On the Nature of Man — First Draft Translation

ON THE NATURE OF MAN. Whoever is accustomed to hearing those who speak about human nature in terms that go further than how far it bears on medicine — for such a person this account is not suited to be heard. For I do not say at all that man is air, or fire, or water, or earth, or anything else that is not manifestly present in man. Rather, I leave that to those who wish to say such things. 1. Those who say such things seem to me not to know correctly. For they all use the same mode of reasoning, yet say different things; but they arrive at the same conclusion from their reasoning. They say that what exists is some single thing, whatever it may be, and that this single thing is also the whole — though on the names they do not agree. One of them says this one-and-whole is air, another fire, another water, another earth, and each adds to his own account witnesses and signs that amount to nothing. When they all use the same mode of reasoning yet say different things, it is clear that they do not know the things themselves. One may best come to understand this by being present when they argue against one another: for the same men arguing against one another before the same audience never come out ahead three times in a row in the argument; instead, now this one prevails, now that one, now whoever happens to have his tongue flow most readily toward the crowd. And yet it is right that whoever claims to know correctly about the matters at hand should always be able to maintain his own argument as prevailing — if indeed he knows things as they are and sets them forth correctly. But to me these men seem to overthrow themselves in the very names of their accounts, through their own failure of understanding, and thereby to prop up the argument of Melissus. About these things, then, what has been said is enough for me. 2. Among physicians, some say that man is blood alone, others say man is bile, and still others phlegm. These too all arrive at the same conclusion: they say there is some one thing — whatever each of them wishes to name it — and that this one thing, being one, changes its form and its power, compelled by the hot and the cold, and comes to be sweet and bitter and white and black and every other sort of thing. But to me these things do not seem to be so either. Most people give accounts of this sort, or very close to it. I for my part say: if man were one thing, he would never feel pain; for there would be nothing from which, being one, he could suffer pain. And if he were to feel pain, the remedy would also necessarily be one thing. But as things are, remedies are many — for there are many things present in the body which, whenever they heat and cool and dry and wet one another contrary to nature, produce diseases. So the forms of diseases are many, and many too is their healing. I hold that whoever asserts man is blood alone, and nothing else, should show that blood does not change its form or become every sort of thing — but should show this at some one season of the year or of the age of man, in which blood alone appears to be present in man. For it is reasonable that there should be at least one season in which it appears to be present by itself alone. I say the same about whoever asserts man is phlegm alone, and about whoever asserts he is bile. For I shall demonstrate that what I say man is — both according to convention and according to nature — is always the same things equally, in the young and in the old, in the cold season and in the warm; and I shall provide signs, and shall point out the necessities by which each of them both increases and diminishes in the body. First, then, generation must necessarily come about not from one thing — for how could anything that is one generate, except by being mixed with something else? Furthermore, things that are not of the same kind and do not have the same power, when mixed, do not generate; nor would these things be brought to completion for us. 3. And again: if the hot does not stand in moderate and equal relation to the cold, and the dry to the wet, but one greatly exceeds the other and the stronger exceeds the weaker, generation would not come about. How then is it reasonable that anything should be generated from one thing, when even from several things nothing is generated unless they happen to stand in a favorable krésis — blending — with one another? It is necessary therefore, given that the nature of all other things is such, and of man's nature too, that man is not one thing, but that each of the constituents contributing to generation retains in the body the power it contributed. And again, when the human body comes to its end, each must of necessity withdraw to its own nature — the wet toward the wet, the dry toward the dry, the hot toward the hot, the cold toward the cold. Such is the nature of animals and of all other things as well: all come into being in the same way and all come to their end in the same way. For their nature is constituted from all these things I have named, and ends, as was said, back into the same place from which each was constituted, withdrawing there in turn. The body of man contains within itself blood and phlegm and bile, both yellow and black — these are the nature of his body, and through these he feels pain and is healthy. 4. He is most healthy when these stand in moderate krésis — blending — with one another in power and in quantity, and are most thoroughly mixed; he feels pain whenever one of them is too little or too great, or separates out in the body and is not blended in with all the rest. For it is necessary that whenever one of them separates and stands on its own, not only the place from which it departed becomes diseased, but also the place onto which it has flooded, overfilling, produces pain and distress. And indeed when any of them flows out of the body in excess of what is surfacing, the emptying produces pain. If on the other hand it makes its emptying and shifting and separation from the others within the body, it necessarily must produce a double pain, as has been said — at the place from which it departed and at the place into which it has overflowed. I have said that I will demonstrate the things which I say man is to be always the same, both according to convention and according to nature. I say these are: blood, phlegm, and bile, both yellow and black. 5. And of these I say that their names are distinguished first according to convention, and that none of them bears the same name as another; and next that their forms are distinct according to nature, and that phlegm in no way resembles blood, nor blood bile, nor bile phlegm. For how could these resemble one another, when looking at them their colors do not appear alike, and to the touch they do not seem to be the same? For they are not equally hot, nor cold, nor dry, nor wet. Since they differ so greatly from one another in form and power, they cannot be one thing — unless fire and water are also one and the same. You may recognize from the following that all these are not one thing but that each of them has its own power and its own nature: if you give a person a drug that draws phlegm, he will vomit phlegm; if you give a drug that draws bile, he will vomit bile. Likewise, black bile is purged if you give a drug that draws black bile; and if you wound some part of the body itself so as to produce a wound, blood will flow from it. And these things will happen for you every day and every night, in winter and in summer, for as long as the person is able to draw pneuma — breath — into himself and release it again. He will be able to do so until he is deprived of one of the things that have grown together with him. These things I have spoken of have indeed grown together with him — for how should they not have? First, man is plainly seen to have all these things always within himself as long as he lives; next, he was born from a man who had all these things, and he was nurtured within a man who had all these things — all those which I now assert and demonstrate. Those who say man is one thing seem to me to have been led to that view by seeing people who drink drugs and die from excessive purging — those who vomit bile, or others who vomit phlegm — and each of them supposed that whatever was being purged when the person died, that was what man is. Those who say man is blood hold to the same view: seeing people who are slaughtered and the blood flowing from the body, they suppose this to be the man's psyche. And they all use such observations as witnesses in their arguments. 6. And yet in the first place, no one has ever died from excessive purging having been purged of bile alone. When someone drinks a drug that draws bile, he first vomits bile, then phlegm; and after these, forced on, they vomit black bile, and finally they vomit unmixed blood. And the same happens with drugs that draw phlegm: first they vomit phlegm, then yellow bile, then black bile, and finally unmixed blood — and in that they die. For the drug, when it enters the body, first draws that which is by nature most congenial to the drug of the things present in the body, then draws and purges the rest as well. Just as things that grow and are sown, when they come into the earth, draw each what is congenial to them and present in the earth — and there is in the earth what is sharp and bitter and sweet and salty and every sort of thing — first drawing into itself the most of what is most congenial to it, then drawing the rest as well: so too drugs do something of this sort in the body. Those that draw bile first purge the most unmixed bile, then the mixed; and again the drugs for phlegm first draw the most unmixed phlegm, then the mixed. And in those who are slaughtered, first the blood flows most hot and most red, then it flows more phlegm-like and bile-like. Phlegm in man increases in winter; for this is the most natural of the things present in the body to winter, since it is coldest. 7. The sign that phlegm is the coldest: if you are willing to touch phlegm and bile and blood, you will find phlegm to be the coldest. And yet it is the most viscous and is drawn with the greatest force after black bile. Whatever comes with force becomes warmer, being compelled by the force — but even so, phlegm appears coldest of all these things, by virtue of its own nature. That winter fills the body with phlegm you may recognize from the following: people spit and blow from the nose what is most phlegm-like in winter, and swellings in them become most white at this season, and the other diseases are phlegmatic. In spring, phlegm still remains strong in the body, and blood increases; for the cold spells relent and the rains come, and blood increases accordingly, from the rains and the warm days — for these are most natural to it in the year, since blood is wet and warm. You may recognize this from the following: in spring and summer people are most seized by dysenteries, and blood flows from their nostrils, and they are most hot and flushed. In summer blood is still strong, and bile rises in the body and extends into autumn. In autumn blood becomes little — for autumn is contrary in nature to it — while bile occupies the body through summer and autumn. You may recognize this from the following: people spontaneously vomit bile at this season, and when they take drugs they are purged most biliously; this is also clear from fevers and from the complexions of people. Phlegm in summer is at its weakest by its own standard — for the season is contrary to its nature, being dry and warm. Blood in autumn becomes least in man, for autumn is dry and is already beginning to cool the person; black bile in autumn is most plentiful and most strong. When winter overtakes, bile cools and becomes little, and phlegm increases again from the quantity of rains and the length of nights. The body of man always contains all these things, but by the season that comes around they become at times more than their own measure, at times less, each in its turn and according to its nature. For as the year shares in all things — in the warm and the cold and the dry and the wet — since none of these would remain even for a moment without all the things present in this world (and if even one were to fail, all would disappear; for from the same necessity all are constituted and nourished by one another) — so too if any one of these things that have grown together with man were to fail, the man could not live. In the year winter prevails at one time, spring at another, summer at another, autumn at another. So too in man phlegm prevails at one time, blood at another, bile at another — first the yellow, then what is called the black. Most convincing evidence: if you are willing to give the same drug to the same person four times in the year, he will vomit in winter the most phlegm-like matter, in spring the most wet, in summer the most bilious, in autumn the most black. 8. It follows then, things being so, that diseases which increase in winter should cease in summer, and those that increase in summer should cease in winter — except those among them that do not resolve within a period of days. The period of days I shall explain again later. Diseases that arise in spring, one must expect their resolution to come in autumn; those that are autumnal diseases must of necessity resolve in spring. Whatever disease exceeds these seasons, one must know that it will last a full year. The physician must treat diseases in this way: recognizing which of these things prevails in the body according to the season most natural to it. He must also know the following in addition to those things: diseases that fullness produces, emptying heals; diseases that arise from emptying, fullness heals; those that arise from exertion, rest heals; those that are produced by idleness, exertion heals. 9. To understand the whole of the matter, the physician must stand opposed to prevailing conditions — both diseases and constitutions and seasons and ages of life — and must loosen what is taut and tighten what is slack. For in this way the suffering part would be most relieved, and healing, it seems to me, is just this. Diseases arise, some from the diaita — the regimen and ordering of life — and some from the pneuma — the breath — which we draw in and by which we live. The distinction between the two must be made as follows: whenever many people are seized by one disease at the same time, the cause must be assigned to what is most common, to what all of us most use. That is what we breathe. For it is clear that the ways of living of each of us are not responsible, when the disease seizes all in succession — the younger and the older, men and women alike, those who drink wine and those who drink water, those who eat barley-cake and those who are fed on bread, those who labor greatly and those who labor little. Since people living in every manner of life are seized by the same disease, the ways of living could not be the cause. But whenever diseases arise of many different kinds at the same time, it is clear that the diaita is responsible, different ways for different people, and the treatment must be conducted by opposing the cause of the disease — as I have set out also elsewhere — and by changing the diaita. For it is clear that the ways of living the person is accustomed to use are not suitable for him — either all of them, or the greater part, or at least one of them — and having determined this one must change them; and having examined the nature of the person, his age and his constitution and the season of the year and the character of the disease, one must conduct treatment, at times taking away, at times adding, as I have also said before, adapting to each of the ages and seasons and constitutions and diseases, in the use both of drugs and of the measures of the diaita. But whenever an epidemic of one disease has settled in, it is clear that the diaita is not responsible, but that what we breathe is responsible, and it is clear that this carries some morbid secretion. At such a time the following advice must be given to people: not to change the diaita, since it is not responsible for the disease; but to see to it that the body will be as free of bulk and as lacking in strength as possible, by diminishing gradually the food and drink that one is accustomed to use — for if the diaita is changed quickly, there is danger that some further disturbance may arise in the body from the change itself — but one should use the diaita thus, with gradual reduction, since it appears to harm the person not at all. And to take care that the inflow of pneuma entering the mouth should be as little as possible and as unfamiliar, by changing locations to the extent possible from those places where the disease has settled, and by thinning the bodies. For in this way people would least require much and dense pneuma. Diseases that arise from the strongest member of the body are the most dangerous. For if the disease stays where it begins, it is necessary that, the strongest of the members being distressed, the whole body be distressed; and if it reaches one of the weaker parts from the stronger, the resolutions are difficult. 10. Whatever diseases pass from the weaker to the stronger parts are more easily resolved, for by the strength the things flowing in will readily be consumed. The thickest of the blood-vessels are arranged as follows: there are four pairs in the body. One of them runs from the back of the head through the neck, externally along the spine on both sides, alongside the hips, and reaches to the legs, then passes through the shins to the outer ankles and extends into the feet. 11 [10] For pains in the back and hips, then, phlebotomies must be made from the hollows of the knees and from the outer ankles. The other vessels run from the head past the ears through the neck — those called the sphagitides — and pass inward along the spine on each side, beside the loins, to the testicles and the thighs, and through the hollows of the knees from the inner side, then through the shins beside the inner ankles and into the feet. For pains in the loins and the testicles, then, phlebotomies must be made from the hollows of the knees and from the inner ankles. The third vessels run from the temples through the neck under the shoulder blades, then converge into the lung, and arrive — the one from the right crossing to the left, the one from the left crossing to the right — and the right one reaches from the lung under the breast and into the spleen and into the kidney, while the one from the left crossing to the right reaches from the lung under the breast and into the liver and into the kidney; both of these end at the rectum. The fourth vessels run from the front of the head and the eyes, under the neck and the collarbones, then over the upper arms from above into the bends of the elbows, then through the forearms to the wrists and fingers, then back from the fingers through the palms of the hands and through the forearms upward to the bends of the elbows, and through the lower part of the upper arms into the armpits, and from the upper ribs the one reaches to the spleen, the other to the liver, and then both end above the belly at the genitals. Such, then, is the arrangement of the larger vessels. There are also very many vessels of every kind running from the gut throughout the body, through which nourishment reaches the body. They carry from the larger vessels into the gut and into the rest of the body — both from the outer and from the inner — and the inner ones communicate outward with one another, and the outer ones inward. Phlebotomies must therefore be carried out in accordance with these principles; and one should make it a practice to cut as far as possible from the places where the pains are accustomed to arise and the blood is accustomed to collect. For in this way the change would occur with least violence and least abruptness, and you would shift the habitual course so that the blood no longer collects in the same place. Those who spit up much pus without fever, those in whose urine much pus settles without pain being present, and those whose stools are bloody as in dysenteries and this persists — being thirty-five years old or older — in all these cases the diseases arise from the same cause: for it is necessary that these persons had been subjected to hard bodily labor and toil and had been workmen in their youth, and then, on being released from their labors, had grown flesh with soft flesh differing greatly from what came before, so that the body has a great divergence between what was there first and what grew afterward, and they do not agree with one another. 12 [35] Whenever, then, some disease overtakes those in such a condition, they escape it at the time, but afterward, in the period following the disease, the body wastes away and flows through the vessels wherever it finds the most room, in a serum-like form. If it rushes toward the lower gut, the excretion that results is more or less like what was contained in the body — for since the path is downhill it does not remain long in the intestine. In those in whom it flows into the chest, they become suppurative; since the cleansing is uphill, and the matter lodges in the chest a long time, it putrefies and becomes pus-like. In those in whom it discharges into the bladder, owing to the warmth of that place it becomes both warm and white, and is separated out; the thinnest part rises to the top, the thickest settles to the bottom, and this is what is called pus. Stones also form in children because of the warmth of that region and of the whole body; in men stones do not form, because of the coldness of the body. For one must know well that a human being is hottest on the first of his days relative to himself, and coldest on the last: for as the body grows and advances it must be warm under compulsion; but when the body begins to wither, running down easily, it becomes colder. And by the same principle, by however much the human being grows most on the first of his days, by so much does he become warmer; and on the last of his days, by however much he wastes away most, by so much must he be colder. Those in such a condition recover spontaneously — the greater number during the season in which they began to waste, within forty-five days; those who pass beyond this season recover spontaneously within a year, provided nothing else is going wrong with the person. Diseases that arise from little and whose precipitating causes are readily recognized — these are the safest to foretell; and treatment must be carried out by oneself opposing the precipitating cause of the disease; for in this way the thing that brought about the disease in the body would be resolved. 14 [10] In those in whom sand-like sediment or chalky stones settle in the urine, in these cases swellings originally formed near the large vessel and suppurated; then, since the swellings did not rupture quickly, chalky stones consolidated from the pus, and these are pressed out through the vessel together with the urine into the bladder. In those in whom the urine is only blood-tinged, the vessels are under strain. In those in whom, with the urine being thick, small flesh-like hair-thin fragments pass out together, these must be known to be from the kidneys and from joint disease. In those in whom the urine is clear at one time and another, but something like bran is carried in it, the bladder of these persons has a scaly itch. The majority of fevers arise from bile; their forms are four, apart from those arising in the distinct localized pains; their names are: continuous, quotidian, tertian, quartan. 15 [25] The so-called continuous fever arises from the most bile and the most unmixed, and reaches its crises in the shortest time; for the body, without any interval of cooling, melts away quickly, being heated by the great heat. The quotidian comes next after the continuous in arising from the most bile, and is resolved most quickly of the others; but it is longer than the continuous by as much as it arises from less bile, and because the body has a period of rest, whereas in the continuous the body has no rest at any time. The tertian is longer than the quotidian and arises from less bile; by as much more time as the body is rested in the tertian than in the quotidian, by that much longer is this fever than the quotidian. The quartans are in other respects in the same proportion, but are considerably longer than the tertians, by as much as they partake of a lesser share of the bile that provides the heat, and partake more of the cooling of the body; and there is added to them, from black bile, this excess and difficulty of resolution — for black bile is the most viscous of the chymoi (bodily fluids) present in the body, and produces the most long-lasting deposits. You will recognize from the following that quartan fevers partake of the melancholic: for it is chiefly in autumn that people are seized by quartans, and in the age from twenty-five years to forty-five — because this age is dominated by black bile more than all other ages, and the autumnal season is the most suited of all the seasons to it. Those who are seized by a quartan outside this season and this age — one must know well that the fever will not become protracted, provided nothing else is going wrong with the person.