On Places in Man — First Draft Translation

[Preface] It seems to me that there is no beginning of the body, but all parts are equally beginning and all are end; for when a circle is drawn, no beginning can be found. And likewise with diseases, from every part of the body equally: the drier part, being naturally disposed to take on diseases and to suffer more, and the wetter part less so; for a disease in the dry part congeals and does not stop, while in the wet part it flows through, and at different times it grips one part of the body most strongly, and by always shifting it gives rest, and ceases more quickly, inasmuch as it has not congealed. 1 The individual parts of the body, each upon another — whenever an impulse moves this way or that — straightway produce disease: the belly upon the head, and the head upon the flesh and the belly, and all the rest likewise in the same proportion, just as the belly upon the head, and the head upon the flesh and the belly. For whenever the belly does not produce a moderate discharge and something enters into it, it waters the body with the moisture from the food being taken in; this moisture, obstructed from the belly, travels in a mass toward the head; and when it arrives at the head, not being contained by the vessels in the head, it flows wherever it chances — around the head, and into the brain through the thinness of the bone; and some of it sinks into the bone, while some remains around the brain through the thinness of the bone. And if it arrives back at the belly, it produces disease in the belly; if it chances to go elsewhere, it produces disease elsewhere. And all the rest likewise — each one produces disease in another. And it is best thus to treat what is diseased through the very means by which diseases are produced; for in this way one would most effectively address the source of what is diseased. The body itself is the same to itself and is composed of the same constituents, though they are not similarly disposed — both its small parts and its large, and its lower parts and its upper. And if anyone wishes to harm the very smallest part by taking it from the body, the whole body will perceive the effect of whatever kind it may be, because the smallest part of the body contains everything the largest part contains; and when the smallest part experiences anything, it carries each thing back to its kindred group, whether it be bad or good; and for these reasons the body both suffers pain and feels pleasure from the group of the smallest part, because in the smallest part all the portions are present, and these carry things back to their own respective parts and report everything. The nature of the body is the beginning of the account in medicine. First: it has been perforated where we hear; for the parts around the ears on either side are hollow, and hear nothing but noise and clamor; but whatever passes through the membrane into the brain is heard distinctly by this route; and the only perforation is through the membrane stretched around the brain. 2 At the nostrils there is no single perforation, but it is porous, like a sponge; and for this reason one hears for a greater distance than one smells, since the smell of a scent is spread over a wide area. Into the eyes, fine vessels are carried from the brain through the surrounding membrane into the sight; these vessels nourish the sight with the purest fluid from the brain, into which sight is also visible in the eyes; and these same vessels also extinguish the sight when they dry out. There are three membranes that guard the eyes — the uppermost, thicker; the middle one, thinner; and the third, fine, which guards the fluid. Of these, the uppermost and thicker one, if it becomes numbed, is a disease; the middle one is the dangerous one, and when it ruptures, it protrudes like a bladder; the third, the finest, is altogether dangerous — the one that guards the fluid. There are two membranes of the brain: the upper one, thicker; and the fine one touching the brain, which is no longer the same once it has been wounded. Veins extend to the crown of the head through the flesh, holding fast to the bone, and they run through the flesh — two from the crown straight to where the eyebrows come together, ending at the corners of the eyes; and one from the crown is carried to the nose and divides into the cartilage of the nose on each side; two other veins run alongside the temples, between the temples and the ears, and these press upon the sight and always pulse — for these alone among the veins do not water, but blood turns away from them; and that which turns away works against what flows in; and that which turns away, tending to retreat, and that which flows from above, tending to move downward — pressing against each other and welling up and circling around one another — produce pulsing in the small vessels. 3 The sight is nourished by the fluid from the brain; but when it receives something from the veins, it is disturbed by the flow, and vision does not appear clearly within it, and there seem to move before it at times something like phantom images of birds, at times something like dark lentils, and otherwise it cannot see anything accurately in accordance with truth. Two other veins between the ears and the other veins are carried to the ears and press on the ears; two other veins from the junction of the bone are carried to the sense of hearing. Those directed toward the lower body: two veins run alongside the tendons of the neck, they are carried alongside the vertebrae, and they end in the kidneys; these also reach to the testes, and when they suffer, the person urinates blood. Two other veins are carried from the crown to the shoulders, and are indeed called the shoulder veins. Two other veins are carried from the crown past the ears, in the front of the neck on either side, into what is called the hollow vein. The hollow vein extends along the same route as the esophagus, and is situated between the windpipe and the esophagus; it runs through the diaphragm and through the heart and between the diaphragm, and divides into the groins and into the inner thighs, making the clefts in the thighs, and is carried along the inside of the shins past the ankles; these also make a person sterile when they are cut, and they end in the great toes. From the hollow vein a branch has grown out to the left arm; it runs below the spleen to the left flank, whence the spleen has grown out through the omentum, and it ends in the kitharos; it branches off at the diaphragm and joins with the shoulder vein below the joint of the elbow, and this one is cut for the spleen; and another has grown out to the right in the same way from the hollow vein. All the veins communicate and flow through one another — some meet directly with each other, while others communicate through the small vessels stretched out from the veins, which nourish the flesh. Whatever disease arises from the veins is easier to treat than disease from the sinews, for it flows off with the fluid present in the veins and does not remain fixed; and the nature of the veins is in the fluid within the flesh. 4 The sinews are dry and have no hollow, and they grow next to the bone, and are nourished for the most part from the bone and also from the flesh, and in color and strength they are naturally between bone and flesh; they are wetter than bone and more flesh-like, but drier than flesh and more bone-like. Whatever disease enters into them takes hold and remains fixed in the same place, and is hard to draw out; and what chiefly enters them are tetanos and other conditions from which the body is seized with trembling and is made to shake. The sinews press upon the joints and are stretched along the whole body; they are strongest in those parts of the body where they are always thickest — that is, in those parts of the body where the flesh is least. 5 The whole body is full of sinews; but about the face and head there are no sinews, but rather fibers resembling sinews, between the bone and the flesh, thinner and firmer — and there are the hollow-sinewed ones. Skulls have sutures — some three, some four: those having four have a suture at each ear on either side, another at the front, another at the back of the head — such is the arrangement for one having four; that with three: at each ear on either side and at the front; as in the one having four, no suture runs completely through here either. Those having more sutures are healthier in the head. 6 In the eyebrows the bone is doubled, and the junction of the jaws is at the midpoint of the chin and at the upper part near the head. Some have more vertebrae, some fewer; those having more number eighteen in total, of which some are in the upper region toward the head and some below toward the seat. Ribs: seven; the back parts of the body are attached to the vertebrae, the front parts of the chest to the sternum, which they meet. The collarbones have joints — those at the middle of the sternum at the windpipe are jointed there; those leaning toward the shoulders are directed toward the shoulder-blades, which are always situated on the shoulders. The shoulder-blades are jointed at the limbs, resting on the bone in the limb. Alongside the bone two fibula-bones extend along it, one on the inside and one on the outside, and these, attached to the shoulder-blades by the bone, are jointed. Below, at the elbow, below they are jointed with a fibula-bone at the natural hollow; and above, a small part of the fibula into the elbow — the bone and the fibula meeting at the same joint in the cubit — form a joint. Along the forearm run four quite thin fibula-bones — two above and two below; and toward the elbow two fibula-bones grown upward from the bone, these together with the bone, growing alongside the bone's joint, are jointed into the cubit; and those lying below and leaning inward, both these joining together toward the fibula carried from above from the limb, are jointed on the inside of the limb and form what is called a fibula, these themselves meeting one another on the inside in the cubit. Below toward the hand the bone has a joint; and the fibula-bones there, being soft, the two of them do not reach to the joint, but the upper one and the lower one are jointed together with the bone toward the hand. The hands have many joints; for however many bones come together with one another, they all make joints. The fingers have many joints — each three: one under the nail, between the nail and the knuckle; another at the knuckle where they also bend the fingers; another third at the place where the finger grows from the hand. In the hip-joints there are two joints called the hip-sockets, and the thighs are jointed into them; alongside the thighs two fibula-bones extend along, one on the inside and one on the outside, and neither of them reaches to the joint from either direction, but they are attached to the bone by the thigh. The thigh above, where it enters into the socket, is forked in the following way: on the inwardly inclined of the two forks there has grown on the tip something round and smooth, which enters into the socket; and the other, the smaller of the two forks, which is more toward the outside, projects outward more and is visible below in the region of the buttocks, and is called the ischion. Toward the knee the bone of the thigh is forked in the following way: into this fork the bone called the shin-bone is fitted as if in a hinge-joint; and over the fitted part the kneecap rests, which prevents the moisture from the flesh from entering into the opened joint. 6 (50) Along the shin-bone two fibula-bones extend alongside it, which below toward the foot end at the ankles, while above toward the knee they do not reach to the joint. Toward the foot the shin-bone has a joint at the ankles, and another lower than the ankles, and in the feet many joints, just as in the hands; for however many bones, so many also are joints, and in the toes of the feet the same number arranged in the same way. There are many small joints in the body, not alike in all persons, but different in different ones; but what has been described here is alike in all, and the veins that have been described are alike in all; there are also other small vessels in different persons, but not worth mentioning. Mucus is present by nature in all, and when it is clean the joints are healthy, and for this reason they move easily, gliding against one another. 7 Pain and aching arise whenever moisture flows from the flesh when it has suffered something; first the joint congeals, for the moisture that has flowed in from the flesh is not slippery; then, inasmuch as it has become too great in quantity and is not continually supplied from the flesh, it dries out, and being too great in quantity and the joint not containing it, it flows out — having congealed badly it lifts up the sinews by which the joint is bound, and makes them loose and slack; and for this reason persons become lame, and when this happens more, more so, and when less, less so. Into the belly go both what is eaten and what is drunk; and from the belly fibers are stretched to the bladder, which filters the fluid. 9 Fluxes arise both when the flesh is chilled excessively, and when it is overheated and somewhat inflamed. Fluxes from cold arise in the following way: when the flesh in the head and the veins are taut — these, as the flesh shudders and contracts into a small volume and is compressed, squeeze out the moisture, and the flesh itself at the same time presses back as it contracts into a small volume, and the hairs stand upright above, as they are being forcefully pressed from every side all at once; whatever is squeezed out from this flows wherever it chances. It also flows from heat, when the flesh becoming porous creates passages, and the fluid, being warmed, becomes thinner; for every fluid when heated becomes thinner, and everything flows toward what yields; most of all when it is excessively inflamed does it flow for this reason: the flesh, becoming too full, whatever it cannot contain — the fluid that cannot be contained flows, and flows wherever it chances. And once the fluxes have become free-flowing, the flux flows to whatever region it chances, until the channels of the flux are compressed together through thinness when the body has dried out; for the body, being in communion with itself, takes hold and draws whatever moisture it encounters toward its own dry parts — and it is not hard to draw, inasmuch as the body is empty and not swollen, being thin. But when the lower parts have become dry and the upper parts wet — the upper parts are rather wetter vessels, since the veins above are more numerous than below, and the flesh in the head requires less moisture — then the dry part of the body draws the moisture from the head; and at the same time there are passages for what draws rather than for what is drawn; for these too benefit by being dry, and at the same time wet things naturally move downward, and if any brief necessity arises. The fluxes from the head are seven: one through the nostrils, one through the ears, one through the eyes — these fluxes are visible to the eyes coming from the head. 10 When flux runs into the kitharos from cold, bile is produced; rather, it flows more into the kitharos from cold for this reason: that it becomes free-flowing into the windpipe, since it is not covered over there; and from the cold, weariness also grips those who are seized with bile, because the flesh, when it is wintry, does not remain still but is shaken, and being shaken it labors and becomes tired, being shaken just as in walking journeys; and they become suppurating internally, when the flux flows to the kitharos, and they waste away. When a flux occurs into the marrow, blind phthisis develops. When the flux runs backward into the vertebrae and into the flesh, dropsy develops; and this is how one can recognize it: the front parts are dry — the head and the nostrils and the eyes; and in the eyes dimness of vision develops, and they become pale, as does the rest of the body, and the person expectorates nothing, even if the flux flows abundantly; for this flux, running through the middle of the flesh, having turned away from both the rear and the front, makes the front parts dry, while it waters the rear flesh, and the inner part more toward the belly than the outer part toward the skin; and for this reason the outer part of the body is more solid than the inner part, and has narrower passages; and these, being fine, are compressed together and close themselves off, and no flux can go that way; while the inner passages are wider and have finer material between them. The flux, flowing as if from higher ground and having fine obstacles before it, flows and fills the flesh with moisture; and the moisture coming from food into the same place is corrupted; and this, being corrupted by the mixing, together with what flows from the head along with it, fills the body with corrupt nourishment; and the flesh, nourished by too much fluid and by unhealthy fluid, flourishing excessively, is full of dropsy. If only a little flows, it has produced hip-disease and kedmata once the flux has stopped; for the small amount that has flowed, being pressed from every side and being overcome by everything around it because it is small, and having no further inflow, and being pressed from every side, finds escape into the joints. Kedmata and hip-disease also arise from such diseases when they are becoming healthy: when the disease that produced them becomes healthy, but something is left behind in the flesh and has no exit — neither does it go inward nor does it make a swelling on the skin as it exits — it flees to what yields, into the joints, and has produced either kedmata or hip-disease. If the nostrils swell together and are full of phlegm that has congealed, it is necessary to thin out this congealed phlegm either by fomentations or by medicine, and not to turn it aside; for if it is turned aside and flows elsewhere, the flow wherever it goes would produce a greater disease. 12 Whenever flux runs into the ears, at first it causes pain, for it passes through with force; and it causes suffering until a fistula is formed; but once it has learned to flow, it produces pain no longer. For the one gripped by pain: take a medicine warm by nature, make it lukewarm, mix it with nard-oil, and pour it in; and apply a cupping-vessel to the back of the head — if it is the left that pains, to the right, and if the right, to the left; not with strong suction, but only enough to draw; but if it does not stop with these measures, pour in things cold by nature, and give a medicine to drink that will produce downward discharge but not upward — just as vomiting does not help either — and otherwise apply cold measures. And always change the method away from that which is not producing health; and if it is making things worse, turn to the opposite; but if it is tending toward health, do not at all remove any of what is being applied, nor separate any part out, nor add anything else. If it has already formed a fistula, and a suppurating ichor flows in quantity and with a bad smell, do this: soak a sponge in a drying medicine and apply it as close as possible to the ear canal, and apply a purging medicine to the nostrils, so that, of what is flowing into the ears, it may be carried forward to the nostrils and not retreat again to the head, being unhealthy. When a flux goes to the eyes, the eyes are inflamed and swollen; this must be treated with a medicine, either liquid or dry, in a compress; but if they are inflamed straightway, do not apply any ointment at all, but either flush downward with the strongest purge, or make lean with some other purgative medicine, taking care not to provoke vomiting; if, however, things like stones pass under, apply an ointment that is intended to draw out the most tears, and make the rest of the body moist and inflamed, so that the eyes may become wetter and be flushed out, in order that you may cause the congealed tear to pass under. 13 [45] When it flows into the eyes little by little and produces a scratching sensation, anoint him with something emollient that will dry at the same time and draw out a small amount of tears, and apply a medicament to the nostrils either every day or every third day, proceeding with the same intention. Let the medicament be of such a kind that it will draw off no more than a saucer's worth through the nostrils, drawing off little by little, and will dry out what is at the eyes, so that whatever the eye medicament dries up and blocks off is redirected through the nostrils. The cleansing medicaments for the head — those that are strong among them draw from the head as a whole; those that are weak draw from the eyes and from the region immediately around the nose. But if the flow toward the eyes arises from the flesh and bone — mucus having settled between the bone and the flesh — it is recognizable from this, that the flow comes from there: the skin on the head, when pressed, yields; ulcers break out on the head; and the eyes water; and the eyelids are not ulcerated, nor does it sting, nor does it cause dimness of sight, but vision becomes sharp. For the discharge is not briny, since it is not from the brain, but is rather mucous in character. This is how one should treat him: purge the head with a medicament that is not strong, and thin the body by drawing downward both with foods and with medicaments, so that through the thinning of the body it may dry up, or be redirected by the medicament applied to the nostrils. No medicament need be applied to the eyes. But if he does not recover even so, incise the head down to the bone — do not make the incisions raised or oblique; cut only as far as you touch the bone; cut frequently, so that what has accumulated may come out faster, flowing off through the wounds; and at the same time the frequent incisions will create adhesion of the flesh to the bone. This is how one should treat him. This is the outcome for such a person if one does not prepare the way: the accumulated matter is not flushed out so as to make the vision sharp upon flushing; with what settles upon it he becomes increasingly scintillating, and the sharp vision of the person is extinguished. If something blood-like and fluid enters into the clear fluid of the visual field, in such a person the image appears within the eye not as a round shape, for this reason: where the blood-like matter is present, that part does not appear, and thus the apparent circular form is deficient there, and it seems to him to move before his eyes, and he sees nothing truly. In this case one must cauterize the veins that press upon the visual fields, the ones that throb constantly and are situated between the ear and the temple. And once you have blocked these, apply to the eyes such medicaments as will moisturize, and draw out as many tears as possible, so that what has accumulated in the eyes — that which is causing the disease — may be flushed away. If the eye ruptures, use soft and astringent medicaments, so that the wound, being drawn together, may contract to smallness, and the scar may be thin. 13 (50) [5] When there is an argemon, it helps the eye to weep. Whenever the flow goes into the chest cavity and there is bile, this is how it is recognizable: pain takes hold in the flank and in the collarbone running toward the flank, and fever, and the upper part of the tongue becomes yellowish-green, and the patient expectorates congealed matter. In this disease the crisis occurs on the seventh or ninth day. 14 [45] Whenever both sides of the chest hurt and the rest is the same as in the other condition, this is all-around-lung disease (περιπλευμονίη), while the other is side disease (πλευρῖτις). These arise for the following reason: when a flow comes into the lung from the head through the bronchus and the air-vessels, the lung, being by nature spongy and dry, draws to itself as much fluid as it can; and when it has drawn it in, it becomes enlarged; and when the flow goes into the whole, the lobe, having become enlarged, touches both sides of the chest and produces all-around-lung disease; when it goes into one side only, it produces side disease. All-around-lung disease is far more dangerous, and the pains into the flanks and collarbones are far more severe, and the tongue is far more pale, and the throat hurts from the flow, and severe exhaustion takes hold, and on the sixth or seventh day labored breathing seizes him. If the fever does not release him by the seventh day, he dies, or suppurates, or both. If on the ninth day, two days having intervened, it seizes again, in most cases this person too either dies or escapes as one with suppuration. If on the twelfth day, he becomes suppurated. If on the fourteenth day, he recovers. And those who become suppurated from all-around-lung disease or side disease do not die, but recover. They mostly become suppurated when the flow comes to the same place as in bile cases; but in bile cases much flows off and when it has flowed off it ceases; in cases of suppuration less flows and it does not cease, and they become suppurated when they expectorate less than what flows into the lung. For this — what accumulates and flows into the lung — becomes pus; and the pus accumulating in the lung and in the chest cavity ulcerates and putrefies; and when it has ulcerated, from the ulcerated part there is further flow and expectoration; at the same time the head, when shaken, flows more, and from the ulcerated tissue in the chest cavity and lung the flow increases further, and the wounds being agitated break open repeatedly, so that even if the flow from the head were to cease, that from the wounds themselves would be sufficient to produce disease. Suppuration also arises from an ulcer, and this disease is easier. It also arises outside the lung — most commonly from rupture and when the flesh is bruised — for in that location pus accumulates, and accumulating, if someone shakes the body, it sloshes about and produces a sound, and such cases are cauterized. Phthisis (wasting) arises when the flow comes to the same site as in the suppurated case, through the bronchus and the aortra — the vessels that suspend the lung and bronchus together; but it flows into the lung frequently in small amounts, and does not produce much moisture in the lung. For the inflowing matter, drying out as it congeals in the bronchus so as not to be flushed out, but flowing in little by little and being held there, produces coughing; and being held in the aortra — since the aortra have narrow passages — it produces congestion for the pneuma, and this causes labored breathing; for since it is always left short it always desires to breathe in, and in the lung, since it is not strongly wet, an irritation arises. But when much flows off from the head, no irritation arises in the lung; for the inflow to it is great. And suppurations arise from these cases of phthisis when the body becomes more moist; and when the body becomes drier, those with suppuration waste away. 14 (50) [60] Those with suppuration are recognizable in this way: pain holds the flank at the outset; and when pus has accumulated, the pain continues similarly, coughing arises, pus is expectorated, and there is labored breathing. If it has not yet ruptured, it sloshes in the flank and sounds as if in a flask. If none of these signs are present but there is suppuration, one should judge by the following: he has much labored breathing, his voice is rather hoarse, and the feet and knees swell — more on the side of the flank in which the pus is; and the chest is bent together, and there is looseness of the limbs, and a sweat pours over the whole body, and at times he seems warm to himself, at times cold; and the nails are stretched taut, and the belly becomes warm. By these signs one should recognize those with suppuration. When the flow goes backward into the spine, a phthisis (wasting) of the following kind arises: he has pain in the loins, and the front of the head seems empty to him. 16 [15] In bile cases the following are dangerous: if jaundice comes on; when livid patches appear in the eyes and in the nails; when the body has ulcers and the area around the ulcers is livid; when the sweat does not break out over the whole body but only over one part of the body; when while the fever is still present something yellowish-green is expectorated; or when, with the yellowish-green matter still inside in the lung, expectoration ceases. One must recognize when it is present and when it is not: when it is present, it makes a rattling sound in the throat while the patient breathes; and labored breathing is dangerous, and hiccup, and the fever still being present when expectorated matter is still inside the lung, and the belly moving when the patient is already weakened. These are dangerous signs in side disease and all-around-lung disease. Side disease should be treated as follows: do not arrest the fever for seven days; let the patient use as drink either oxymel-and-water or vinegar and water; these should be given as abundantly as possible, so that moistening occurs and, occurring, produces expectoration. Arrest the pain with warming medicaments; give things to sip down that will produce expectoration; use baths on the third and fourth days; on the fifth and sixth day anoint with oil; on the seventh day give a bath — if the fever is not about to let go — so that sweat may arise through the bath. And still on the fifth and sixth day use the strongest expectorant medicaments, so that the seventh day passes as easily as possible. If it does not cease even on the seventh day, it will cease on the ninth, unless something else dangerous develops. When the fever lets go, prepare and give the weakest possible gruels. If a flux arises in the bowels, and the body is still warm, reduce the drinks; but if the fever has let go, use wheaten gruels. 17 [5] Treat all-around-lung disease in the same way. For those with suppuration, purge the head with medicaments that are not strong, but redirect little by little toward the nostrils, and at the same time use foods that promote evacuation through the bowels. And when the initial phase of the disease is no longer present but the flow is being redirected, produce expectoration and coughing, and use poured-in medicaments together with foods. And whenever expectoration must be produced, use more foods and salty and fatty ones, and dry wine, and produce coughing when the patient is in this condition. 19 [5] For those with phthisis (wasting) treat the other things in the same way, except that foods should not be given in large amounts at once, and the side dishes should be no greater in quantity than the foods, and use diluted wine with the food so that it does not overheat, and that it may provide warmth to the weakened body, and both together may warm at the same time and produce heat. When a large flow goes through the esophagus into the belly, flux arises below, and sometimes above too. For this patient, if pain is present in the stomach, first lead it off with a medicament or with a juice, then use a binding medicament, and binding foods so long as the pain holds; when the pain ceases, use binding foods as well. And treat in the same way when flux has persisted for many days. If he is weak and cannot take anything on account of weakness, first cleanse with ptisane juice, then when you have purged with this, use one of the astringents. 21 [5] Whenever the flow going backward along the vertebrae into the flesh produces dropsy, treat it as follows: cauterize the flesh in the neck between the veins, making three eschars, and when you have cauterized, bring them together and make the scars as narrow as possible. And once you have blocked it off, apply a medicament to the nostrils so that it may be redirected, and do this again and again with a weak medicament until it is turned away. Warm the front of the head and cool the back. And when the front of the head has been warmed through by you, give the most phlegm-producing and least evacuating foods, so that the channels at the front of the head may be dilated as much as possible. Then once you have blocked and redirected the inflow, if anything reaches the body before you have prepared the flow, treat it thus: if it has settled more toward the skin, apply fomentations externally; if it is inside toward the belly and is not visible externally, give a medicament by mouth; if it is in both directions, draw off from both. One should aim to find the nearest exit, whether below or above or wherever exits exist in the body. When sciatica arises from a flow, apply a cupping vessel, draw outward without pressing it in hard, and warm through from within by giving warming medicaments to drink, so that there may be an exit both outward toward the skin under the suction of the cup and inward toward the belly under the heat. For when it is blocked and has no path to travel, traveling it flows into the joints, into what yields, and produces sciatica. 23 [5] The backward phthisis (wasting): for this patient one must purge the head with a weak medicament until the flow is turned away, and use the diaita (regimen) as before; give elaterium to drink as a medicament, and purge below with milk as an enema, and treat the other things with fomentations. When the spleen becomes enlarged on account of fever — and this happens when the body becomes wasted, for the same conditions that make the spleen flourish cause the body to waste — and when the body is thin and the spleen flourishes and the omentum becomes wasted along with the body, the adipose tissue (πιμελή) in the omentum melts away. When these parts become empty of adipose tissue and there is a flow off from the flourishing spleen into the omentum, since the omentum is very close by and has spaces that are also empty, it receives it. And when the disease has once established itself in the body, it turns toward what is diseased — unless someone prepares the way — such that even what is being treated is dangerous. 24 [15] Treat this patient as follows: give medicaments to drink by which water is purged, and give the most phlegm-producing foods. If he does not improve even so, cauterize as thinly and as superficially as possible so that you may be able to hold back the water — in a circle around the navel, but not into the navel — and release it daily. In those diseases that are most dangerous, one must take the risk: if you succeed you will restore him to health; if you fail, he has suffered what was going to happen anyway. For a child with dropsy one should treat as follows: open the swollen parts full of water with a small knife, opening them frequently and in small amounts, opening in each region of the body in turn, and use fomentations, and always anoint what has been opened with a warming medicament. 26 [10] Dry side disease without a flow arises when the lung has been dried out too much by unavoidable thirst. For the lung, being by nature dry, when it is further dried beyond its nature, becomes thin, and having lost its firmness, lying against the side from lack of control, touches the rib. And when it touches something that is moist, it fastens on and produces side disease. At that point pain arises in the side and the collarbone, and fever, and white matter is expectorated. Treat this patient with abundant drinks, and baths, and give a medicament for the pain and the other things that produce expectoration. This patient recovers in seven days, and the disease is without danger, and food should not be given. Fevers arise for the following reason: when the flesh swells up because the body has become excessively inflamed, and the phlegm and the bile, shut in, remain still, and nothing is cooled — nothing going out, nothing moving, nothing else coming in beneath. 27 [15] When exhaustion holds together with fever and fullness, one should bathe abundantly and anoint with oil and warm as much as possible, so that the thermolē (accumulated heat), the body being opened, may go out through sweat. Do this consecutively for three or four days. If it does not cease, give a bile-purging medicament to drink, and do not cool the fever until the fourth day, nor give a medicament to drink while the body is still flourishing; for they do not flux except a little while the body is still inflamed. But when it is thin, give to drink and it will flux. Do not give food to one with fever, nor lead off with gruels; as drink give warm water and mead and vinegar with water, and give these to drink as abundantly as possible. For if nothing cold enters, the drink being warm and remaining draws off from the diseased body, whether through urination or through sweating; and as the body is opened in every direction and breathes and moves, it will be beneficial. But when it burns a body that is thin, it is clear that the fever does not persist because of inflammation. If it does not cease, nourish and cause inflammation; and if it does not benefit even so, it is clear that the fever was not supposed to be produced. For such a patient, give a medicament to drink so as to lead it off wherever the fever is more pronounced, whether below or above — if above, above; if below, below. It is no less necessary to give medicaments to drink to the weak than to the strong, but equally, or only in this way: to the strong, strong medicament; to the weak, weak. For the burnings, use drinks and gruels so as to dissolve the fever with a cooling medicament — lobster or something else of that kind. And when you have not dissolved it with the cooling medicament, use warming ones in succession; and when it does not cease, use cooling ones again. Jaundice must be treated as follows: when you take the patient, nourish, and with baths and fattening things and drinks and foods keep him moist for three or four days. When the body has been moistened, purge and dry the body — draw off the fat suddenly, applying a medicament in all directions wherever it is possible to draw out moisture; apply a weak purging medicament to the head; give diuretics to drink. And before food during the time when you are purging the disturbed moisture, give something to swallow, so that the body may not be nourished from that time on. When he becomes thin, purge also with baths; crush the root of the wild cucumber, throw it into water, and bathe from this. Do not give bile-purging medicaments to drink, lest this disturb the body further. When what is disturbed has become dry, nourish with nothing that promotes evacuation through the bowels or that is diuretic, but with vinous wine and things that make the person more ruddy. If he is yellowish-green, draw off again; but do not dry at all, lest he become fixed while still yellowish-green. 29 [5] A creature comes upon a wound on the body for this reason: when the flesh around it is inflamed and the lips of the wound are large, and the wound is moist, and dried ichor lies on the wound, or the wound is congealed or has putrefied together, the ichor flowing off from the wound is prevented from going outward by the matter that has congealed on the wound against the flesh; and the flesh receives it, since it is itself lifted up by inflammation, and when the ichor flowing beneath reaches it, it putrefies and lifts it further. Treat this by anointing the wound itself with moistening medicaments, so that as it is moistened the flow from the wound runs outward and not under the flesh; and the areas flowing down from the wound should be treated with cooling medicaments, so that being chilled the flesh is compressed together and does not, bursting apart, flow back in turn. And the other wounds too should be anointed all around with cooling medicaments, and the moistening ones applied upon them. Cynanche (throat-throttling) arises from blood when the blood in the veins in the neck congeals. From the veins in the limbs one must draw blood, and at the same time lead off downward, so that this — which is causing the disease — may be drawn downward. And the tongue, whenever it develops large ulcers, must be prepared in the same way. 31 [5] Diseases must be treated from the beginning: those that arise from flows, first stop the flows; those from other causes, stop the origin of the disease and prepare the way; then the accumulated matter — if it is great, lead it off; if it is little, settle it by means of diaita (regimen). Fractures of the head: if the bone is fractured and crushed, it is without danger, and one should treat with moistening medicaments. But if it is cracked and a fissure arises, it is dangerous. In this case saw it, so that the ichor flowing along the crack of the bone may not putrefy the meninx; for entering through a narrow passage but not exiting, it distresses the man and makes him delirious. One must saw it so that there may be an exit for the ichor — not an entrance only — by sawing broadly, and use medicaments that draw the fluid toward themselves, and bathe. **33 [20]** When someone has a fever, do not purge the head, lest madness result; for the drugs that purge the head are heating, and the heat coming from the drug added to the heat from the fever produces madness. Deadly wounds: in whatever person in bad condition vomits up black bile, the one who has the wound dies. And whoever, seized by diarrhea and being weak and thin, suddenly sits up dry, dies. When, in someone seized by intense heat, small pustules break out around him while he is weak and livid, he dies. When, in someone seized by some disease who is already weak, livid eruptions break out, it is deadly. When someone who has drunk a drug is seized by violent purging and it passes out both below and above, give wine to drink down — at first mixed, then unmixed, frequently — and it stops. But a drug neither for diarrhea nor as an emetic: bile, when it breaks out spontaneously either below or above, is harder to stop; for when it arises spontaneously, it forces its way through the body by its own violence; but when it flows by reason of a drug, it is not forced by any native violence. When you take charge of someone who has both diarrhea and vomiting, do not stop the vomiting; for vomiting stops the diarrhea; and the vomiting would more easily stop afterward. But if the one suffering these things is weak, prepare a sleep-inducing drug and give it as an emetic. Blood, when it produces disease, causes pain; phlegm causes heaviness, for the most part. For diseases of which one has no understanding, give a drug that is not strong; if the patient becomes easier, a way has been shown and one must prepare, having reduced him; but if he is not easier, but his condition is worse, the opposite. **34 [10]** If it is not beneficial to reduce, it will be beneficial to inflame and to change frequently, using this principle. With diseases, if one takes charge when the one who is suffering is strong but the disease is weak, there one may boldly use a drug stronger than the disease, so that if even anything of the healthy should be drawn away along with the ailing, there is no harm. But when one finds the disease stronger and the sick person weak, prepare with weak drugs — those that will master the disease itself and remove it, but will make the one who is suffering no weaker. Athletics and medicine are by nature opposed: for athletics does not need to make changes, but medicine does; for it does not help the healthy person to change from his present state, but it does help the one who is suffering. **36** Of diseases that are wounds standing above the rest of the body, one must treat with both drugs and starvation. For a flux flowing from the head, vomiting is beneficial. **38 [10]** Old diseases are harder to cure than recent ones; but one must first make old diseases new. A wound that has hardened over — cast out the hard part with a putrefying drug, then bring it together. Of drugs, those that most cause inflammation — these bring together what is clean; those that reduce — these clean. But if one brings together what is not yet ripe, the diseased body nourishes whatever has a wound. And if it is necessary to bring together the wound and fill it, inflammation helps, and also if you want flesh in the head; for the flesh, raised up by foods, pushes out what is being putrefied by the drug and works together with it. But if it is too elevated, reduce with foods. Those who are distressed and sick and wish to hang themselves: give mandrake root to drink in the morning, in a dose less than what would produce madness. **39 [10]** Spasm must be treated thus: kindle fire on either side of the bed, give mandrake root to drink in a dose less than what would cause madness, and apply warm sacks to the tendons at the back. If fever takes hold following a spasm, it ceases on the same day, or the next, or the third day. Following a rupture, fever does not seize for more than three or four days; but if it does seize, thinking that it comes from a rupture, it would come from something else, and one must not prepare as though it were from a rupture. Whenever a person is rigid in the feet and hands, he produces madness in himself. One must cauterize a vein in the appropriate place, according to whatever disease the person has. If the person has been cauterized and some blood is flowing, such that this is not dangerous to him, both of these things are possible to do: if you do not cauterize through completely, in the very place of the pain for which he was being cauterized, it does not grow together, but you have helped with respect to the flux; for if it is cauterized through, it does not flow. For when it is cauterized through, each end of the vein that was cauterized through retracts and dries up together; but if something remains, by reason of what remains, as the blood flows through, it is moistened. If blood flows from a vein, cauterize it crosswise; if it does not stop with these measures, cut across it above and below on either side, so that the flowing blood is diverted; for blood held apart by a drug is easier to stop than when it flows all together. **40 [5]** For pain in the head, draw blood from the veins; if it does not stop but is of long duration, cauterize the veins, and he becomes healthy; but if you purge the head, you cause more suffering. Medicine cannot be learned quickly for this reason: it is impossible for there to be in it any settled clever device, as when one who has learned the one way of writing that they teach knows everything; and all who know it know it alike, for this reason: that the same thing done in the same way now and not now would not turn out opposite — but it is always uniformly the same, and needs no occasion. **41 [10]** But medicine does not do the same thing now and immediately after, and it does opposite things to the same person, and these opposites are contrary to one another. First, in the matter of bowel-evacuation: purgatives do not always produce evacuation, and both purgatives produce the same effect; and perhaps purgatives are not so opposite to styptics as they appear. When the belly is stopped up, through excessive stoppage the body becomes inflamed, and when phlegm arrives in the belly, in this way the stoppage has produced movement; for when phlegm enters the belly, diarrhea arises; and in this case, purgatives by nature produce stoppage in the belly. If you administer purgatives, and the cause of the disease is dissolved and moistened, when it is flushed out, the person becomes healthy. And so styptics do the same thing to the belly as purgatives, and purgatives do the same as styptics. In the same manner also with those who are ruddy and those who are sallow; and phlegm-producing things make people sallow and pallid, while reducing things make people of good color; the remedy for each is the opposite applied to the opposite. At once, whenever someone who is sallow becomes inflamed, he is relieved, if any reducing drug is applied; here the reducing thing has benefited the inflamed person. Of these things, what once benefited through the beneficial thing now benefits here when one is pallid and sallow from reduction; for if one applies something phlegm-producing, the sallowness ceases. Pain arises both from cold and from heat, and from too much and from too little; and in parts of the body that have been chilled, pain arises through the warming thing, and in parts that have been heated, through the cooling thing; and in those cold by nature, through heat, and in those warm by nature, through cold; and in those dry by nature when they are moistened, and in those moist by nature when they are dried. For the pains arise in each case when the nature is altered and destroyed; and the pains are cured by the opposites. This is specific to each disease: for those warm by nature who are sick because of cold, warming and the rest accordingly. **42 [5]** There is another mode: disease arises through similar things, and from similar things being applied, sick people are cured. For example, the same thing produces strangury when it is not present, and when it is present the same thing stops it. And cough, in the same way as strangury, arises and ceases from the same things. There is another mode: fever that arises from inflammation is sometimes produced and stopped by the same things, and sometimes by the opposites of what produced it. For on the one hand, if one wishes to bathe with warm water and give much to drink, the patient becomes healthy through the inflammation — the existing fever is resolved by what causes inflammation when applied. And if one wishes to give a purging and emetic drug, in the same manner it stops through what produces it, and arises through what stops it. For if one wishes to give much water to drink to a person vomiting, what he is vomiting will be flushed out along with the vomiting; in this way the vomiting stops through the vomiting itself. And for the other manner, through stopping it, because it will make pass downward from that point what is within producing vomiting. By both opposing modes the patient becomes healthy. And if things were so for all cases, it would have been settled: thus some things are treatable by their opposites — what they are and what produced them — and some by similar things — what they are and what produced them. The cause of this is the weakness of the body; for the body is nourished equally by equal foods, and the foods are mastered by the body; but when more or less is applied, or if by changing differently it is overpowered, then this and the foods prevail; and whenever the body is overpowered by what is applied, those same things cause it to flourish and simultaneously master the body — and the opposite things do the same. **43 [5]** For instance, bathing in warm water: as long as the body masters the application, it flourishes; but when it is mastered, the bathing makes the body thin. And feasting works in the same way as bathing; for these things, as long as they are mastered, cause flourishing; but when they prevail, they produce purgings and other kinds of harm. And when what is applied is changed, the thing to which it is applied is necessarily also altered; for the body, being altered and sluggish and overcome by everything, produces reversals. This is also what purgatives and what cause flourishing and reducing do — these things do this to the body, and all the others suffer the opposites of these things. Medicine is a matter of short occasion; and whoever knows this has it settled for him, and knows the forms and the non-forms, which in medicine the right moment means to recognize: that purgatives become non-purgative, and that other things are opposite, and that the most contrary are not the most contrary. **44 [5]** The right moment is this: to apply foods of which the body when they are applied will master the amount — so that if one does this, it is entirely necessary that purgative food applied is purgative, and phlegm-producing food is phlegm-producing. If the body then masters the foods, neither disease nor opposition arises from what is applied, and this is the right moment that the physician must know. When the right moment is exceeded, the opposite arises, and those who before think they are in a state of super-ripening, and of being heated: for as long as the body masters the application it is nourished; but when this right moment is exceeded, the opposite arises — it is reduced. And all the other things that cause inflammation: as long as the body masters them, they still do each thing in accordance with the occasion and with nature — the phlegm-producing ones cause inflammation; but when the right moment is exceeded, the opposites arise. All drugs are things that shift what is present; all the stronger things shift more. One may, if one wishes, shift with a drug; if one does not wish, with food. Shifting the sick person from his present state always helps; for if you do not shift what is diseased, it increases. **45 [25]** One must not give drugs that are strong by nature for weak diseases, making them weak by the smallness of the dose; but use drugs strong by nature for strong diseases, and for weak diseases use drugs that are not strong — not altering the drug, but according to the nature of each: weak drugs by nature for weak diseases, and strong drugs by nature for strong diseases. Diseases should be expelled by the path nearest to their location, and expelled by whatever exit is closest to each. Purgatives are of this sort: all that are slippery and cutting, and all that become refined in heat — for the belly is hot — and the rest that are salty and all those that have the most of such qualities. Those that are not aperient but styptic are those that produce wind; for moist things when dried produce wind, and astringents, and those that are congealed by heat, and things that are crumbly, and dry things. All things that when applied internally produce inflammation are those that when applied externally reduce; and these are also strengthening and phlegm-producing. And purgatives when reducing warm such things; moreover also acids and phlegm-producing things. All things cooling those in the belly: such things are purgative; also cold things and moist things; but when they are not purgative, they warm. And warm things applied to the belly, when they quickly produce passage, cool; when they do not produce passage, they are warm in the belly. Of these, those that produce repletion are most phlegm-producing; those that when applied in the greatest quantity do not produce repletion are aperient. Medicine, it now seems to me, has been discovered whole — medicine of this kind, which teaches each thing both the habits and the right moments. **46 [20]** For whoever thus understands medicine waits least upon fortune, but both without fortune and with fortune might do well. For the whole of medicine stands firm, and the most beautiful of its devices appear to be composed requiring least fortune; for fortune is self-ruling and is not governed, nor is it within our prayer to reach it; but knowledge is governed and is fortunate whenever the one who knows wishes to use it. Then what need does medicine have of fortune? For if there are clear remedies for diseases, I think the remedies do not wait upon fortune to heal the diseases — if the remedies exist. But if it helps to give them along with fortune, no more do the remedies than non-remedies along with fortune heal when applied to diseases. Whoever drives fortune out of medicine or anything else, claiming that those who know how to do a thing well do not use fortune, seems to me to understand the opposite. For in my view only those who know how to do something well and badly both succeed and fail; for to succeed is to do well, and this the knowers do; and to fail is this: whatever one does not know, this one does not do well; and being ignorant, how could one succeed? For even if one did succeed at something, one would not make the success worthy of account; for one who does not act well would not succeed in the rest of the likely things he ought to do. The so-called women's diseases: the womb is the cause of all diseases; for wherever it is shifted from its natural place, it produces diseases, whether it comes forward or moves to the side. **47 [45]** And when the womb is displaced but not thrusting its mouth and not touching the edges, the disease is very slight. But when it moves forward and thrusts its mouth into the edge, first by touching it causes pain, then the womb, blocked up and sealed by the thrust into the edge, the flow called the menses does not occur; and this accumulating produces swelling and pain. And if it descends downward and turned away thrusts into the groin, it will cause pain; and if retreating upward it is turned away and blocked up, in this way also through the looseness it causes disease; and whenever it is sick through this, it causes pain in the hips and the head. When the womb becomes swollen and swells up, nothing flows and it becomes full; and when it becomes full, it touches the hips; and when the womb, filled with moisture and dilated, cannot be contained, and touches the hips, it causes pain both in the hips and in the groin, and as if balls were rolling under the belly, and the head suffers, sometimes on one side, sometimes whole, as the disease also presents. Thus these things must be treated as follows: if it has only come forward and is manageable, use whatever you wish of the foul-smelling ones — cedar, mussot, or any other of the heavier and foul-smelling ones — and fumigate, but do not apply steam-heat; and do not use food or drink that promotes urination during this time, nor bathe with warm water. But if it has retreated and is not turned away, use sweet-smelling suppositories of those that warm at the same time; and these are of this sort: myrrh, or perfumed oil, or another single sweet-smelling and warming thing; use such suppositories; and apply steam-heat with wine from below, and bathe with warm water, and use diuretics. It is clear that if the womb has retreated and is not turned away, a flux arises; but if it is turned away, the flow called the menses does not occur. This disease must first be treated with steam-heat of this kind: put a fig into wine; heat this; place a gourd around the mouth of the vessel in which it is being heated, doing thus: cut the gourd in the middle, empty it, cut a small piece off the tip, so as to fit this over vessels like a stopper, in order that the scent, sent through the narrow part, may reach the womb. Bathe with warm water, and use warming suppositories. Warming are those of the kind mentioned before, and such things as these: ox-dung, ox-bile, myrrh, alum, galbanum, and other such things — as many of these as possible. And draw downward with evacuating drugs — those that do not cause vomiting — for weak patients, so that excessive diarrhea may not arise from over-purging. The suppositories must be made thus, if you wish to make them strong: make honey half-boiled, put in the written suppository ingredients that cause the flow, and when you put them in, make them like the pessaries applied to the rectum — make these long and thin. Lay the woman on her back, raise up the foot-end of the bed, then apply, and warm either in a chamber-pot or in something else until it melts. If you wish to apply the suppository more weakly, wrap it in linen. And if the womb, full of moisture, becomes swollen at the mouth and produces absence of flow, one must treat by producing a flow, using suppository drugs and steam-heat as written, doing it as in the previous absence of flow. And if moving forward it is turned away, one must produce a flow as in the earlier absence of flow. **47 (50) [60]** When the flow is too great, one must not warm with warm water or with anything else, nor use diuretics nor aperient foods; let the foot-end of the bed be higher, so that the reclining position does not favor flow; and use suppositories that are astringent at the same time. The flows, when the purification comes directly, are straightaway blood-tinged; when it comes less strongly, they are purulent. And in younger women the menses are more blood-tinged, while older women have the so-called menses more mucoid.