On Affections — First Draft Translation

PREFACE [5] Every man who is sensible ought, having reckoned that health is of the greatest worth to human beings, to understand how to benefit himself from his own judgment in sicknesses; and to understand what is both said and applied to his own body by physicians, and to discern it; and to understand each of these things to the extent that it is reasonable for a layman. 1 [5] One would best understand these things by knowing and practicing the following: all sicknesses in human beings arise from bile and phlegm. Bile and phlegm produce sicknesses when, within the body, they are excessively dried, or excessively moistened, or excessively heated, or excessively chilled. The phlegm and the bile undergo these states both from foods and drinks, and from exertions and wounds, and from smell and hearing and sight and sexual activity, and from heat and cold. They undergo these states whenever each of the things mentioned is applied to the body either not in the needful manner, or not in the accustomed amounts, or in greater and stronger measure, or in lesser and weaker measure. All sicknesses in human beings arise from these causes. A layman needs to understand, regarding these matters, as much as it is reasonable for a layman to know. As for what it is reasonable for practitioners to know and to apply and to manage — regarding both what they say and what they do, the layman is capable of forming some judgment. Now, from what source a layman must know each of these things, I shall explain. If pains fall upon the head, it is beneficial to heat the head thoroughly by bathing it with copious hot water, and to draw out phlegm and mucus by inducing sneezing. If with these measures the patient is freed from the pain, these suffice. But if not freed, one must purge the head of phlegm; regulate the diaita — regimen of living — with gruel and water as drink, and apply no wine until the severe pain ceases. For when the head, being warm, draws in wine, the severe pain becomes stronger. 2 [5] The pains fall upon the head through phlegm, when it is set in motion within the head and collects there. If pain and dizziness fall upon the head from time to time, these same measures are beneficial when applied. It is also beneficial if blood is removed from the nostrils or from the vein in the forehead. But if the sickness in the head becomes prolonged and severe and does not resolve after the head has been purged, one must either scarify the head or cauterize the veins all around; for from these remaining measures alone is there hope of recovery. Physicians must examine patients straightaway while the sicknesses are settled in their course, as to what they need, and whether they are in a condition to be given a medicinal purge, or to receive any other thing one might wish to apply. But if one passes over the beginning and applies treatment at the end of the sickness, when the body is already exhausted, and a single strong thing needs to be applied, there is more danger of going wrong than of succeeding. 4 [25] If pain falls upon the ears, it is beneficial to bathe with copious hot water and to apply fomentation to the ears. If with these measures the phlegm recedes, thinned, away from the head, and the pain departs, these suffice. If not, the best of the remaining measures is to drink a purge upward that clears phlegm, or to purge the head with what purges the phlegm of the head. This pain too arises when phlegm from the head falls against the sense of hearing from within. If the area alongside the throat becomes inflamed, one must gargle; these too arise from phlegm. If the gums or anything under the tongue becomes inflamed, masticatories should be used; these too arise from phlegm. If the uvula hangs down and causes choking — some call this the 'gargareon' — one should immediately use gargles prepared as written in the pharmacopeia. But if with these it does not become thin, shave the back of the head, apply two cupping vessels, draw away as much blood as possible, and draw the flux of phlegm backward. If it does not settle even with these, incise it with a small knife and draw out the fluid; incise when the tip has become somewhat reddened. If it is cut without having reached that state, it tends to become inflamed, and has at times caused sudden choking. This too arises from phlegm, when it flows down in a mass from the head once the head has been warmed. For pains that occur around the teeth: if a tooth is decayed and loose, extract it. If it is not decayed nor loose but causes pain, apply cautery to dry it. Masticatories are also beneficial. The pains arise when phlegm passes under the roots of the teeth. Teeth are eaten away and corroded — some by phlegm, others by foods — if they are naturally weak, and have hollow space, and are poorly fixed in the gums. If a polyp forms in the nose, it is as though something is being blown out, and it swells out from the nostril to the side. It is removed by drawing a noose through the nose into the mouth. Some rot it away with medicinal preparations. It grows from phlegm. 5 [5] These are the sicknesses that grow from the head, except those of the eyes; those will be written up separately. Concerning the sicknesses in the abdominal region, one must attend to the following. Pleuritis, peripneumonia, burning fever, phrenitis — these are called acute, and they arise most frequently and most severely in winter, though they also arise in summer, but less so and more mild. Should you find yourself attending such cases, here is what you would do and advise, with the best chance of success. 7 [15] Pleuritis: fever seizes, and pain in the side, and orthopnea, and cough. The sputum that is expectorated at the beginning is somewhat bile-tinged; by the fifth or sixth day it is also somewhat purulent. For this patient, give for the pain in the side what will cause phlegm and bile to withdraw from the side — for the pain would thus be most relieved. Treat the belly by loosening and cooling it with an enema; for this is most beneficial to the sickness as a whole. Offer drink and gruel, and give the drinks somewhat sharp, so that the sputum is cleansed from the side. When the pus begins to clear, it is beneficial to warm the side from without and thereby ripen what is at the side; before that point this is not beneficial, for it dries it out. This sickness arises most often from drinking, when a person, with the body in a moist state, chills whether drunk or sober; but it also arises in other ways. The sickness reaches its crisis at the shortest in seven days, at the longest in fourteen. If by that day the pus is expectorated and cleared from the side, the patient recovers; if it is not expectorated, the patient becomes empyic and the sickness is prolonged. 'Crisis' in sicknesses is when sicknesses are increasing, or waning, or shifting to another sickness, or ending. 9 [5] Peripneumonia: fever seizes and cough. What is coughed up is at first thick and clear phlegm; on the sixth and seventh day it is somewhat bile-tinged and somewhat livid; on the eighth and ninth day it is somewhat purulent. For this patient, if pain arises in either the back or the sides, give what is written in the pharmacopeia for the pain in the side in pleuritis. Treat with drinks and gruel, and regarding the evacuation and cooling of the belly, manage in the same way as in pleuritis. In order to clear the sputum and the pus from the lung, give medicinal drinks by which the lung is moistened and the pus cleared upward. This sickness arises when phlegm flows down in a mass from the head into the lung. Sometimes it also shifts from pleuritis into peripneumonia, and from burning fever. It reaches its crisis in days — at the shortest in fourteen, at the longest in eighteen. Few escape this illness. Empyic conditions also arise from this sickness if the lung is not cleared at the critical days. When phrenitis seizes, fever holds first as a low smoldering heat, and pain toward the hypochondria, more toward the right in the direction of the liver. When the fourth and fifth day arrives, both the fever and the pains become stronger, the complexion becomes somewhat bile-tinged, and there is derangement of the mind — this last being the distinguishing sign of the disease. 10 [15] For this patient, give for the pain what was given in pleuritis, and apply warmth where the pain holds. Treat the belly, and do all the rest the same, except for the drink. Use whatever else you wish for drink, except wine, or give vinegar and honey and water. Wine is not beneficial when the mind is deranged, neither in this sickness nor in the others. Bathing the head lavishly with hot water is beneficial in this sickness; for as the body is softened, sweat is more readily produced, the belly and urine move, and the patient becomes more in control of himself. This sickness arises from bile, when it is set in motion and settles against the viscera and the diaphragm. It reaches its crisis at the shortest on the seventh day, at the longest on the eleventh. Few escape this illness either. It also shifts into peripneumonia, and if it does shift, few escape. Burning fever: when it holds, fever seizes and severe thirst. The tongue becomes rough and black from the heat of the pneuma — breath — and the complexion becomes somewhat bile-tinged, the stools are bilious, the external parts become cold while the internal parts are hot. 11 [15] For this patient it is beneficial to apply cold applications both toward the belly and externally to the body, taking care that he does not shiver. Give drinks and gruel frequently and in small amounts, as cold as possible. Treat the belly; if what is within does not pass downward, apply an enema. Cool with enemas as cold as possible, either daily or every other day. This sickness arises from bile, when it is set in motion and fixes itself within the body. It tends to shift into peripneumonia. It reaches its crisis at the shortest on the ninth day, at the longest on the fourteenth. If it shifts into peripneumonia, few escape; if it does not shift, many escape. These then are called acute sicknesses, and one must treat them in this way. As for all other fevers that arise in winter, whether from wine, or from exertion, or from some other cause, one must be on guard; for they sometimes shift into the acute sicknesses. 12 [5] The shifting of these fevers into the acute sicknesses occurs in this way: when both phlegm and bile have been set in motion and what is beneficial is not applied to the body, the phlegm and bile, consolidating upon themselves, fall upon whatever part of the body they happen upon, and either pleuritis or phrenitis or peripneumonia results. One must therefore be on guard against fevers in winter. The guard should consist of rest, reduction, and emptying of the belly. Pass the time on gruel and drink until the fever diminishes. Of all sicknesses, the acute ones especially both kill and are most painful, and they require the greatest vigilance and the most precise care. From the one treating, no harm should be added — it is enough that what comes from the sicknesses themselves is already present — and whatever good one is capable of should be done. If, while the physician treats correctly, the patient is overpowered by the magnitude of the sickness, this is not the physician's error. But if the patient is overpowered by the sickness because the physician is not treating correctly or does not understand, that is the physician's error. 14 [20] In summer the following occur: strong fever seizes and thirst, and some vomit bile; in some it also passes downward. Give these patients to drink and to sip whatever seems to you appropriate. If bile or phlegm settles against the cardia, let them drink cold water or honeyed water and then vomit. If the stomach does not pass downward, use an enema or a suppository. This sickness arises from bile. Most recover by the seventh or ninth day. If, while the fever holds, there is no purging either downward or upward, and pain is present throughout the whole body, when it is the third or fourth day, purge gently downward with a medicinal preparation or a drink. Make gruel from millet or meal, and treat with the same drinks. These too are affected through bile. If the external parts are not very feverish but the internal parts are, and the tongue becomes rough and black, and the feet and the extremities of the hands are cold — give no medicinal purge to this patient, but treat by applying cold applications to the belly and to the rest of the body. This fever is called the burning type. It reaches its crisis most often on the tenth, the eleventh, and the fourteenth day. If the fever takes hold and releases, and heaviness of the body holds the patient, treat this patient with gruel and drink while the fever holds; when it does not hold, give solid foods as well. Purge as quickly as possible with a preparation, whether upward or downward as seems to you necessary. If there is no fever but the mouth is bitter, the body feels heavy, and there is loss of appetite, give a medicinal purge. These things are suffered through bile, when it fixes itself into the veins and the joints. 15 [5] For all other pains that arise in summer in the abdominal region: for those toward the hypochondria and the cardia, prepare dilute honeyed water, about three kotylai, pour in vinegar, and give it to drink lukewarm. After waiting a short time, having warmed the patient thoroughly with fire and coverings, let him vomit. If after vomiting it settles again and causes choking, let him vomit again. Or bathe him with copious hot water, apply an enema below, and apply warm fomentations if the pain holds. These conditions are suffered most often from phlegm, when it is set in motion and falls against the cardia. To those suffering such pains, also give from among the medicinal preparations those written to stop pain in the pharmacopeia. If the pain shifts from one part of the abdomen to another and there is no fever, bathe with copious hot water, and give to drink what is written for pain in pleuritis, or whatever else seems appropriate to you. If relief from the pain does not come, purge gently downward with a medicinal preparation, and abstain from foods as long as the pain holds. Such pains as wander about in this way arise from bile. For pains that arise below the navel, apply a gentle enema below. If it does not cease, give a medicinal purge downward. For pains that arise suddenly in the body without fever, it is beneficial to bathe with copious hot water and to apply warmth. For phlegm and bile, when they are condensed, are strong and prevail over whatever part of the body they settle in and cause great labor and severe pain; but when they are dispersed they are weaker wherever they are manifest in the body. 17 [5] Sicknesses that arise in summer tend to arise in this way: when the body is warmed by the sun it becomes moist; being moistened, it falls sick either entirely or in whatever part phlegm and bile settle. If one treats these at their onset, they become neither prolonged nor dangerous. But if one does not treat them, or treats them badly, they tend to become more prolonged, and often they also kill. Tertian and quartan fevers naturally arise from the same causes. This condition of sicknesses arises most often in summer, but in some people in winter as well. 18 [5] When a tertian fever holds: if it seems to you that the patient is unpurged, give a medicinal purge on the fourth day. If it does not seem to you that a purge is needed, give medicinal drinks by which the fever will shift or leave; give them as written in the pharmacopeia. On the day of the paroxysm, regulate with gruel and drink; on the intervening days, with foods that move the bowels. It generally does not last very long; but if left untreated, it tends to shift into a quartan and become prolonged. If a quartan fever seizes: if the patient is unpurged, first purge the head; then, waiting three or four days, give a purge upward at the very time of the paroxysm; then waiting again, give another downward during the same paroxysm. If with these measures it does not cease, wait again, bathe the patient with copious hot water, and give from among the preparations that are written. Use drinks and gruel and the rest of the diaita — regimen of living — as with the tertian. This fever holds most patients for a long time, and some for a shorter time. Both the tertian and the quartan arise from bile and phlegm; the reason why the tertian and the quartan are as they are has been written by me elsewhere. The medicinal drinks taken in these fevers have the power to keep the body in its proper condition with respect to its accustomed heat and cold, neither being heated beyond its nature nor chilled. Give them as written in the pharmacopeia. When white phlegm holds: the whole body swells with a pale white swelling, and within the same day the patient sometimes seems to improve, sometimes to worsen; the swelling becomes greater and lesser in one part of the body or another. Give this patient medicinal purges downward by which water or phlegm is cleared. Regulate with foods, drinks, and exertions by which he will be as dry and as reduced as possible. 19 [5] This sickness arises from phlegm, when a person, coming out of prolonged fevers while still phlegmatic and unpurged, has the phlegm turn and spread through the flesh. This phlegm is no whiter than other phlegm; but the complexion appears whiter — for the blood becomes more watery from the abundance of phlegm and the healthy color is not present in it as before — and for this reason they appear whiter, and the sickness is called white phlegm. If treated at the onset of the sickness, the patient recovers. If not, the sickness shifts into dropsy and destroys the person. As for those who have an enlarged spleen: those who are bilious become poor in color and prone to bad ulcers and foul-smelling from the mouth and lean. The spleen is hard and always about the same size. Foods do not pass through. Those who are phlegmatic suffer these things less, and the spleen becomes sometimes larger, sometimes smaller. 20 [25] For these patients it is beneficial, if they appear unpurged, to purge both the head and the rest of the body. If they do not require medicinal treatment, regulate with diaita — regimen of living. For those who are phlegmatic, with foods and drinks and emetics and as many exercises as possible and walks that dry and reduce the body; and in spring purge upward with hellebore. For those who are bilious, it is beneficial with a moistening diaita to move the belly and the bladder downward, and to let the splenic vein frequently, and to use diuretic preparations — those written to soften the spleen — and to purge at the season of the year, purging in this case bile. Some of those with spleen conditions are not benefited by drinking the preparations, nor by the rest of the treatment, nor does their spleen become any smaller; the things applied are overpowered by the magnitude of the sickness. As time goes on, in some the sickness shifts into dropsy and they are destroyed. In some it suppurates, and after cauterization they recover. In some it grows old with them, remaining hard and large. The sickness arises when, from fevers and bad treatment, bile or phlegm or both fix themselves into the spleen. The condition is prolonged but not fatal. Among the preparations given for the spleen, some clear through the bladder and make it lighter; others do not clear anything through the bladder that is apparent, nor by any other route, but they nonetheless relax the spleen. When ileus seizes, the stomach becomes hard and nothing passes. Pain holds throughout the whole abdomen, and fever and thirst. Sometimes from the distress the patient also vomits bile. 21 [5] This patient must be moistened from within and from without. Bathe with copious hot water. Give to drink whatever moves the belly and promotes the urine, and apply an enema below if he accepts it. If he does not accept the enema, attach a small tube to the neck of a wineskin, blow in air, and inject a large quantity of air; and when the intestine and belly are lifted by the air, remove the small tube at once and inject an enema. If he accepts it, the bowel will move and he will recover. If even so he does not accept the enema, he dies, most often on the seventh day. This kind of sickness arises when excrement is densely compacted all at once in the intestine; phlegm accumulates around this, and the intestine, since these things have hardened in a mass within it, swells around them. Neither the medicinal purges taken from above are accepted — they are vomited up — nor the enemas applied from below. The sickness is acute and dangerous. Dropsy arises most often when a person, coming out of a prolonged sickness while still unpurged, is carried through a long time; for the flesh is corrupted and melts away and becomes water. Dropsy also arises from the spleen when it is diseased, and from the liver, and from white phlegm, and from dysentery and leientereia. NOTE: The section numbering in the source text is non-consecutive (sections 32, 34, 37, 41, and 45 are absent from the transmitted text); this edition preserves the transmitted numbering without interpolation. 22 [25] If dropsy arises from impurity, the belly fills with water, the feet and shins swell up, while the shoulders, collarbones, chest, and thighs waste away. If you catch this condition at its beginning, before the patient has become overtaken by water, give medicines to drink downward, by which water or phlegm is purged — but do not move bile — and manage him by means of diaita (regimen of food, drink, exertions, and walks) by which he will become lean and dry, and the flesh as strong as possible. The disease is deadly, especially if the belly happens to fill up with water first. When the condition shifts from the spleen, or the liver, or white phlegm, or dysentery into dropsy, the same treatment is beneficial; yet very few escape. For whenever one disease follows upon another, it generally kills — since when the body is already weakened by the disease at hand and another disease comes upon it on top, the patient perishes beforehand from weakness, before the later disease that arose second has run its course. The water comes about in this way: when the flesh is corrupted by phlegm, by time, by disease, by impurity, by bad treatment, and by fevers, it wastes away and becomes water; and the belly does not absorb this water into itself, but it collects in a ring around it. If the patient is benefited by the medicines and the rest of the diaita, the belly is also evacuated of it; if not, one must incise and let the water out. The incision is made either beside the navel or behind along the flank; but even from this few escape. When dysentery holds a patient, pain holds throughout the whole belly, and griping, and he passes bile and phlegm and burnt blood. 23 [15] For this patient: purge the head, give a medicine to drink upward that purges phlegm, wash out the belly with boiled milk, and treat the rest of the body. If he is without fever, always move what is present in the belly with fatty, rich, sweet, and moist foods, bathe the parts below the navel with much warm water if pain holds, and administer drinks, broths, and solid foods according to what is written in the pharmacopoeia. The disease comes about when bile and phlegm lodge firmly in the veins and the belly; the blood sickens and passes out corrupted, the intestine also sickens and is scraped and ulcerated. This disease becomes long, distressing, and deadly; if treated while the body still has strength, there is hope of escape; but if the body is already wasted away and the belly is ulcerated throughout, there is no hope of life. Leientereia: the foods pass through unputrefied and moist; there is no pain; but the body grows thin. Treat this patient with the same means as those held by dysentery. 24 [5] The disease comes about when a downflow of phlegm occurs from the head and the upper belly into the lower belly. When this happens, the foods are chilled by it and moistened, their passage while still unputrefied becomes swift, and the body wastes — partly because the foods are not being concocted in the belly for sufficient time, and partly because they are being heated abnormally by the belly, which is hot beyond nature. When prolonged diarrhea holds a patient, what is consumed first passes through moist, then phlegm passes; he eats fairly well, but from the frequent passing he becomes weak and thin. 25 [10] For this patient: dry him out from above by giving hellebore to drink and purging phlegm from the head, wash out the belly with boiled milk, and then treat him in other respects with foods and drinks by which the belly and the whole body will be dried out. The disease arises from the same causes as leientereia. These diseases — dysentery, leientereia, and diarrhea — are closely alike, and one must treat them in this way: intercept or divert the downflow from the head and the upper belly; for from there the nature of the disease arises, and no one will blame your reasoning in this. One should look at virtually all other diseases in the same way — from where the nature of each arises; and by looking in this way and taking hold of the origin of the diseases, you would err least. When tenesmos seizes a patient, dark blood and mucus pass, and pain occurs in the lower belly, most of all when he sits down to stool. For this patient it is beneficial to moisten, lubricate, and warm the belly, to move what is present in it, and to bathe with warm water — except the head. 26 [5] This disease tends to require more food; for the gripings occur when the belly is emptied by the blood and mucus passing through and falling against the intestine. When food is present, it causes less gnawing to the intestine. It arises from the same causes as dysentery, but is milder, shorter-lived, and not deadly. When cholera seizes a patient from wine or feasting, for the diarrhea it is beneficial to fast through the day, and if thirst holds him, give sweet wine or sweet marc; toward evening give what is also given to those purged by a medicine. If it does not stop and you want to stop it, produce vomiting from food or a lentil preparation; and straightaway the lower passage is drawn back upward. And if you rinse the bowel with juice of lentils or chickpeas, it will stop that way too. 27 [5] For cholera it is beneficial: if pain holds, give what is written among the medicines for stopping pain; treat the belly both above and below, moistening with drinks and softening the body with warm baths — except the head. In this way vomiting becomes easier if something moist has gone in, and what has lodged above is vomited out, and the lower passage flows more freely. If the patient is empty, he vomits with violence and passes downward more violently. Toward evening give this patient too what is given to the one who has taken a purgative medicine. These pains that arise from drinking or from feasting occur when more food and drink than usual enters the belly, and when things that are accustomed to heating the body from outside stir up bile and phlegm. Of dysuria there are many and various kinds. It is beneficial to soften the body from outside with warm baths, and to moisten from inside — the belly with foods by which it will flow freely, and the bladder with drinks by which the urine is dispersed as fully as possible; also give the diuretic medicines written in the pharmacopoeia for stopping the pain. 28 [10] The disease arises from phlegm; and whenever the bladder becomes dry, chilled, or emptied, it produces pain; when it is moist and full and relaxed, less so. The disease is longer-lasting in older patients, shorter in younger ones, and not deadly for either. When ischias (hip-joint pain) occurs, pain seizes the attachment of the hip-joint and the extreme end of the rump and the buttock; and finally the pain wanders through the whole leg. 29 [15] For this patient, when the pain holds, it is beneficial to soften whichever part of the leg the pain happens to be fixed in, with baths, warm applications, and fomentations, and to move the belly. When the pain lets up, give a medicine downward; and after this, give boiled ass's milk to drink; also give what is written among the medicines for the pain. The disease comes about when bile and phlegm lodge firmly in the hemorrhoidal vein [a vessel conceived as conducting corrupted blood through the leg], either from another disease or otherwise — whatever portion of the blood has sickened by being congealed by phlegm and bile. This wanders up and down the leg through the hemorrhoidal vein, and wherever it comes to rest, the pain becomes most apparent there. The disease is long and distressing, but not deadly. If the pain settles and stays fixed in one particular place and is not driven out by medicines, cauterize at whatever spot the pain happens to be, burning with raw linen. When the disease of the joints (arthritis) holds a patient, fever takes hold, and sharp pain seizes the joints of the body, and the pains, sharper and milder, settle in one joint after another. 30 [5] For this patient it is beneficial to apply cold applications wherever the pain holds, to move what is present in the belly with enemas or a suppository, and to give broths and drink whatever seems to you beneficial; when the pain lets up, give a purgative medicine downward, and after this have the patient drink boiled whey or ass's milk. The disease arises from bile and phlegm, when they are set in motion and lodge firmly in the joints. It is short-lived and acute, but not deadly; it tends to occur more in younger than in older patients. Podagra (foot-trap gout) is the most violent of all such conditions affecting the joints, the longest-lasting, and the hardest to be rid of. This disease consists in the blood in the small vessels being corrupted by bile and phlegm; and in proportion as it is in the finest vessels and those that by necessity are subject to the most constraint in the body, and among many dense sinews and bones, to that degree the disease is most persistent and hardest to be rid of. 31 [5] The same things that benefit arthritis also benefit this disease; and this disease too is long and distressing, though not deadly. If the pain is left behind in the great toes, cauterize the vessels of the toe a little above the knuckle, burning with raw linen. Jaundice must be treated in this way: soften the body from outside with warm baths; moisten the belly and the bladder, and give the diuretic medicines written above; if the condition is severe, purge the head and give a medicine downward that purges bile, then use the diuretics. The disease arises when bile, being set in motion, turns toward the skin. 33 [5] A layman who understands these things would not fall similarly into incurable diseases; for diseases are accustomed to become great and long-lasting from small occasions. Whatever things concern foods, drinks, broths, or medicines given for the sake of pain are all safe to administer at any time, provided you administer them according to what is written; but in those medicines that purge bile or phlegm, that is where the dangers and the grounds for blame to those who treat arise. One must therefore guard against these matters above all. These then are the diseases occurring in the belly — except concerning those with internal suppuration and those with phthisis (wasting consumption), and women's conditions; these will be written separately. All growths that grow, grow from phlegm or blood; when they are gathered from a wound or a fall, it is beneficial to disperse some of them by applying poultices and giving medicines to drink, and to ripen others by applying poultices. What disperses among poultices is whatever, being warm, moistens without drawing toward itself; what ripens is whatever, by warming, draws together. When a growth has been incised or bursts of its own accord, clean out the fluid with a medicine; when it stops discharging pus, treat it as a wound. 35 Lepra [scaly skin conditions, not necessarily Hansen's disease], itching, scabies, scale-lichens, alphos, and fox-mange arise from phlegm; such conditions are a disfigurement rather than diseases. Honeycomb-sores, scrofulous swellings, carbuncles, boils, and anthrax grow from phlegm. In using these cleansing medicines, proceed as follows: to those who are bilious, give what purges bile; to those who are phlegmatic, what purges phlegm; to those suffering black bile, what purges black bile; to those with dropsy, what purges water. 36 [10] All medicines given as drinks that do not purge either bile or phlegm, when they enter the body, must provide their power by either cooling, or warming, or drying, or moistening, or drawing together, or dispersing. Those that produce sleep must provide the body with stillness. When you come to a sick person, ask: what is he suffering, and from what, and on which day, and is the belly moving, and what diaita is he following — and consider first whether the disease has arisen from bile or phlegm or both, and know well that it must of necessity arise from one or both of these; then whether the patient needs drying or moistening, or the body in some parts needs drying and in other parts moistening; then whether the disease needs to be treated upward or downward or through the bladder, and whether the disease is increasing or waning or being resolved or shifting into another disease. 38 [5] For those with wounds: keep them hungry, move what is present in the belly — either by enema or by giving a medicine downward — and give water and vinegar to drink and broths to sip. Cool what is inflamed with poultices; such poultices should be either beets boiled in water, or celery, or olive leaves, or fig leaves, or elder leaves, or bramble, or sweet pomegranate — use these boiled; use raw: buckthorn leaves, or chaste-tree, or sage, or spurge, or fresh pennyroyal, or leeks, or celery, or coriander, or woad leaves. If you have none of these and no other poultice at all, mix barley flour with water or wine and apply as a poultice. These poultices are beneficial for as long as they remain cooler than the wound; when they are warmer or equally warm, they are harmful. Oily things are not beneficial for inflammations, nor for foul wounds, nor for putrefying ones; rather, for inflamed wounds cold things are beneficial, and for foul and putrefying ones, sharp things and whatever by producing some gnawing action cleanses them. When you want to grow flesh, oily and warm things are more beneficial, for flesh flourishes under these conditions. Whatever foods and drinks healthy people use in their diaita, from what is available among these one must prepare things for the sick — warm and cold, moist and dry — making warm from cold, making not-warm from warm, and dry from not-dry, and the rest in the same way. 39 [5] One must not be at a loss, nor be unable with what is at hand and, by seeking what is absent, be unable to help the sick person at all; if you look rightly beyond the things used for the sick patient, you will find few things lacking. In all diseases give broths: either ptisane, or millet, or fine meal, or groats. Of these, whatever you give for the sake of bowel movement, give thin and more thoroughly boiled, and sweeter or saltier or warmer; whatever for the sake of strength or recovery, give thicker and fattier and moderately boiled. 40 [10] As for drinks: if you want to move the belly and the bladder, use sweet wine or water-honey-drink; if you want to bind, an astringent, white, thin, well-watered wine; if for strength, an astringent, dark wine. For those who drink wine immoderately, give what is written in the pharmacopoeia as prepared drinks. For those who have taken a purgative medicine, give after the purging: to those with fever, lentil broth or thin millet or ptisane juice; give ptisane and millet as being light, groats as stronger than these, and fine meal as the strongest of all. Prepare the lentil broth fragrant, and give a small second portion, as it is both a light broth and good for the upper stomach (cardia); mix into the lentil broth either salt or honey and cumin and oil, or a little fresh pennyroyal and vinegar. For those without fever: crumble the inner part of clean bread into broth, or barley cake and a boiled slice of salt fish, or the meat of as young a sheep as possible, or of a bird, or of a puppy — boiled — or beet or gourd or blite, and after the food drink fragrant wine, aged, white, well-watered. 42 [5] For those for whom bathing is not beneficial, anoint with warm wine and oil and wipe down every other day. When you want to moisten the belly with foods in a weakened patient, give barley cake and relishes — boiled slices of sea-fish in sauce, the meat of as young a sheep as possible, or of a kid, or of a puppy, or of a bird — boiled — and beets, or blite, or dock, or gourd if it is the season; for vegetables: celery and dill and basil; and the wine honey-sweet, aged, white, well-watered. 43 [20] When you are drying the body, give bread and roasted and dry relishes — all warmer — and of meats the limbs that are fleshy, of fish the rock-fish, of vegetables rue or thyme or marjoram, and the wine dark and astringent; prepare the relishes with salt and cumin, and use all other seasonings as sparingly as possible. When you want to restore a patient from disease, give the same things as when moistening the belly, except the meats — stronger instead of suckling animals, and birds and hares instead of dog-meat, and some of these roasted, both meats and fish, and prepared in the best way. For those diseases in which dryness is beneficial: one meal a day is beneficial, and give less food and drink than would make the patient full, and work this off with exercise and walking, and sleep as little as possible. For those again in which moistness is beneficial: do not keep the patient fasting, and let him not be deficient in food or drink, and not exercise, and let him sleep as much as he wishes. Whatever foods, relishes, or drinks the sick crave, let these be provided, unless there is going to be some harm to the body. 44 [5] Whenever you begin adding to or subtracting from foods or drinks, additions and subtractions must be made gradually. For those who are able to take sufficient solid food, do not give broths — for the broth blocks out the solid food; for those who are unable, give broths. If you want to give something for the sake of recovery, give groats or wheaten ptisane; for these are the strongest of the broths, and give them after dinner. All medicines — those given as drinks and those applied to wounds — are worth learning, for the knowledge is worth everything; people do not discover these from reasoning but more from chance, and not craftsmen any more than laymen. But whatever in the craft of medicine is discovered by reasoning, whether concerning foods or medicines, one must learn from those capable of discerning what belongs to the craft, if one wishes to learn anything. 46 [5] Give solid food to the sick after the broths; have them drink fragrant wine afterward. Before the foods and drinks or broths, give — looking at whatever seems right to you, observing the sick person's body and psyche (vital condition) — both the food and the drink; for in this way you would benefit most. As for what power each food has, one must judge from those whose power is evident — as many as produce wind, or gnawing, or repletion, or belching, or griping, or that pass through the bowels or do not pass through — and it is clear that they produce these effects; from these one must examine the rest. For each of the foods has a reason why it benefits and why it harms; but some produce their effects more visibly, others more dimly. 47 [35] Prepare and give to the sick foods and relishes from which there will be neither flatulence, nor acid belching, nor griping, nor excessive looseness of the bowels, nor excessive drying out. This comes about as follows: whatever the belly masters and the body takes up, these produce neither flatulence nor griping; but if the belly does not master them, from these both flatulence and griping and everything else of the sort arise. The lightest of foods and relishes and drinks are those which, entering the body in moderate amounts or somewhat above moderate, produce neither fullness nor griping nor flatulence nor anything else of that kind, and are concocted most quickly, and while being concocted pass through the bowels, and entering the belly every day are least burdensome, and also when one has gone a long time without them. Heavy ones are those which, taken in moderate amounts or less than moderate, produce fullness and distress; indeed one cannot eat or drink them daily without distress; and if one drinks or eats them after an interval, even so they produce distress, and they do not pass through the bowels in proportion. Best for health are those which, entering in the smallest quantity, are sufficient to be a remedy for both hunger and thirst, which the body receives for the longest time, and which pass through the bowels in proportion. Best for strength are those which grow the most flesh and the densest, and thicken the blood, and pass through the bowels in proportion to what has entered, and which the body takes up for the longest time. Fatty and rich things, and things of the nature of cheese and honey, and sesame preparations, produce acid belching most of all, and also bilious vomiting and purging [cholera], griping, flatulence, and fullness; and this same thing happens also whenever one eats or drinks more than the belly is capable of concocting. For the sick: if you give whatever you give in proportion to the disease and the body, the body gradually uses up these things, and is neither deficient nor overfull; but if you err on one side or the other in timing, harm results in both cases. Of foods and relishes and drinks, those which the body takes up most readily produce from them neither griping nor flatulence nor acid belching; for when they enter the belly, the body draws from them what is suitable to itself, and what remains must already be weaker, so that it cannot produce griping or flatulence or anything else of the sort in the belly. Of wines, both the sweet and the harsh and the honey-like, when aged, move the belly downward most of all, and are diuretic and nourishing, and produce neither flatulence nor griping nor fullness. 49 [10] Of meats, both the twice-boiled and the thoroughly roasted are both weak for strength, but as for passing through the bowels, the twice-boiled are suitable, while the roasted are more binding; those that are moderately boiled and moderately roasted hold a middle position both for strength and for passing through the bowels; while those that are somewhat undercooked are suitable for strength but not for passing through the bowels. Of foods and drinks, those most suited to the body and most sufficient both for nourishment and for health — from these very things, when one uses them out of season or in excess of what is seasonable, both diseases and from diseases deaths arise; while other foods and drinks that do not have such power benefit somewhat if one always uses them in season, and harm somewhat as well — they are weak in both directions, for doing good and for doing harm. The foods and drinks that have this power are the following: bread, barley-cake, meats, fish, wine — though among these some have more and some less. 51 [5] For those following a dry diaita (regimen / ordering of life), do not give drink together with the food, but after the food, having left a long interval; for in this way the moisture arising from dry foods, being itself dry, dries the body; but if one drinks together with the food, the nourishment becomes moister and makes the body more moist. Warm bread and warm meats, eaten by themselves, dry out; but if you give them along with something liquid, or give drink to be drunk immediately after the food, they do not dry out. Bread made from pure fine flour is more beneficial for strength and recovery than bread made from unbolted meal, and fresh bread more than stale, and bread from fresh flour more than from older flour. 52 [30] Barley-groats from unsoaked and husked barley are stronger than from soaked, and fresh more than older; and barley-cake kneaded beforehand is stronger than one not kneaded beforehand. Wine, when poured off, chilled, and strained, becomes thinner and weaker. Of boiled meats, if you make them twice-boiled they are weaker and lighter; of roasted meats, if thoroughly roasted; and old meats from vinegar or salt are weaker and lighter than fresh. Weak and light foods do not trouble the belly or the body, because they do not swell when heated and do not fill, but are concocted quickly and while being concocted pass through the bowels; yet the moisture that comes from them to the body is weak, and provides neither growth nor strength worth speaking of. Strong foods, on the other hand, swell when they enter the belly and produce fullness, and are concocted more slowly and pass through more slowly; but the moisture from them, being strong and unmixed as it is added, provides much strength and growth to the body. Of meats, lightest for the body are dog's meat, bird's meat, and hare, when twice-boiled; heavy are beef and pork; most moderate in nature, both boiled and roasted, for both the healthy and the sick, are small-livestock meats [τὰ μήλεια: sheep, goat, or small livestock generally]; pork is good for those who labor and exercise, for good condition and strength, but for the sick and those leading a sedentary life it is too strong. Wild animals are lighter than domestic ones, because they do not eat a similar fodder; and meats of livestock differ according to whether they eat grain-fodder or not; and grain-fodder does not produce the same thing in all cases, but one kind makes the flesh of the animal dense and strong, while another makes it loose and moist and weak. To speak in sum: fish is a light food both boiled and roasted, both on its own and with other foods; but they differ among themselves as follows: those from lakes and those that are fat and those from rivers are heavier, while coastal fish are lighter, and boiled fish are lighter than roasted. Of these, give the strong ones when you wish to restore someone, and the light ones when you need to make someone thin and slender. A warm bath, when moderate, softens and builds up the body; but more than is seasonable moistens the dry parts of the body and dries out the moist parts, and the dry parts, being moistened, produce weakness and faintness, while the moist parts, being dried, produce dryness and thirst. 54 [10] Of vegetables: garlic, both boiled and roasted, is diuretic and promotes passage through the bowels and is beneficial for women's conditions. Onions are suitable for promoting urine; for their juice provides a certain sharpness that causes passage through the bowels; use them in this way, but do not give them to the sick. Celery, both boiled and raw, is diuretic; and marsh celery has more power than garden celery. Coriander is good for the stomach and promotes passage through the bowels, both boiled and raw. Basil is moist and cooling and good for the stomach. Leeks when boiled are diuretic and promote passage through the bowels, but raw they cause burning and promote phlegm. Pomegranate is restorative and phlegm-promoting; with the seeds it is binding, without the seeds it promotes passage through the bowels. Hot foods when dry arrest passage, because they dry out the moisture in the belly; but when moist, by moistening with their heat they promote downward movement. Astringent things dry and contract the body, and are also binding. Sharp things make thin, producing a biting sensation. Salt things promote passage through the bowels and are diuretic. Fatty and rich and sweet things provide moisture and phlegm, and are restorative. Gourd, beet, blite, and dock are loosening of the bowels by their moisture. Cabbage has a certain sharpness that promotes passage through the bowels, and at the same time provides good chymos (bodily juice/fluid). Cheese and sesame and dried grapes are restorative and phlegm-promoting. Sweet wines and honey-like wines are both restorative and diuretic and phlegm-promoting; harsh wines are suitable for strength and drying; and of the harsh wines those that are thin and aged and white are also diuretic. 55 Olive oil and things of that kind are restorative and phlegm-promoting. Of boiled vegetables, those that pass through the bowels are those which are by nature most moist or have sharpness or heat; give these lukewarm and soft. 57 The ripe cucumber is both diuretic and loosening of the bowels and light; the other melon provides a certain cooling and relieves thirst; nourishment from neither of them is produced except of the thinnest kind, but neither do they cause any harm worth speaking of. Honey, when eaten together with other things, both nourishes and gives good color; but taken by itself it makes thin rather than restores, for it is diuretic and purges more than is moderate. 59 [5] Things that are loosening of the bowels are heated quickly in the belly, and being heated they waste away and melt, and for this reason produce quick passage through the bowels; while foods that are binding are also heated slowly, and being heated they dry out and coagulate, and for this reason becoming quite hard do not pass through the bowels. Loosening foods are full of juice and hot by nature; diuretic foods are dry and cold. Grain and wine differ among themselves by nature with respect to strength and weakness and lightness and heaviness; region too differs from region according to where they come from — whether it is well-watered or waterless, well-sunned or much-shaded, good or poor — so that all these things contribute to each kind of food being stronger or weaker. 61 [30] For those who are accustomed when healthy to eating bread, give them this also when they are ill. Whenever someone takes more food or drink than usual, or fails to complete their customary intake, it is best to vomit immediately. Summer fruits and tree-fruits are for this reason more troublesome when taken after food, both for the healthy and the sick: because when one has already eaten, the body draws little moisture from them; but if one eats them fasting, more. When foods produce flatulence or burning or a biting sensation or fullness or griping, wine drunk after them unmixed relieves these conditions; for the body, being thoroughly warmed by the wine, is freed of what is in it by the heat. From foods and drinks of a like kind the belly is sometimes disturbed, sometimes bound, and sometimes passes through the bowels in proportion. Why does this happen? First, the belly, when it receives food in a condition that is either more moist or more dry, does not damage it; then, when a change occurs either from cold to warmth or from warmth to cold, it does damage — so that necessarily the belly becomes both more relaxed and more contracted from the same foods and drinks for these very reasons. Of foods and drinks and relishes, except for bread and barley-cake and meats and fish and wine and water, all the rest provide only slight and weak benefits for growth and strength and health; and the harms from them are also slight and weak. For those of the sick whose fevers do not hold continuously but take them at intervals, give food after the seizure, calculating so that the fever will not fall upon them when the food is still new in the belly, but when the food has already been concocted. Wine and honey are most finely blended for human beings, if they are offered in season and in moderation in proportion to the nature of both the healthy and the sick; good on their own and good when mixed together, as well as everything else that provides benefit worth speaking of. Whatever is beneficial for the healthy, when given to the sick is stronger, and one must reduce their intensity before giving them; otherwise the body does not bear them, but is harmed more than helped.