On the Art — First Draft Translation

ON THE ART There are some who have made it their art to speak ill of the arts — doing so not as I describe it, but as those who pursue this themselves believe: making a display of their own learning. 1 To me, the discovery of what has not yet been found — whatever, once found, is better than if left undiscovered — seems both the desire and the work of understanding; and likewise the bringing to completion of works half-done. But to be eager to dishonor with the art of ignoble words the discoveries of others, correcting nothing, while traducing the findings of those who know to those who do not know — this no longer seems the desire and work of understanding, but rather a bad declaration of character than of lack of skill. For this activity suits only those who are themselves without skill: people who are ambitious but are nowhere capable, through their own vice, of either traducing the works of their neighbors when those works are sound, or of finding fault with them when they are not sound. Let those, then, who concern themselves with the other arts and with those who matter, stop those who fall upon them in this manner, those who are capable of stopping them. The present argument will oppose those who traffic in this way against medicine: emboldened through those it censures, well-resourced through the art it defends, capable through the wisdom in which it has been trained. It seems to me, then, to speak summarily: no art exists that does not exist. For it is unreasonable to regard something that exists as not existing. Since what substance of things that do not exist could anyone observe and report that they are? For if things that do not exist can be seen, just as things that exist can, I do not see how anyone could consider them not to exist — things that could be both seen with the eyes and grasped by the mind as being. But let that not be the case in that way. Rather: things that exist are always both seen and known; things that do not exist are neither seen nor known. 2 They are known, then — the arts having already been demonstrated — and there is none of them that is not seen from some form. And I myself believe that arts have received their names on account of their forms; for it is unreasonable to suppose that forms spring from names, and impossible. Names are conventions established by nature, but forms are not conventions — they are growths. If anyone does not sufficiently understand these matters from what has been said, they could be taught more clearly in other arguments. 3 Concerning medicine — for that is where this argument tends — I will offer a demonstration of it, and first I will define what I take medicine to be: to free the sick altogether from their distresses, to blunt the violence of diseases, and — knowing that medicine cannot do so for those who have been overpowered by their diseases — not to attempt to treat such cases. As for how it does these things, and how it is capable of doing them throughout, that will be the remainder of my argument. And in demonstrating the art, I will at the same time refute the arguments of those who think to dishonor it, at whatever point each of them supposes he is making progress. My starting point is one that will be conceded by everyone: it is conceded that some of those treated by medicine recover their health; but because not all do, the art is already blamed on that account, and those who speak the worse say that those who escape their diseases escape by chance and not through the art. 4 I, for my part, do not myself strip chance of any role in any outcome; but I believe that misfortune mostly follows diseases badly treated, and good fortune those well treated. And then again, how is it possible for those who have been healed to attribute their recovery to anything other than the art, if they were healed by employing it and submitting to it? They did not choose to behold the bare form of chance, in the moment when they entrusted themselves to the art — so that they are freed from referring their recovery to chance, but are not freed from referring it to the art. For in the very act of entrusting and committing themselves to it, in that act they examined its form, and when the work was accomplished, they recognized its power. The one who argues the opposite will say at this point that many people have already recovered from illness without consulting a physician; and I do not disbelieve that argument. But it seems to me possible that even those not using a physician may chance upon medicine — yet not so as to know what in it is correct and what is not correct, but so that, if they happened to treat themselves with such measures, they might treat themselves in ways parallel to how they would have been treated had they also been using physicians. 5 And this is a great proof of the real existence of the art, that it exists and is great — seeing that even those who deny it exists are plainly saved through it. For it is altogether necessary that those who do not use physicians but fall sick and recover should know that they were healed either by doing something or by not doing something. For whether by fasting, or by eating much, or by drinking more, or by thirst, or by baths, or by not bathing, or by exertions, or by rest, or by sleep, or by wakefulness, or by the disorder of all these combined, they were healed. And by the benefit of being helped they are of necessity constrained to recognize what it was that helped; and when they were harmed, by the harm, what it was that harmed. For what is determined by benefit and what by harm are not for everyone to know adequately. If, then, the sick person undertakes either to praise or to blame any of the regimen-measures by which he was healed, he will find that all these things belong to medicine. And the mistakes made are no less witnesses on behalf of the art as to its existence than the helpful things: for the helpful things helped by being applied rightly, and the harmful things harmed by no longer being applied rightly. And yet where both the right and the not-right each have a limit, how could this not be an art? For what I call a lack of art is where nothing right is present and nothing not-right — but where both of these are present, that could no longer be the work of a lack of art. Furthermore, if healing were brought about by medicine and physicians through purgative and styptic drugs alone, my argument would be weak. But as it is, the most highly praised among physicians are seen to heal both through regimen-measures and through other forms which no one — not only no physician but not even an uninstructed layman who heard of them — would deny to belong to the art. 6 Where, then, nothing among the good physicians and in medicine itself is without use, but in the great majority of things that grow and of things that are made the forms of treatments and remedies are present — it is no longer possible for any of those healed without a physician to attribute it with right reason to the spontaneous. For the spontaneous, when subjected to scrutiny, appears not to exist; for everything that comes to be is found to come to be through some cause, and within the logic of causation the spontaneous has no real existence, but only a name. Medicine, on the other hand, in both the 'through a cause' and the 'things foreknown' appears and will always appear to have real existence. To those who assign health to chance and take it away from the art, one might reply in these terms. But I wonder at those who, in the misfortunes of those who die, make the art invisible — by what argument they consider it worthy to lay the blame not on the intemperate behavior of those who die, but on the understanding of those who have practiced medicine: as if physicians have it in their power to issue wrongful orders, but sick persons have no power to transgress the orders given them. 7 And yet it is far more reasonable for sick persons to be unable to carry out what is ordered, than for physicians to give wrongful orders. For physicians set to work with sound judgment and a sound body, having reasoned out both the things before them and those things from the past that were disposed similarly to what is now present, so as to be able to say of something once treated that they cured it. But the patients — not knowing what they suffer, nor why they suffer it, nor what will follow from what is now present, nor what follows in cases like the present — receive orders while suffering pain in the moment, fearing what is to come, full of the disease and empty of food, wishing to receive what is pleasant with respect to the disease rather than what is beneficial with respect to health, not in love with dying but unable to endure. In such a condition, is it more plausible that these patients will do what the physicians order, or will do other things they were not ordered to do; or that the physicians, being in the condition described by the earlier argument, give wrongful orders? Is it not far more that the physicians give right orders, and the patients are reasonably unable to obey, and not obeying fall into deaths — deaths whose causes those who do not reason rightly attribute to those who are not responsible, freeing those who are responsible? There are also those who blame medicine because physicians are unwilling to attempt treatment of those who have been overpowered by their diseases — saying that these cases would themselves recover on their own, the ones physicians do take in hand to heal; but those that require help, they do not touch; and that medicine, if it truly were an art, ought to heal all cases alike. 8 Now those who say these things, if they were finding fault with physicians for not caring for them when they speak such things as though they were out of their minds, would be finding fault more reasonably than they are in that other fault-finding. For if someone thinks it proper that either an art can do what no art is fitted to do, or that nature can do what no nature is fitted to do, he is ignorant with an ignorance fitting madness rather than mere lack of learning. For those things of which it is given to us, with the instruments of the natural faculties or of the arts, to gain mastery — of those we can be craftsmen; of others we cannot. When, therefore, a person suffers some evil that is stronger than the instruments available in medicine, it must not at all be expected that this will be mastered by medicine. For example, among the instruments in medicine, fire burns to the extreme; and other instruments less than this, and many of them. Among the instruments of lesser power, what is stronger is evidently not yet incurable; but among the most powerful instruments, what is stronger — how is it not evidently incurable? For what fire does not work upon — how is it not evident that what is not affected by the most powerful medical instrument falls outside medicine's proper domain entirely, requiring a different art, and not this one in which fire is an instrument? The same argument applies for me also concerning all the other things that work alongside medicine — of all of which, I say, when a physician does not succeed in mastering any given one, he must blame the power of the affliction, not the art. Those who find fault with physicians for not attempting to treat those who have been overpowered are urging them to lay hands on what is not fitting no less than on what is fitting. And in urging this, they are admired by those who are physicians in name only, but laughed at by those who are physicians also in art. Yet those experienced in this craft have no need of critics or praisers of such witlessness; but of those who reason through to what extent the works of the craftsmen, when they reach completion, are full, and wherein, when they fall short, they are deficient — and further, among the deficiencies, which are to be laid to the craftsmen and which to the things being worked upon. What pertains to the other arts, another time with another argument will show; what pertains to medicine, what it is like and how it is to be judged — part of this the preceding argument has taught, part of it the present one will teach. 9 For those who know this art adequately, some diseases are not in the realm of hard to observe and are not many; but those that are not easy to discern are many. For diseases turned toward the interior lie in the difficult-to-observe, while those that erupt onto the surface in coloration or in swellings lie in the easy-to-discern; for they make themselves available to the sight and to touch — to perceive their firmness and their moisture — and which of them are hot and which cold, and through what each of them is such by presence or absence. For all cases of that sort, in all their aspects, the cures must be without error — not as though easy, but because they have been found out. They have been found out, indeed, not by those who merely wished, but by those among these who were able; and able are those for whom the requirements of education are not impeding and those of their nature not pitiable. For the visible diseases, then, the art must have resources in this way. And yet it must not be without resources even against the less visible ones. These are the ones turned toward the bones and the belly. The body has not one belly but many. For there are two that receive food and release it, and others more than these, which those know who have given thought to them — for every limb that has round flesh, which they call muscle, has a belly. 10 For everything that is not grown together with what surrounds it, whether covered by skin or by flesh, is hollow. When healthy it fills with pneuma, when ailing with ichor. The upper arms have such flesh; the thighs have it; the shins have it. And even in the parts without much flesh, such a cavity is shown to exist as in the well-fleshed parts. For what is called the thorax, in which the liver is enclosed, and the circle of the head, in which the brain lies, and the back, against which the lung rests — none of these is not itself hollow, full of many channels, which are hardly different from being vessels for many things — some of them harming the one who contains them, some helping. And beyond these, many blood-vessels (phlebes), and sinews (neura) not floating within the flesh but stretched against the bones — a binding at certain of the joints — and the joints themselves, in which the articulations of the moving bones are compassed round; and none of these is not susceptible from below and does not have around itself chambers that ichor discloses, which when these chambers are opened comes out in great quantity and having caused great distress. For there is no knowledge to be had of any of these things mentioned by one who sees them with eyes alone. This is why they have been named by me 'obscure' and judged by the art to be so — yet not because they are obscure have they been overpowered; rather, they have been mastered as far as is possible. And possible means: as far as the natures of the sick make themselves available for examination, and as far as the natures of those who will investigate them are fitted for the investigation. 11 For they are known with more labor and not with less time than if they were seen with the eyes. Whatever escapes the vision of the eyes, those things are mastered by the vision of the mind. And whatever the sick suffer from not being seen quickly, the cause is not those treating them, but the nature — both of the sick person and of the disease. For the physician, since it was not possible for him to see the affliction with his eyes or learn it by hearing, pursued it by reasoning. Indeed, what those who are sick in invisible ways try to tell their healers about their diseases, they tell by conjecture rather than by knowing. For if they knew, they would not have fallen into those diseases; for it belongs to the same understanding both to know the causes of diseases and to know how to treat them with all the treatments that prevent diseases from growing greater. Since, then, not even from what is reported is it possible to hear flawless clarity, the healer must also observe something further. This slowness, then, is caused not by the art but by the nature of bodies. For the art, perceiving, considers it proper to treat by examining how to treat by judgment rather than by boldness, and by ease rather than by force. Nature, for its part, if it endures long enough to be seen, will endure long enough to be healed; but if in the time during which it is being observed it is overcome — either because the patient came too slowly to the healer, or because of the swiftness of the disease — it will be gone. For a disease setting out on equal terms with the treatment is not faster; but having gotten a head start it is faster. It gets a head start because of the opacity of bodies, in which diseases do not dwell in the easy-to-see, and because of the patients' carelessness; for this is how it seems: they wish to be treated not when they are first taken by their diseases, but when they have already been seized by them. And yet the power of the art, whenever it raises up one of those sick with hidden diseases, is more worthy of wonder than when it attempts the impossible. For in no other established craft among those already discovered is there any such thing — rather, those of them that are worked with fire are idle when fire is not present, and active once fire has been kindled. And those worked upon bodies that are easy to reshape — some with wood, some with leather, others by painting, with bronze and iron and things like these in most cases — though the things made from these and with these are easy to reshape, yet they are worked not by speed so much as by proper procedure; nor can the craftsman bypass steps — if any instrument is absent, the work must pause. And yet for those other crafts too, slowness in comparison with greater efficiency is inexpedient, but nonetheless it is preferred. Medicine, however — deprived here of seeing with the sight by which all men see all things best, in the case of those with suppuration, there with those whose liver or kidneys are diseased, and again in all those sick within the belly — has nonetheless found other resources as collaborators. By the clarity and roughness of the voice, and by the quickness and slowness of breathing (pneuma), and by the various flows that are accustomed to run through, each along its given outlets — judging some by their odors, some by their colors, some by their fineness and thickness — it infers both what these are signs of, and what the affected parts are, and what the parts capable of being affected are. 12 When these things are not disclosed, and nature itself does not release them willingly, it has discovered compulsions by which nature, forced without harm to itself, releases them; and once released, they reveal to those who know the art what is to be done. It compels, in one case, fire to dissolve the innate phlegma by the sharpness of foods and drinks, so that something seen may give evidence about those inner things which could not be seen; in another case again, pneuma — of what it is the informant — is forced to inform by uphill paths and running courses. And bringing sweat by these means just described, by the emanations of hot waters and fire, it infers what those who use fire infer. There are things, too, which having passed through the bladder are more capable of revealing the disease than those exiting through the flesh. It has found, then, such drinks and foods as, becoming hotter than the things that heat, melt those inner things and cause them to flow through, which would not have flowed through without undergoing this. Some things are different from others, and one set passes through by one means and reports by another — so that it is not surprising that distrust of these takes more time, and attempts at treatment take less, when what is being interpreted is being interpreted through the medium of interpretations that are foreign to the understanding that treats. That medicine, then, has within itself sufficient resources of argument for its aids, and would not justly attempt diseases that cannot easily be set right — or if it does attempt them, would not offer error-free results — both the arguments now being made show this, and the demonstrations of those who know the art: demonstrations which they more readily present through their actual works than through arguments, not from neglect of speaking, but from the judgment that the many find what they see more compelling than what they merely hear.