through other forms of all sorts (wherefrom crises also and fixing their periods derive great importance in cases of illness)—to all these things surely heat and cold are not in the least liable. For neither could either ferment or thicken. †For what shall we call it? Combinations of humours that exhibit a power that varies with the various factors. † Since the hot will give up its heat only when mixed with the cold, and the cold can be neutralized only by the hot. But all other components of man become milder and better the greater the number of other components with which they are mixed. A man is in the best possible condition when there is complete coction and rest, with no particular power displayed. About this I think that I have given a full explanation.

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

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

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

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

As I have said before, we must examine the powers of humours, and what the effect of each is upon man, and how they are related to one another. Let me give an example. If a humour that is sweet assumes another form, not by admixture, but by a self-caused change, what will it first become, bitter, or salt, or astringent, or acid? I think acid. Therefore where sweet humour is the least suitable of all, acid humour is the next least suitable to be administered. If a man can in this way conduct with success inquiries outside the human body, he will always be able to select the very best treatment. And the best is always that which is farthest removed from the unsuitable.

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

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

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

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

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

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