On the Physician — First Draft Translation

ON THE PHYSICIAN. [Preface] The physician's outward bearing requires that he appear of good color and well-fleshed, in accordance with his natural constitution; for the many judge that those who are not in good bodily condition themselves could not attend well to others. Furthermore, he must keep himself clean in person, wearing decent clothing and using well-scented ointments that give off no suspicious smell; for in all these things it happens that the sick take pleasure. 1. The prudent man must observe these things regarding the psyche [living and reasoning principle]: not only silence, but also an altogether well-ordered conduct in his way of life — for these things contribute greatly to good repute. His character must be fine and good, and being such, he must be both dignified and humane to all; for rashness and over-readiness are held in contempt, even if they are quite useful. One must also consider the matter of restraint; for the same things, when held in scarcity among the same people, are prized. In bearing: from his face, thoughtful but not harshly so — for one who is such seems arrogant and misanthropic; but one who relaxes into laughter and is overly cheerful is taken for a boor; and one must guard against this especially. He must be just in all dealings; for justice must render much assistance in many things; and toward the physician the dealings of the sick are not small — for they place themselves entirely in the physician's hands, and he encounters women, maidens, and the most prized possessions at every hour. One must therefore hold oneself with firm self-restraint in all these things. Let the psyche and the body be so disposed. The precepts of the art of medicine, through which one may become skilled, must be surveyed from the beginning, from which a person would first learn; the things treated in the surgery are, roughly speaking, the domain of learners. 2. One must first have a suitable place. This will be the case if neither incoming pneuma [moving air / draft] disturbs it, nor does sunlight or glare cause discomfort. Far-reaching bright light is painless for those giving treatment, but it does not equally serve those being treated; one must above all avoid that sort of glare, for it is through this that the eyes become diseased. The light is thus prescribed to be of this sort: that the rays should in no way shine directly toward the face of the patient, for this troubles vision when it is in a weak state; and any sufficient occasion will aggravate weakened eyes. Light, then, must be used in this manner. The seats should be as level in height as possible, so that those seated on them are at the same level. Let no bronze vessel be used except for the instruments; for it seems to me a vulgar kind of ostentation to use such equipment. Clean, drinkable water must be provided for those being treated. For wiping, use clean and soft materials — linen cloths for the eyes, sponges for wounds; for these by themselves seem to assist well. All instruments must be fit for use — in size, weight, and fineness. Everything applied must be surveyed as a whole for how it will benefit; and most especially where it will be in contact with the diseased part. These are bandages, medicinal preparations, linens about the wound, and poultices; for these remain longest in contact with the diseased parts. 3. The subsequent removal of these, the cooling and cleansing, and the pouring of water over, occupy a certain short time; and one must have considered where more and where less is needed; for in both cases the use of these, whether timely or not, makes a great difference. Bandaging is a proper domain of medicine, from which the one being treated must benefit. Two things give the greatest benefit, and these must be used: to press where necessary and to bind with appropriate looseness. Regarding the seasons of the year — when one must apply covering and when not — one must survey this so that it does not escape even the weak patient's notice which of the two must be used in each situation. Graceful and showy bandagings that give no benefit are to be rejected; for such things are burdensome and altogether boastful, and will often bring harm to the one being treated; for the sick man seeks not ornament but what is beneficial. 5. In surgical procedures accomplished by cutting or burning, speed and slowness are similarly commended; for there is use for both. Where the surgical work is accomplished in a single cut, the division must be made quickly; for since those being cut happen to suffer pain, the source of distress must be present for as short a time as possible — and this will be achieved when the cutting is done quickly. Where it is necessary to make many cuts, a slow procedure must be used; for rapidity makes the pain continuous and great, while the intermission gives some rest from pain to those being treated. The same may be said of instruments. We do not prescribe the use of blades both sharp and broad equally in all cases; for there are certain parts of the body where the rush of blood is swift and not easy to check — these are varicose veins and certain other vessels. The cuts for such parts must be narrow, so that the flow cannot become excessive; yet it is sometimes beneficial to carry out blood-removal from such parts. 6. For parts without danger and where the blood is not thin, broader blades must be used; for the blood will flow, and otherwise it will not at all. It is altogether shameful when what is intended from the surgical work does not come about. We say there are two useful modes of cupping vessels. First mode: when a gathered flow is situated deep, away from the visible flesh, the rim of the vessel must be narrow and the body of it rounded, not elongated toward the part near the hand, and not heavy; for being such, it happens to draw in a straight line, and the ichors [serosities] that have settled apart are well drawn up toward the flesh. Second mode: when the suffering is diffused more broadly through the flesh, the other features are much the same, but the rim must be large; for in this way you will find it drawing the troublesome matter from the most parts to the place where it is needed; for it is not possible for the rim to be large unless the flesh is drawn together from a larger area. 7. Being heavy, it also inclines toward the upper parts; but removal must be made more from below, and often it happens that the diseases are left behind. For flows that are superficial and far from the upper parts, wide rims draw much from the surrounding flesh; and it happens that the moisture drawn from there comes in the way of the ichor gathered from below, and that the troublesome matter is left behind while what causes no distress is removed. The useful size of a cupping vessel must be estimated in relation to the parts of the body to which it is to be applied. When one strikes it, the drawing must be from below; for the blood must be visible at the sites being operated on — otherwise one must not strike the drawn-up rim at all; for the flesh of the suffering part is more taut. For the curved blades, use those not too narrow at the tip; for sometimes ichors come viscous and thick, and there is a danger of their collecting at the cuts when they are cut too narrow. The veins on the arms must be guarded at the ligatures; for the covering flesh in many people is not well joined to the vein. When the flesh is slippery, it does not happen that the cuts of both fall in the right place; for the vein happens to be blown away when covered, and the flow of blood is hindered, and in many cases pus collects because of this. Such a surgical procedure is thought to bring two harms: pain to the one cut, and great ill-repute to the one cutting. The same has been prescribed to hold for all cases. 9. These, then, are the necessary instruments in the surgery, and the things in which the learner must be skilled. As for tooth-forceps and uvula-forceps, their use belongs to any chance practitioner, since their use seems to be simple. Concerning phymata [swellings / growths] and wounds that belong to more serious diseases: the most skilled thing is to be able to resolve the phymata and to prevent their hardening [σύστασις]; next after this, to bring them to the surface in as small a compass as possible, and to bring about even firmness [σύστασις] throughout the whole growth; for when it is uneven there is a danger that it will burst and the wound will become hard to treat. One must even out by concocting [pepsis] uniformly throughout, and neither cut earlier nor allow it to burst on its own. What is capable of bringing about complete concoction uniformly has been set out elsewhere. 11. Wounds seem to have four directions of extension: one going into depth — these are the fistulous ones and those that are undermined and hollowed from within; another going into height — those that have overgrown with flesh; a third going into breadth — these are the ones called herpetic [spreading]; the fourth direction is toward growing-together [symphysis]; and this alone seems to be movement in accordance with nature. These, then, are such conditions of flesh. All are shared in the process of growing together; and the signs of these have been shown elsewhere, and the manner of care that must be used. The means by which the growing-together will proceed, and what is filling or what has become hollow, or what is taking the direction toward breadth — concerning these things the fitting account has been given elsewhere. Concerning poultices, in this manner: where the application of linens upon the disease seems to need to be precise, fit the applied linen to the wound, and use the poultice on the area surrounding the wound; for this is the skilled and most beneficial use of a poultice. The power of what is placed around seemed to assist the wound, while the linen guards it; and the poultice benefits what is outside the wound. 12. Such, then, must be their use. As for the appropriate moments when each of these is to be used, and how the properties of what has been written must be thoroughly learned — such things have been left aside, since they advance further into medical care and belong to one who has already progressed far in the art. 14. Related to these matters is also the surgical procedure, performed amid military campaigns, for the extraction of missiles. When one practices in a city setting, the use of these has small scope; for in the whole course of time, civic and warlike military activities rarely occur; but such things happen most often and most continuously with foreign armies. One who intends to perform surgery must therefore serve in campaigns and follow foreign armies; for only in this way would one be trained for this use. What seems to be the more skilled aspect of these matters will be stated: for when weapons are lodged inside, to obtain signs of this is the greatest part of the skill and of the surgical procedure regarding these cases; for when this is secured, a casualty will not be overlooked from ignorance — provided that the surgeon operates rightly. Only one skilled in the signs could rightly undertake this work. Concerning all of these things, it has been set down elsewhere.