On Ancient Medicine — First Draft Translation

ON ANCIENT MEDICINE All those who have undertaken to speak or write about medicine, having laid down for themselves a hypothesis as the basis of their argument — whether hot, or cold, or wet, or dry, or whatever else they wish — reducing to something narrow the originating cause of diseases and death among human beings, and positing the same cause for all, one or two such postulates, are plainly in error on many of the points about which they speak. They deserve censure above all because they err concerning an art which all men use in their most serious moments, and in which they hold the skilled craftsmen and makers in highest honor. [Chapter 1] There are craftsmen, some poor, others far surpassing them. This difference could not exist if medicine did not exist at all, and nothing had been inquired into or discovered within it; instead, all would be equally inexperienced and ignorant of it, and everything concerning the sick would be managed by chance. As it is, things are otherwise: just as in all the other arts the craftsmen differ greatly from one another in hand and in judgment, so too in medicine. For this reason I myself have never thought that medicine stands in need of some empty hypothesis, as do things that are obscure and unresolvable — matters where whoever undertakes to speak must necessarily use a hypothesis. For instance, if someone were to speak and claim to know how things stand concerning what is in the heavens or beneath the earth, it would not be clear, either to the speaker himself or to those listening, whether what he says is true or not; for there is nothing one can refer back to in order to know with certainty. But medicine has long possessed everything within itself — a starting point and a path already discovered — by which many fine discoveries have been made over a long time, and the remaining ones will be discovered, if a person of sufficient capacity, knowing what has already been found, sets out from these to pursue the inquiry. [Chapter 2] Whoever, however, throws all this aside and rejects it, and attempts to pursue the inquiry by some other road and in some other form, and claims to have found something, has been deceived and goes on deceiving himself; for it is impossible. By what necessities it is impossible, I shall try to show, by speaking and demonstrating what the art actually is. From this it will become clear that discoveries cannot be made in any other way than these. It seems to me most important, when speaking about this art, to say things that are intelligible to ordinary people. For it is fitting to inquire and speak about nothing other than the sufferings from which those very people are sick and in pain. As for ordinary people learning for themselves the nature of their own sufferings — how they come about and cease, and through what occasions they increase and diminish — this is not easy for them, being laymen. But what has been found and set out by another is easy for them. For each person, on hearing, is only reminded of what has happened to himself. If anyone fails to reach the understanding of ordinary people, and does not put those who hear into that relation with what is being said, he will miss reality. And for these reasons, medicine has no need of a hypothesis at all. For from the beginning, the art of medicine would never have been found or even sought — since there would have been no need for it — if the same diaita and the same foods that healthy people eat and drink and otherwise live by had been beneficial to sick people as well, and if there had been nothing better than these. [Chapter 3] As it is, necessity itself caused medicine to be sought and found by human beings: because the same things that were given to sick people as to the healthy did not benefit them — as indeed they do not now. Going still further back, I hold that not even the diaita and nourishment of healthy people as they are now used would have been discovered, if it had sufficed for a human being to eat and drink the same things as an ox, a horse, and all animals other than the human — things that grow from the earth: fruits, timber, and grass. For from these animals grow and live without suffering, needing no other diaita. And indeed, at the beginning I hold that a human being also used such nourishment. The current ways of living and eating seem to me to have been found and worked out through a long stretch of time. For as people suffered much that was terrible from a harsh and beast-like diaita — consuming things raw and unmixed and of great power, just as they would suffer from them even now — falling into severe pains and diseases, and dying quickly; yet it is likely that these things caused less suffering then, because of habituation, though still severely; and it is likely that most people, those with weaker natures, perished, while those who surpassed them endured longer — just as even now with strong foods: some shake it off easily, others with much suffering and harm. For this reason, I think, these people too sought nourishment suited to their nature and found this which we now use: taking wheat, they soaked it, husked it, ground it thoroughly, sifted it, mixed it, and baked it, and produced bread; from barley they made barley-cake, going through many other processes as well — boiling and baking, mixing and blending what was strong and unmixed with what was weaker, shaping everything to fit human nature and capacity, in the conviction that whatever was too strong, their nature would not be able to master once taken in, and from these would come suffering, disease, and death; while whatever they could master would yield nourishment, growth, and health. To this discovery and inquiry, what name could anyone more justly or fittingly give than medicine? — since it was discovered for the sake of human health, nourishment, and preservation, as a replacement for that diaita from which sufferings, diseases, and deaths came. If this is not reckoned to be an art, that is not unreasonable: for when there is no layman in a thing — when everyone is knowledgeable through use and necessity — it is not fitting that any one of them be called a craftsman. Yet the discovery itself is great and the work of much art and inquiry. [Chapter 4] Even now, those who oversee gymnastic training and physical conditioning keep making additional discoveries by following the same path of inquiry — what a person should eat and drink to gain the most mastery of himself and to be stronger than he himself was before. Let us now also examine what is agreed to be medicine proper — that discovered for the care of the sick — which has both a name and recognized craftsmen, to see whether it too aims at mastery of the same things, and where it first started. [Chapter 5] For my part, as I said at the outset, it seems to me that no one would ever have sought medicine if the same regimens suited both sick and healthy alike. Even now, all those who do not use medicine — barbarians and some Greeks — live according to pleasure in the same way as the healthy do, and would neither abstain from anything they desire nor hold back at all. Those who sought and found medicine, holding the same understanding that I described in my earlier argument, first reduced, I think, the quantity of those very same foods, and instead of more made it less. And since this sufficed sometimes for some of the sick, and proved manifestly helpful, yet not for all — for there were some in such a condition that they were unable to master even small quantities of food — such people seemed to need something weaker still; and so they found gruel, mixing a small amount of strong things with much water, and removing the strength by dilution and boiling. As for those who could not tolerate even the gruel, they removed that too and arrived at drinks, maintaining these as well in terms of blending and quantity so as to achieve a measured result, offering neither more than needed nor more unmixed, nor yet insufficient. It is important to know well that for some people gruel in illness is not beneficial but, on the contrary, whenever they take it, their fevers and pains are immediately intensified; and it is plain that what is given becomes nourishment and increase for the disease, while for the body it becomes wasting and weakness. [Chapter 6] Those people who are in this condition and take dry food — barley-cake or bread — even a very small amount, would be harmed to a ten-fold degree more severely and more evidently than if they were taking gruel, for no other reason than the strength of the solid food relative to the condition. And for one to whom gruel is beneficial but solid food is not, if he eats more he would be harmed far more than with little; and even with a little, he would suffer. All the causes of suffering thus lead to the same point: that what is most powerful damages the human being most severely and most evidently — both the healthy person and the sick. What difference, then, is apparent in the thinking of the one called a physician — the one agreed to be a skilled craftsman — who found the diaita and nourishment for the sick, versus that person from the beginning who found and prepared for all human beings the nourishment we now use, out of that wild and beast-like diaita? To me they appear to be the same method, one and the same kind of discovery. [Chapter 7] The one sought to remove what healthy human nature could not master when it encountered things, because of their wildness and their unmixed strength; the other sought to remove whatever the condition — in whatever state each person happened to be at any given time — was not capable of mastering. How does this differ from the other except that it is more varied in form, more complex, and requires greater effort, while the other discovery that came first is its principle? And if one were to examine the diaita of the sick alongside that of the healthy, one would find it no more harmful than the diaita of the healthy is by comparison with that of beasts and other animals. [Chapter 8] For a man sick with a disease that is neither one of the severe and intractable ones, nor yet one of the wholly mild ones, but one in which a misstep on his part is likely to become apparent — if he wishes to eat bread and meat, or something else that healthy people eat with benefit, not much, but far less than a healthy man could manage — and another man of healthy nature, neither altogether weak nor strong, who eats something from what an ox or a horse would eat with benefit and strength — vetch, or barley, or something else of that kind — not much, but far less than he could eat; this healthy man doing this would suffer and be in no less danger than that sick man who took the bread or barley-cake inopportunely. All these things are evidence that the whole art of medicine, when sought by the same path, is to be found. And if the matter were simple — as the principle seems to suggest: that whatever was stronger was harmful, whatever was weaker was beneficial and nourishing, for both the sick and the healthy — then the business would be easy; for one would need to take a large margin of safety and guide everything toward what is most weak. [Chapter 9] As things are, giving too little and falling short of what is adequate is no less a mistake and no less harmful to the person than giving too much; for the power of hunger is strong enough in human nature to cripple, weaken, and kill. Many other harmful effects arise from depletion as well — different from those of excess, but equally grave — by which the matter becomes far more varied and requires far greater precision. For one must aim at some measure; and a measure — no weight, no scale, no number, no other reference point by which you might refer and know the exact — you will find nothing other than the body's own perception. And so it is hard to attain such precise knowledge as to err only slightly one way or the other; and I would greatly praise the physician who errs only slightly. The exact result is seldom to be seen; for most physicians seem to me to be in the same position as bad helmsmen: when bad helmsmen make errors while steering in calm weather, they are not exposed; but when a great storm and a driving wind overtakes them, then clearly to all men it becomes evident through their ignorance and their mistakes that they have wrecked the ship. So too with bad and the great majority of physicians: when they treat people who have nothing serious — cases where even the gravest errors would cause no harm; and many such diseases occur and are far more common among people than serious ones — when they err in such cases, they are not exposed to laymen. But when they encounter a great, severe, and dangerous disease, then their errors and their lack of art are plain to everyone; for the reckoning for each of them arrives not in the distant future but quickly. As for the fact that no fewer sufferings come upon a person from untimely depletion than from excess, it is worth understanding well by referring to the healthy. [Chapter 10] For there are those among them for whom it is beneficial to eat one meal a day, and they have ordered this for themselves accordingly, because it is beneficial; and others for whom it is beneficial to have a midday meal, for the same reason of necessity — for this is what suits them — and not those who have taken up one or the other practice for pleasure or some other chance circumstance. For most people it makes no difference which they practice, whether eating once or having a midday meal, using whichever habit they have. But there are some who could not manage easily if they acted contrary to what was beneficial for them; in such cases an extraordinary degree of suffering occurs for each type even with a single day's change — and that not a full day. Those for whom midday eating is not beneficial, if they do eat at midday, immediately become heavy and sluggish in body and in mind, full of yawning and drowsiness and thirst; and if they also eat dinner, flatulence and colic too, and the bowels are violently loosened; and for many this has been the beginning of a great disease, if they took twice over the same food they were accustomed to consuming once, with nothing more in addition. On the other hand, for one who has been accustomed to a midday meal and finds it beneficial, if he does not have it, the moment the hour passes he immediately has terrible weakness, trembling, faintness; then upon these, eyes that are somewhat pale, urine thick and hot, mouth bitter, and the viscera seem to him to hang suspended, dizziness, low spirits, inability to work. And all of these persist even when he tries to eat dinner: the food is more unpleasant, and he cannot consume as much as he used to eat for dinner when he had previously had his midday meal; and these same foods, going down with colic and rumbling, burn the bowels, and people sleep badly and have troubled and agitated dreams; and for many of these, too, this was the beginning of disease. We must consider through what occasions these things happened to them: to the one accustomed to eating once a day, I think, because he did not wait enough time for the bowels to draw full benefit from the food consumed the day before, and to master it, and to be emptied and settled, but while still fermenting and in ferment he brought in new food; and such bowels concoct far more slowly and need more rest and quiet. [Chapter 11] And the one accustomed to a midday meal — because when the body most needed nourishment, and the previous food was consumed and had no enjoyment left, new nourishment did not come to it at once — he wastes and melts away from hunger. For everything I say this sort of person suffers, I attribute to hunger. And I say that all other human beings — whoever among the healthy go without food for two or three days — will suffer what I have described in the case of those who missed their midday meal. And those natures which I say quickly and severely feel the effects of errors, I hold to be weaker than the others; and the weak person is nearest to the one who is sick; and the one who is sick is weaker, and it is more fitting for him that whatever misses the right moment should bring him suffering. [Chapter 12] It is hard, given that the art does not admit of such precise exactness in all things, always to hit on what is most exact; yet many aspects of medicine do arrive at this level of precision, and they will be discussed. I do not therefore say that the art should be rejected as if it did not exist or were being poorly pursued in its ancient form, simply because it does not have exactness in everything; rather, one should much more — because it can, by reasoning, come close to the most exact, I think — accept it, and marvel at its discoveries as being beautifully and rightly found, and not by chance. I wish to return now to those who pursue the art in the new way by means of hypothesis. [Chapter 13] If it is heat, or cold, or dryness, or wetness that is harming the person, and the one who treats correctly must counter the hot with the cold, the cold with the hot, the dry with the wet, and the wet with the dry — let there be a man, not of strong nature but of the weaker sort; let him eat wheat just as he might take it from the threshing floor, raw and unworked, and raw meat, and drink water. Using this as his diaita, I know well that he will suffer much that is terrible; for he will suffer pains, and the body will be weak, and the bowels will be ruined, and he will not be able to live long. What remedy then must one prepare for one in this condition? Hot, or cold, or dry, or wet? For it is clear that it must be one of these. Since if what is harming him is one of these, the right thing, as their argument goes, is to resolve it by the opposite. The most certain and most evident remedy, removing the regimen he was using and giving him bread in place of wheat, and boiled meat in place of raw, and wine to drink with these — making these changes, it is impossible that he should not become healthy, unless he has been entirely ruined by time and by his diaita. What then shall we say? When they gave him these things, did they help him because he was suffering from cold and they were giving hot? Or the opposite? For I think this question would produce great perplexity in one asked to answer it. For when one prepares bread from wheat, has he removed the hot, or the cold, or the dry, or the wet from it? For this bread is treated with fire and with water, and it has been worked by many processes, each of which possesses its own particular power and nature; and some of its original properties it has shed, while others have been blended and mixed into it. I know also, of course, that pure bread differs from mixed-grain bread in its effect on the human body, and bread made from unprocessed wheat from that made from husked wheat, and bread mixed with much water from that with little, whether vigorously kneaded or not kneaded, whether fully baked or underbaked — and ten thousand other things besides; and likewise for barley-cake. And the powers of each are great, and no one is like any other. 14 Whoever has not examined these things, or who, in examining them, does not come to know them — how could such a person know anything of the sufferings that belong to the human being? For by each and every one of these things the human being is affected and altered in one way or another; and through these things all of life runs its course — for the person in health, for the person recovering from illness, and for the person who is sick. There is nothing, I should think, more useful or more necessary to know than these things. And so, searching well and with fitting reasoning toward the nature of the human being, those who first discovered these things found them, and they judged the art worthy of being attributed to a god, as is indeed the custom. For it was not the dry, nor the wet, nor the hot, nor the cold, nor any other of these, that they took to be the thing that harms the human being or that the human being stands in need of, but rather the strong in each thing and what overpowers human nature; that which human nature could not master, this they held to be the thing that harms, and this they sought to remove. Now the strongest of the sweet is the sweetest, of the bitter the most bitter, of the sharp the sharpest, and of each of all existing things its extreme pitch; for these they saw both to be present in the human being and to harm the human being. For in the human being there is both bitter and briny, and sweet and sharp, and astringent and slack, and countless other things, having capacities of every kind, both in quantity and in strength. These, when mixed and blended together, are neither apparent nor troublesome to the human being; but whenever one of them separates out and comes to stand on its own, then it is both apparent and troublesome to the human being. And this too: of the foods that are unsuitable for us and that harm the human being when they fall upon him, each of them is either something bitter and unblended, or briny, or sharp, or something else unblended and strong — and for this reason we are disturbed by them, just as we are also by those things that separate out within the body. Now all foods and drinks that a human being eats or drinks — those such as bread and barley-cake and what follows upon these, which the human being is accustomed to use most and always, apart from those prepared and made up for pleasure and for satiety — will be least manifestly seen to partake of any such unblended and outstanding chymos (bodily fluid); and from the greatest quantity of these entering into the human being, disturbance and separation of the capacities about the body occurs least, while strength and growth and nourishment occur most — for no other reason than that they are well blended together and contain nothing unblended, nothing strong, but have become altogether one and simple and not strong. I am at a loss, for my part, to see how those who speak that other argument and drag the art away from this path toward a hypothesis will ever treat human beings in the manner they postulate. 15 For in their account, as I see it, there has been found no thing that is hot in itself, or cold, or dry, or wet, sharing in no other character — rather, I believe they have available to them those same drinks and foods which all of us use. They then attach to one the attribute of being hot, to another cold, to another dry, to another wet. Since to prescribe to the sick person simply to take something hot would at once be impractical — for he will immediately ask: 'What is it?' — and so one must either talk nonsense or take refuge in one of the known things. If it happens that one hot thing is astringent, another hot thing is slack, yet another hot and causing unease (for there are also many other hot things having many other capacities that are contrary to one another), and if it should be necessary to offer one of them — either the hot-and-astringent, or the hot-and-slack, or cold-and-astringent at the same time (for that too exists), or the cold-and-slack — well, as far as I know, the opposite effect comes from each of these, and not only in the human being, but also in leather and in wood and in many other things that are less sensitive than the human being; for it is not the hot that has the great capacity, but the astringent and the slack, and the other things I have mentioned — both in the human being and outside the human being, whether eaten, drunk, rubbed on from outside, or applied in some way as a plaster. Cold and heat, for my part, I regard as the least dominant of all capacities in the body, for the following reasons: as long as they are mixed together with one another, the cold and the hot together, they do not cause distress — for the cold gets a blending and a tempering from the hot, and the hot from the cold; but when each separates apart by itself, then it causes distress. And in this situation, when the cold supervenes and causes some distress to the human being, quickly, in the first instance, because of this very thing, the hot is present there from within the human being itself, requiring no external aid or preparation. And these effects occur both in healthy human beings and in those who are sick. 16 On the one hand, if someone in good health wishes to chill his body in winter — by bathing in cold water or by some other means — the more extensively he does it, provided the body does not freeze altogether, the more and the longer his body becomes warm once he takes his clothes and comes into shelter. On the other hand, if he should wish to be thoroughly heated — by a warm bath or by a great fire — and then, still in the same garment, passes his time in the same place as if he had been chilled, he will appear far colder and otherwise more prone to shivering. If someone being fanned in stifling heat and in this way procuring coolness for himself should stop doing it, the burning and the stifling will be tenfold compared with what it would be for the person who had done none of these things. And far greater still: those who, having walked through snow or some other form of cold, suffer exceptional chilling in the feet, or the hands, or the head — what they suffer in the night when they are wrapped up and come into warmth, under the burning and the itching; and for some, blisters arise as though they had been burned by fire; and they do not suffer this until they have been warmed. So readily does each of the two pass over to the other. I could cite countless other examples. As for what happens in the sick: is it not in those in whom shivering occurs that the sharpest fever blazes out? And yet it is not so severe — but rather ceases within a short time, and is otherwise for the most part without harm. And for as long as it is present, warmth passes through the whole body and, running through throughout, ends up especially in the feet — the very place where the shivering and the chilling were most vigorous and had lingered longest. Then again, when the patient sweats and the fever departs, he is far more chilled than if it had never begun at all. Since, then, that which is most contrary to it and which strips it of its capacity arrives so quickly of its own accord, what great or terrible thing could come from this? Or what great assistance is needed for it? Someone might say: but those who are fevered in burning fevers and inflammations of the lung and other severe diseases do not quickly get relief from the heat, and the hot and the cold are no longer operative there. 17 I for my part take this as the greatest evidence that human beings do not have fever simply on account of the hot, and that this is not the sole cause of the affliction, but that there is also what is bitter-and-hot in the same thing, and hot-and-sharp, and briny-and-hot, and countless others, and again cold with other capacities. These, then, are the things that harm; and the hot is co-present, sharing in the force, as the leading and the aggravating element, growing along with that other thing — but having no capacity exceeding what is appropriate. That these things are so is clear from the following signs: first, the most evident are things of which we are all experienced many times already and will be again. 18 For instance: whenever any of us gets a runny nose and a discharge moves through the nostrils, this discharge is far sharper than the discharge that ordinarily forms and passes from the nostrils; it makes the nose swell, and burns it, making it hot and fiery to the utmost degree — and if you bring your hand to it and it is present for a longer time, the area is even ulcerated, being fleshless and hard. The burning in the nose ceases somehow, not when the discharge is occurring and the inflammation is present, but when the discharge flows more thickly and less sharply, concocted and more mixed with what was forming before — then at last the burning also ceases. But for those in whom this occurs manifestly from cold alone, with nothing else accompanying, the relief in all of them consists in becoming warm through from the cold, or becoming cool through from the burning heat — and these changes arrive quickly and require no pepsis (concoction). All other conditions, however, which I say arise from the sharpnesses and unmixedness of chymoi (bodily fluids), are resolved in the same way — by being blended and concocted. And such of the discharges as turn toward the eyes, having strong and varied sharpnesses, ulcerate the eyelids, and in some eat into the cheeks and the areas beneath the eyes, wherever they flow down, and rupture and consume the membrane that surrounds the sight. 19 Pains and burning and intense inflammation persist for a time — until the discharges are concocted and become thicker, and crusted matter goes from them; and the being-concocted comes about from being mixed, blended together, and seethed down with one another. And again, the discharges that pass to the throat — from which come hoarsenesses, throat-stranglings, erysipelases, lung-inflammations — all of these at first give off briny, wet, and sharp matter; and in these the diseases are at their strength. But when the discharges become thicker and more ripened and freed from all sharpness, then at last the fevers also are resolved and the other things that trouble the human being. These things, then, should properly be regarded as the cause of each condition — things in whose presence it is necessary that the condition come about in this way, and when they change into another blending it ceases. So, whatever arises from pure heat by itself or from pure cold, and shares in no other capacity whatsoever, would cease in this way — when it changes from the cold to the hot, and from the hot to the cold; and it changes in the manner I have already described. Furthermore, all other things by which the human being suffers — all come about from capacities. For instance: when a certain bitterness pours out — which we call yellow bile — nauseas, burnings, and weaknesses seize the patient; and when they are being relieved of this, sometimes purged either spontaneously or by a drug, if any of these things occur at the right moment, they are clearly freed from their pains and their heat as well. But for as long as these matters are in an unsettled state, unripened and unblended, there is no way that either the pains or the fevers can cease. And those in whom sharp and verdigris-like acidity lodges — such as frenzy, and gnawing of the viscera and chest, and distress — this does not cease until the acidity is purged and laid down and mixed with the rest. Being concocted and changed and refined and thickened into the form of chymoi — through many and diverse forms (which is also why the crises and the counts of the days in these matters have great force) — of all these things, it is least fitting that they should be affected by heat or cold; for heat by itself would not cause putrefaction, nor would it produce thickening. What then shall we say these things are? Blendings of them, having different capacities in relation to one another. For in no other way will the hot, when mixed, cease from its heat than by the cold, nor again the cold than by the hot. But all other things concerning the human being — the more things they are mixed with, the milder and the better they become. And the human being is in the best state of all when concoction is occurring and he is at rest, displaying no capacity peculiar to itself. I consider these matters to have been demonstrated sufficiently. Now, certain people — both healers and natural philosophers (σοφισταί) — say that it is not possible to know the healing art unless one knows what a human being is; that this is what one who intends to treat human beings correctly must learn. 20 Their argument tends toward philosophy, after the manner of Empedocles or others who have written on nature from the beginning — what a human being is, and how it came to be in the first place, and how it was put together. For my part, I think that whatever any natural philosopher or healer has said or written about nature belongs less to the healing art than to painting. And I hold that to come to know something clear about nature is possible from no other source than medicine. This is possible to learn when one has correctly grasped the whole of medicine itself; but until then, it seems to me there is still much lacking. I mean by this inquiry the knowledge of what a human being is, and by what causes it comes to be, and all the rest with precision. For it certainly seems to me necessary for every healer to know about nature, and to be very earnest to know it, if he is to do any of what is required — namely, what the human being is in relation to what is eaten and drunk, and in relation to the other practices, and what will follow for each person from each thing. And not simply to think that cheese is a bad food because it causes distress to the person who is sated on it, but rather: what kind of distress, and why, and for which of the things present in the human being is it unsuitable? For there are also many other foods and drinks that are bad by nature, and they affect the human being not in the same way. To carry out my argument by an example: undiluted wine drunk in large quantity puts the human being in a certain weakened state; and all who observe this would recognize that this is the capacity of wine and that wine itself is the cause; and in relation to which of the things in the human being it is most powerful, we know. Such a truth I wish to be made apparent concerning the other things as well. For cheese — since I have used this as my example — does not harm all human beings alike, but there are those who eat their fill of it and are not harmed at all; on the contrary, it furnishes remarkable strength to those for whom it is suitable; while there are those who get off badly from it. The natures differ among these people; and they differ in this respect: whatever is present in the body that is hostile to cheese, by such a thing it is awakened and set in motion; those in whom such a chymos happens to be present in greater amount and to be more dominant in the body — it is reasonable that these are more severely affected. If it were bad for all human nature, it would harm everyone. Those who know these things would not suffer. And in the recoveries from diseases, and in prolonged diseases as well, many disturbances occur — some spontaneously, others also from things offered by chance. 21 I know that most healers, like laypersons, if it happens that they have done something novel on that particular day — bathing, or taking a walk, or eating something different — all of which things are offered either better or worse, assign blame for these things no less than for anything else to one of those coinciding factors, being ignorant of the true cause and sometimes, if the case so falls out, having obscured what was most beneficial. This should not be. Rather, one must know what an untimely bath will do, and what exertion. For the same distress never arises from these things — from one or another, nor from repletion, nor from one food or another. Whoever, then, does not know how each of these things stands in relation to the human being, will be able neither to know the consequences that come from them, nor to use them correctly. And I think one must also know the following: what sufferings come to the human being from capacities, and what come from shapes. 22 What do I mean by this? By capacity I mean the extremities and strengths of the chymoi; by shapes I mean whatever is present within the human being. For some parts are hollow and drawn together from wide to narrow, others spread open, others solid and round, others broad and overhanging, others stretched out, others long, others dense, others loose and lush, others spongy and porous. Now, which would be most capable of drawing toward itself and of attracting moisture from the rest of the body — the hollow and spread-open, the solid and round, or the hollow and drawn from wide into narrow? I think, those drawn from wide into narrow out of a hollow. One must learn about these from what is visible outside. For with the mouth gaping open you would draw up no moisture; but by pursing and compressing, by pressing the lips together, and by further applying a tube to them, you would easily draw up whatever you wished. And cupping vessels, which are designed by tapering from wider to narrower, are fashioned with this very end — to draw from the flesh and attract; and many other things of this kind. Of the things within the human being, the nature and shape is of this sort: the bladder, the head, and the womb in women — and these manifestly attract the most, and are always full of fluid drawn in from elsewhere. The hollow and spread-open parts would best of all receive moisture that flows in upon them, but would not attract it equally. The solid and round parts would neither attract nor receive what flows in — for it would slip around them and find no resting-place to stay. The spongy and porous parts — such as the spleen, the lung, and the breasts — upon adhering, would drink in most and become hard and grow, these most of all, when moisture is added. For in the spleen, not as in the belly, in which belly the moisture would be contained, the belly holding it on the outside and draining it off each day — but when the spleen itself drinks and receives moisture into itself, the empty and porous parts are filled, and all the small ones, and instead of porous and soft it becomes hard and dense, and neither concocts nor lets go; and it undergoes these things on account of the nature of its shape. As for the flatulence and the coilings that are produced in the body — in the hollow and roomy parts, such as the belly and the chest, these are apt to produce rumbling and crashing; for whenever the flatulence does not fill them so completely as to stand still, but has changes and movements, necessarily rumbling and visible movements are produced by them. But in fleshy and soft parts, in such parts there arise numbness and feelings of fullness, such as come about in those who are struck motionless; and when flatulence strikes against something broad and lying opposite, and hits against it, and that thing happens by nature to be neither strong enough to withstand the force and suffer no harm, nor soft and porous enough to receive and yield to it, but tender and lush and blood-filled and dense — such as the liver — because of its density and breadth it stands firm and does not yield. And the flatulence, as it is poured in upon it, grows and becomes stronger, and it bears most directly against whatever is opposite. And because of the tenderness and the blood-filled nature, it cannot be without pains; and for these reasons the sharpest and most frequent pains arise in this region, and also the most abscesses and swellings. 22 (50) This also comes about powerfully below the diaphragm, though much less so. For the diaphragm is broad in its spread and lies opposite, but its nature is more sinewy and strong — therefore it is less painful. Yet around these parts also pains and swellings arise. And there are many other forms of shapes, both inside and outside the body, which differ greatly from one another in relation to the sufferings — both in the sick and in the healthy — such as heads small or large, necks thin or thick, long or short, bellies long or round, breadths or narrownesses of chest and ribs, and countless other things, all of which one must know in how they differ, so that, knowing the causes of each, one may watch over them correctly. 24 Concerning the capacities of the chymoi — both what each of them is capable of doing to the human being — this has been considered and stated before, and also how they stand in their kinship with one another. By this I mean the following: if the sweet chymos were to change into another form — not from blending, but by shifting on its own — what would it first become: bitter, or briny, or astringent, or sharp? I think, sharp. Then the sharp chymos would, of the remaining ones, be most unsuitable as a food — if the sweet is the most suitable of all. Thus, if one were able in searching to hit upon this from outside, one would be able always to select the best of all things; and the best is that which stands furthest from the unsuitable.