On the Use of Liquids — First Draft Translation

ON THE USE OF LIQUIDS. Water for drinking, brine, seawater. 1 For drinking, water is most excellent in medical practice — for it is most excellent with iron and bronze instruments, and is the most common vehicle for the majority of drugs that are aged. As for the skin, one must know that water will either moisten, cool, or warm it, and in no other way does it benefit or harm as a drink. Where only a small quantity is applied, use a sponge — this is best for the eyes, when the surface itself has ulcerated. With warm water: fomentation; steam-bathing of the whole body or a part; softening of hardened skin; relaxation of what is taut; relief of contracting sinews; exudation from flabby flesh; promotion of sweating; moistening; flushing, as of the nasal passages, the bladder, the bowels; building up of flesh; softening; melting; diminishing; restoring color; dispersing color. It induces sleep, both when applied to the head and elsewhere; it soothes spasms and tetanic seizures; it dulls pains of the ear, the eyes, and all such things. Cold things it warms — for example, pitch in wounds — except in cases of hemorrhage or impending hemorrhage, in fractures, in dislocations, and in all other cases where the physician applies linen bandages; and in heaviness of the head. The moderate degree for each individual — not exceeding it — we know how to test, as for instance warmth upon the skin, testing the limits in both directions so as to err on neither side, as indicated by the presence of harms or absence of benefit, as for example with lukewarm water. For one must continue the application — whether harms or benefits arise — up to the point of benefit or up to the point where harm begins. Moistening, then, is a weak effect; cooling and warming are strong, as from the sun; cold water, being warm as a drink, is somewhat weak. But as to heat — not burning beyond measure: the patient himself judges this, except in those who are voiceless, or in those with paraplegia, or in those who are numbed, or in cases like those who are chilled from wounds or are in extreme pain — in these the senses are not reliable, for you might burn them without knowing it; and also in deep and extensive dislocations. Indeed feet have already fallen off, chilled, from the pouring of hot water — but in these cases the skin of the one doing the pouring is the judge. And similarly with cold water. Of these same things, a small amount of either is a weak effect; a large amount is strong. But one must indeed let the application continue until the aim for which it is done is achieved; at the extreme, one must stop just before that aim is reached — each of these errors causes harm. The harms from excessive use of warm water are: softening of the flesh, weakness of the sinews, numbing of the mind, hemorrhages, fainting — these leading to death. From cold water: spasms, tetanic seizures, blackening, shivering-fevers. The moderate degrees are derived from these. The other ways in which the things described cause harm and benefit accord with the pleasures and easings and distresses and sufferings that are seen to correspond to each one individually. A healthy body accustomed to being sheltered — because it is unaccustomed to cold, because it is furthest from its own proper warmth and nearest to the alien cold — for these reasons takes pleasure in warmth and is able to bear it. 2 The brain and all that depends from it is distressed by cold and takes pleasure in warmth, even if it is by nature somewhat colder and more solid. And it is far from its own proper warmth, and most of all among its parts. — For this reason cold is hostile to bones, teeth, and sinews, and warmth is friendly to them — because from these arise spasms, tetanic seizures, shivering-fevers, which cold produces and warmth stops. — For this reason too, in sexual function, pleasure and arousal come from warmth, while pain and aversion come from cold. — For this reason the loins, chest, back, and hypochondria are more distressed by cold and take pleasure in warmth and are able to bear it. — For this reason the loins, back, chest, and hypochondria are affected oppositely, because they are opposite in nature. — For this reason warmth used in this region causes nausea for those who use it there, while cold stops it. — For this reason one takes pleasure in cold drink. — For this reason one takes pleasure in warm foods. — For this reason too, pouring cold water over the extremities in fainting is beneficial. — That the back parts bear warmth more than the front — the reasons given account for this; that they also bear cold — that is correct too, for the extremities are at the front and not accustomed to shelter, as the inner parts differ from the outer. — One must also keep in mind that in each region of the body each temperature is more potent upon the outer skin, because it is continuous with itself and with the blood-carrying sinew; because the outer skin is outside its own proper warmth and in the external cold, in both cases it is frequently overpowered and frequently has need of both, and more frequently has need of warmth for pleasure. — The extremities are also affected in such a way as to respond quickly to many things; but they are slow to be raised up at first — and this is clear from the veins, which respond earlier and later — so everything appears thus: where the extremities are chilled, and where they are warmed, in states of vessel-emptying, in fainting states, and in accordance with reason. Naturally then the veins and what follows from them are affected accordingly, and warmth warms first — for instance the inner parts of the hands. — Wounds take pleasure in warmth without exception, because they are accustomed to shelter; naturally they are distressed by the opposite. — Naturally the veins themselves too, because they are in warmth. — Naturally the chest itself and the belly itself, when overpowered by cold, are most disturbed and brought to death — because they are most unaccustomed to it. But they are furthest from suffering this; for they are nearest to needing it. Naturally one takes pleasure in cold drink; thus all these things agree. — That above all, abrasions and surface burns — not being chiefly accustomed to shelter — are chiefly distressed by cold: naturally, for they are most quickly overpowered; and the deepest parts, if they were overpowered, would be most distressed; moreover they share in the nature of sinew. — That the lower belly seems to take pleasure in warmth — one must consider the region: it shares in it; and the extremities, and the bladder, and the seed, and the other naked generative part; it is by nature colder than one might suppose, for warmth rushes upward, not downward — for these reasons it takes pleasure in it. — That after warmth the body cools more, being loosened, and after cold it warms more, being contracted — just as waters too must be cooled and warmed on account of their thinness; that after warmth the body hardens more, being dried out — as for example the eyes after cold — for the one is like the surrounding medium, the other is not. — Seawater: for those with itching and biting conditions, both for bathing and for fomentation while warm; for those unaccustomed to it, it leaves an oily residue; against fire-burns and abrasions and all such things it is hostile; but against clean wounds it is suitable, and it is good for reducing well, as the wounds of fishermen show — for these do not even suppurate unless touched; and it is good for bandage strips; and it stops and arrests spreading ulcers, as do salts, brines, and natron. All these things, when used in small amounts, are irritating, but when applied persistently are beneficial; warmth however is better for most purposes. 4 Vinegar, in its effect on skin and joints, is comparable to seawater but more potent, both for pouring over and for fomentation; and for freshly wounded ulcers, for clots, for blackening of the genitals, burning of the ears or also of the teeth. These things with warm vinegar, as well as the other uses; and one should take the season into account; salts arise from evaporation; and against other things — all cases of lichen, leprosy, and white-scale — it is effective when thickened in warm sun; most especially against scaly nails, for it prevails after time. It softens warts, heals dirt in the ears, softens the skin in many other ways too — if only it did not harm by its smell, especially in women. It could also be used for podagra, if only the skin were not wounded by it. Vinegar-lees does these same things. Sweet wine: for all chronic wounds, used continuously it is sufficient; and also for medicinal drinking. 5 Harsh white and dark wine, applied cold to wounds, is admissible — cold in application despite its warming nature. The limits are these: for whatever is poured on or injected or dipped for the sake of cooling, it should be as cold as the coldest water; for whatever is done for the sake of astringency, dark wine — and wools soaked, for example, or beet leaves or linens are dipped in it for most purposes; for whatever needs a degree of astringency — for example ivy leaves, white wine — and for whatever is more puckering or more friable, such as cistus and bramble, tanning sumac, sage, and whatever must be softened, such as boiled meal-porridge. Cold benefits red eruptions — the kind that break out here and there across the shoulder-blade area, the kind that those with swollen spleens produce, in those with good flesh and soft flesh; reddish ones in dark-skinned persons; and the round ones they call aihtholikas, and those that arise during hot-baths themselves when they appear; and in women from the upward rushing of the menses under the skin; and from irritation of the skin, or from the unaccustomed wearing of rough garments; and from the exit of sweat; or from someone coming suddenly from cold to a fire or to hot baths — if cold is applied afterward, these no longer break out at all. 6 For all such things as arise from cold, or as become rough and millet-like and then form a surface crust, cold is harmful and warmth is beneficial. Those conditions that both benefit: swellings in the joints and gouty conditions without ulceration and most sprains — cold poured abundantly on these brings relief, reduces, and numbs the pain; moderate numbing stops pain; and warmth also reduces and softens. For gouty conditions, paralyses, tetanic seizures, spasms, and such things; for tension states, tremors, paraplegias, and such things; for relaxations, numbnesses, loss of voice, and such things; for stoppages from below — one must be on guard in the use of cold, using cold rather than the opposite. For parts hardened in the joints, whether from former inflammation or from ankylosis — most usefully, pouring warm liquid into a skin-bag and binding the hand into it. And for the eyes: leaving a soothing preparation for tears; against sharp humors, a gentle fat so that the salty matter does not make contact; and for hollow ulcers, washing and filling, bringing them back to their natural state. For the eyes: warmth for pains, suppurations, biting tears, all dry conditions. Cold: for pain-free conditions, for those very red; but for those accustomed to it, cold produces coiling in the vessels — the kind of things that are glandular-swelling-like, along the chest, and other hard things; for the rectum and the womb it is not very suitable at all; blood in the urine when the patient is in cold. For wounds: cold is biting, hardens the surrounding skin, makes wounds painful, unsuppurating, livid, black, causes shivering-fevers, spasms, tetanic seizures. There are cases in which, in tetanic seizure without a wound in a young well-fleshed person in midsummer, pouring a large quantity of cold water brings about the return of warmth. Warmth resolves these things, and in the head also heaviness of the head. Warmth promotes suppuration — not in every wound, but this is the greatest sign of safety — softens the skin, reduces, relieves pain, soothes chills, spasms, and tetanic seizures; in the head, it also dissolves heaviness of the head. It makes the greatest difference in bone fractures, especially in those where the bone is stripped bare, and most of all in wounds to the head whether self-inflicted or not, and in all cases of parts that die or ulcerate from cold; further, in deliberate and accidental ulcerations, abrasions, spreading gnawing herpetic conditions, parts blackening in disease, the ear, the rectum, the womb — in all of these warmth is friendly and decisive, cold is hostile and killing, except where hemorrhage is to be expected. So too with the pouring of liquids, the smearing of oily substances, the application of leaves or linens, the laying on of a poultice — in all cases where cooling or warming either benefits or harms.