Instructions — First Draft Translation

INSTRUCTIONS. Time is that in which there is occasion, and occasion is that in which time is not much; healing belongs to time, but there are moments when it belongs to occasion as well. 1 One who knows these things must not practice medicine by first attending to a plausible line of reasoning, but rather through trained practice together with reason. For reasoning is a kind of synthetic memory of what has been grasped through perception; for perception, being susceptible beforehand and capable of sending itself up into the thinking mind, appeared vividly. The thinking mind, receiving this many times, noting the circumstances—to whom, when, in what manner—and laying it up within itself, has remembered it. I assent, then, to reasoning as well, if indeed it takes its starting point from what falls to experience and methodically derives its descent from what appears; for if reasoning takes its starting point from what is manifestly accomplished, it is found to exist within the power of the thinking mind, as the mind receives particular things from others. One must therefore suppose that nature has been set in motion and instructed by the many and varied events of life, necessity being present beneath; and the thinking mind, receiving from nature, as I said before, has subsequently led it toward truth. But if not from a clear approach, but from a persuasive fabrication of argument, it has often brought about a heavy and distressing condition. Those who proceed thus are handling a trackless path; for what harm would there be if those who practice the works of medicine badly received their deserved recompense? As things now stand, it falls upon the blameless among the sick—those for whom the force of the disease did not seem sufficient to destroy them, were it not to join with the inexperience of the physician. Let so much have been said about these matters. May one gain no fruit from conclusions reached by argument alone; from the demonstration of practical work—there is indication. For the insistence accompanied by idle chatter is precarious and easily tripped up. 2 For this reason one must also hold broadly to what is happening in practice, and not be minimally engaged with these matters, if one intends to possess the easy and unerring condition which we call medicine. For it will provide very great benefit both to the sick and to those who practice medicine for them. One should not shrink from inquiring even from laypeople, if anything seems likely to contribute to a timely care. For in this way, I think, the whole art has come to be revealed—through the fact that each outcome has been observed and gathered into one. One must therefore attend to what commonly occurs in experience, and proceed more with benefit and calmness than with proclamation and justification after the fact. The preliminary appraisal of what is brought to the sick person is also useful and varied, since only something brought to bear in a particular way will help; for insistence is not called for, since all affections, through many surrounding circumstances and changes, settle into some particular persisting state. 4 This point also would stand in need of the consideration of advice: if you were to begin from the matter of fees—for this too contributes something to the whole—you will produce in the person in pain a thought such as this: that you will leave him and depart without having reached agreement, or that you will be neglectful and will offer no guidance toward what is present. One must not, then, be preoccupied with the fixing of a fee; for we consider such mental agitation harmful to someone who is distressed, and far more so in an acute illness. For the swiftness of disease, giving no opportunity for second thoughts, does not spur the one who practices medicine well to seek what is advantageous, but rather to hold to good repute. It is better, then, to reproach those who have been saved than to take advantage of those who are perishing. And yet some of the sick make changes, preferring what is foreign and unclear; they are deserving of neglect, though not of punishment. Therefore you would reasonably set yourself in opposition to these, who are proceeding through change amid upheaval. 5 For who, by Zeus, is a physician brothered to medicine who could be persuaded to practice medicine with harshness? So that in examining every affection from the beginning one must not fail to offer some guidance beneficial for treatment, and must treat the sick person to the end and not disregard him. As for the fruit of the work, it must not be without the desire that equips one toward learning. 6 I urge that not too great an inhumanity be introduced, but rather that one look to what is present and to means; and sometimes to give freely, calling to mind either a prior expression of gratitude or a present goodwill. And if there is occasion for generosity toward one who is both a stranger and in want, one should especially give aid to such persons; for where love of humanity is present, love of the art is present too. For some sick persons, perceiving that the affection around them is not in a state of safety, and being pleased by the physician's reasonableness, are transformed toward health. It is well to attend upon the sick for the sake of health; to give thought to those who are healthy, for the sake of freedom from disease; to give thought also to those who are in good health, for the sake of good condition. Those, then, who are sunk in the depths of artlessness would not perceive any of what has been said. 7 For these—being without medical skill, exposed to criticism, puffed up on tiptoe, yet dependent on chance—gain good repute from certain prosperous and weakly persons who make concessions in either direction upon each outcome; and when things fall to the worse, they make merry in their contempt, having neglected the unaccountable aspects of the art. In such matters a good physician, called a fellow craftsman, would be in his prime. And the one who easily accomplishes healings without error would not transgress any of these, not at all through a lack of ability; for he is not distrusted as though acting unjustly. For they do not come to treatment, observing a condition of phthisis (wasting), guarding against the introduction of other physicians, remaining in a hatred of assistance through toil. And the sick, given slack, drift on each side of wretchedness, not having entrusted themselves to the end to the greater care within the art; for a remission of some disease affords the sick person great relief. Therefore, desiring a healthy condition, they are unwilling always to accept the same treatment, not understanding the variety of the physician. For being in want though of lavish means, falling into bad habits and proving ungrateful in their encounters, being capable of having means, they are ground down over fees, while genuinely wishing to be healthy for the sake of the returns of work or farming, being careless about receiving anything on their own account. Let so much suffice regarding such a pattern; for relaxation and intensification of the patient's condition require physician's management. 8 It is not unseemly either, if a physician, being in difficulty over what is present in some sick person and being obscured by inexperience, should direct that others also be brought in, for the sake of learning about the sick person's affairs through shared discussion, and for them to become fellow workers toward the ready supply of assistance. For in the waiting upon distress, when the affection is intensifying, most decline to proceed with the case at hand for want of means; one must therefore take courage in such a moment. For I would never define the matter as one in which the art has made a judgment on the point. Those who are in company with one another must never fall into contentiousness and into mockery of one another; for what I shall say with an oath—a physician's reasoning could never feel envy toward another, for such a one would appear feeble; rather it is those who are engaged in the work of the marketplace who do such things readily. And yet it has not been falsely observed: for in every abundance there is want. Alongside all of these things, a great proof would appear in conjunction with the substance of the art, if one who practices medicine well were not to stand apart from such an address, directing the sick to be troubled about nothing in their thinking mind, in the urgency to arrive at the moment of preservation. 9 For we are the ones who perceive what is needed for health, and the one who is directed will not go astray. For the sick themselves, worn out by the painful condition, despairing and abandoning themselves, are changed away from life; but the one who has taken charge of the sick person, if he demonstrates the discoveries of the art—preserving rather than altering nature—will carry away the present bitterness or the immediate distrust. For the well-being of the human being is a certain nature—naturally equipped by nature with a motion not foreign to itself, but fully well-fitted, wrought from pneuma (breath / moving air) and warmth and the working-through of the chymoi (bodily fluids), and in every way and through every diaita (regimen / ordering of life) and with all its parts fashioned—unless there is some deficiency from birth or from the beginning. But if something comes to be, since it is subject to passing away, one must try to assimilate it to what underlies; for the diminishment is contrary to nature and is a matter of time. One must also avoid the crushing of the hair near the crown of the head through contact in the course of healing, and also excessive odor; for through sufficient unfamiliarity you have acquired reproach, and through slight familiarity, good appearance; for in one part, little toil; in all, sufficient. 10 I do not set aside gratitude; for it is worthy of the care of medicine. And let there be present also a record of the application through instruments and of symbolic demonstrations, and of matters of this kind. 12 If you also wish to give a hearing for the sake of an audience, you do not desire something altogether inglorious—yet not accompanied by poetic testimony; for laboriousness reveals incapacity. For I reject laboriousness investigated with toil for some other use, which for that reason holds its pleasing character only within itself alone; for you will gain only the empty striving of a drone with its escort. Desirable too is a condition that is free of late-learning; in the presence of those present it accomplishes nothing, while in their absence the memory of it is tolerable. 13 There arises, then, an all-fighting misfortune, combined with fresh harm, heedless of seemliness—through definitions and proclamations and mighty oaths (for the gods' sake)—with a physician presiding over disease, through continuous reading and the instruction of laypeople who love ease, pursuing discourses by way of transferred meaning, and assembled before disease has brought them into total difficulty. Of such persons, wherever I might take charge, I would not boldly ask them to help at a gathering for care; for the understanding of seemly inquiry has been corrupted in these cases. Since these persons are, through necessity, incapable of understanding, I urge that trained practice be what is useful, not the adherence to doctrines of inquiry. For who desires to investigate accurately a many-branched variety of doctrines, without the steadiness of manual practice? Therefore I urge those who speak such things to pay attention, but when they are in action, to check them. When the diaita (regimen) has been drawn in, one should not embark on a lengthy course; the desire of the one who labors is long-standing; relief even in chronic disease sets a person upright, if one pays proper attention in blindness to what is needful. 14 As great a fear must be guarded against, so also must the terribleness of joy. A sudden disturbance of the air must be guarded against. The prime of life has all that is pleasant; its decline is the opposite. Obscurity of speech comes about either through affection, or through the ears—either speaking further things before former ones have been expressed, or thinking further things before the intended thought has been spoken; what is said without any visible affection befalls especially those devoted to the art. With regard to age: when the subject is small, the capacity is sometimes very great. Disorder of disease indicates length; crisis is the release of disease. A small cause is resolved by healing, unless there is some affection in a critical region. Because fellow-suffering arising from distress troubles one, some are troubled by a fellow-suffering from another source. Speaking aloud causes pain. Under strong laboriousness: encouragement, warmth, song, a beneficial place.