On the Sacred Disease — First Draft Translation

ON THE SACRED DISEASE. Concerning the disease called sacred, the matter stands thus: it seems to me no more divine or sacred than any other disease, but has a nature and a cause from which it arises, just as the rest do. 1 Men came to believe that its nature and cause were something divine, out of inexperience and astonishment, because it resembles no other disease. And their inability to understand it preserves its divine character for them, while the easy availability of the mode of treatment by which they treat it destroys that character — since they treat it with purifications and incantations. But if it is to be considered divine on account of its wondrous nature, there will be many sacred diseases, not just one, as I will show: there are others no less wondrous and strange, which no one considers sacred. For daily fevers and tertian fevers and quartan fevers seem to me no less sacred and sent by god than this disease — yet no one marvels at them. And I see people going mad and raving from no evident cause, and doing many untimely things; and I know of many who groan and cry out in sleep, others who are choked, others who spring up and flee outside and are out of their minds until they wake — and then are healthy and clear-headed as before, though pale and weak; and this not once but many times. There are many other things of every kind, for each of which to speak would take much discussion. Those who first made this disease sacred seem to me to have been the same kind of people as exist now — magicians, purifiers, begging priests, and charlatans — those who make a great show of being devout and knowing something more. These people, using the divine as cover and screen for their inability to find anything that would help when they applied it, so as not to be exposed as knowing nothing, declared this affliction to be sacred, and added suitable words and set up a treatment that kept them safe: applying purifications and incantations, ordering abstinence from baths and from many foods inappropriate for sick people to eat — from sea fish: the red mullet, the black-tail, the grey mullet, the eel (for these are the most harmful fish); of meats: goat, deer, pig, and dog (for these are the most disturbing to the belly of all meats); of birds: cock, dove, and bustard, and whatever is considered to have the greatest strength; of vegetables: mint, garlic, and onion (for what is sharp is no good for a sick person); and they forbid wearing a black garment (for black is deadly), and lying on or wearing a goatskin, and placing foot upon foot, or hand upon hand (for all these are obstacles). All these things they add on account of the divine, as though they knew something more, and they allege other causes, so that if the patient recovers, the credit and the skill are theirs; and if he dies, they can keep themselves safely protected by their defences and have a pretext that they are not responsible, but the gods — for they gave no drug to eat or drink, they had not burned him with baths, so as to seem responsible. As for me, I think that none of the Libyans who live in the interior are healthy, since they sleep on goatskins and eat goat meat, having neither blanket nor cloak nor sandal that is not of goat — for they have no other flocks but goats and cattle. 1 (continued) But if it is these things, when applied and eaten, that produce and increase the disease, and when not eaten that cure it, then god is not the cause of anything, nor do purifications help; rather, it is the foods that heal and harm, and the power of the divine vanishes. So those who attempt to treat these diseases in this way seem to me to hold them neither sacred nor divine. For when they are removed by such purifications and by such treatment, what prevents them from being brought on and visited upon people by other contrivances similar to these? — so that the divine is no longer the cause, but something human. Whoever is able by purifying and working magic to drive away such an affliction, could also bring on others by his art; and in this reasoning, the divine is destroyed. By saying and contriving such things, they pretend to know something more, and they deceive people, attaching to these things purities and cleansings; and the greater part of their discourse moves toward the divine and the daimonic. And yet to me they seem to make their arguments not about piety, as they suppose, but rather about impiety, and as if the gods did not exist — and what is pious and divine in them is impious and unholy, as I will show. For if they undertake to know how to draw down the moon, make the sun vanish, bring storm and fair weather, rain and drought, make sea and earth barren, and all other such things — whether they claim these things can be done through rites of initiation or through some other skill or practice — those who pursue this seem to me to be impious, and to hold that the gods neither exist nor, if they do exist, have any power, and that they would not be restrained from the most extreme acts; and in doing these things, how are they not terrible in the gods' sight? For if a man by magic and sacrifice can draw down the moon, make the sun vanish, and bring storm and fair weather, I would not think any of these things divine, but human — if indeed the power of the divine is mastered and enslaved by the intelligence of a man. But perhaps things are not so; rather, people in need of a livelihood contrive and embroider many different things, in all other matters and in this disease as well, assigning the cause to a different god for each form of the affliction. Not once, but many times, they invoke these. For if the patient imitates a goat, or bellows, or has convulsions on the right side, they say the Mother of the Gods is the cause. If he utters a sharper and stronger cry, they liken it to a horse and say Poseidon is the cause. If some excrement is passed — which often happens to those forced by the disease — the title of Enodia is attached. If it is thinner and more rapid, like a bird, Apollo Nomios. If he throws foam from the mouth and kicks with his feet, Ares has the cause. As for the terrors that come upon people at night, and the fears and derangements and leapings from the bed and frights and flights out of doors — these they say are the assaults of Hecate and the onslaughts of heroes. They make use of purifications and incantations, and act in the most unholy and most godless way, as it seems to me: they purify those seized by the disease with blood and other such things, as though they had some defilement, or were tormented spirits, or had been bewitched by other people, or had done some unholy deed — when they ought to be doing the opposite: sacrificing and praying, and bringing the sick to the sanctuaries as suppliants to the gods. As it is, they do none of these things, but purify instead. 1 (continued) Some of the materials from the purifications they bury in the earth, others they throw into the sea, others they carry away into the mountains where no one will touch or tread on them. These things ought rather to be carried to the sanctuaries and given back to the god, if indeed the god is truly the cause. I do not myself think it right that the body of a person be defiled by a god — the most mortal thing by the most holy. But even if it happens to have been defiled by something else, or to have suffered some affliction, it would tend to be cleansed and purified by the god rather than to be defiled by him. Indeed the divine is what cleanses and purifies our greatest and most unholy offences and becomes an ablution for us; and we ourselves set boundaries for the gods at their sanctuaries and sacred precincts, so that no one may enter unless he is pure; and when we enter, we sprinkle ourselves, not as being defiled, but to wash off whatever pollution we may already have. So that is how it seems to me regarding purifications. This disease seems to me no more divine than any other, but has the same nature as other diseases and a cause from which each arises. Its nature and cause are divine from the same source as all other things; it is treatable, and no less so than others — unless it has already been overwhelmed by time and has thus become stronger than the remedies applied. 2 It begins, like other diseases, according to hereditary tendency. For if a phlegmatic child comes from a phlegmatic parent, and a bilious from a bilious parent, and one prone to phthisis from one prone to phthisis, and a splenetic from a splenetic — what prevents someone whose mother and father had this disease from also being taken by it? For the seed comes from all parts of the body — healthy seed from the healthy parts, diseased from the diseased. And here is another great proof that it is no more divine than other diseases: it occurs in those who are phlegmatic by nature, but does not fall upon those who are bilious. Yet if it were more divine than the others, this disease ought to arise in all alike, and not distinguish between the bilious and the phlegmatic. The brain is responsible for this affliction, just as it is for the greatest of the other diseases; and in what manner and from what cause it arises, I will explain clearly. 3 The brain of a human being is double — as it is also in all other animals; a thin membrane divides it down the middle. For this reason the head does not always ache in the same spot, but in each half alternately, or sometimes throughout. Veins also stretch into the brain from the whole body — many fine ones — and two thick ones, one from the liver and one from the spleen. The one from the liver is as follows: one part of the vein extends downward through the parts on the right, past the kidney and the loin, into the inside of the thigh, and reaches down to the foot, and is called the hollow vein; the other part extends upward through the right side of the diaphragm and the lung, and it has a branch both to the heart and to the right arm; the remainder travels upward through the collarbone to the right side of the neck, close to the skin, so as to be visible; beside the ear it becomes concealed, and there it divides — the thickest, largest, and most hollow portion ends in the brain; a small fine vein runs to the right ear; another to the right eye; another to the right nostril. That is how the veins from the liver run. A vein is also stretched from the spleen to the left — both downward and upward — just as from the liver, but thinner and weaker. Through these veins we draw in the greater part of the pneuma; for these are the breathing-channels of our body, drawing air into themselves, and conveying it through the small veins to the rest of the body; they cool it and release it again. 4 For the pneuma cannot stand still, but moves up and down; if it stops somewhere and is cut off, that part where it stops becomes without power. As proof: when a person is sitting or lying and the small veins are compressed, so that the pneuma cannot pass through the vein, numbness immediately takes hold. So it stands regarding the veins and the rest. This disease arises in those of phlegmatic nature, but not in those of bilious nature. 5 It begins to take hold while the embryo is still in the womb; for the brain, like the other parts, is purified and blossoms before birth. If in this purification the cleaning is good and moderate — if neither more nor less than the right amount flows away — then the head will be most healthy. But if more flows from the whole brain and there is much melting away, the head will be diseased as the child grows and full of ringing, and the child will bear neither sun nor cold. But if the overflow comes from one part — from an eye or an ear, or some vein becomes dried up — that part is damaged, according to the degree of the melting away. If no purification follows, but what should have been purged is rolled up within the brain, then the person must be phlegmatic by nature. And those children in whom sores break out on the head and the ears and the rest of the skin, and who become drooling and mucus-running — these pass most easily through life as they grow older; for there the phlegm that should have been purged in the womb is discharged and cleansed away. Those so purged generally do not fall prey to this disease. But those who are clean — in whom no sore, no mucus, no saliva comes out, and in whom no purification has taken place in the womb — for these there is danger of being seized by this disease. If the downflow takes its course toward the heart, palpitation and shortness of breath take hold, and the chest is damaged, and some become hunchbacked; for when the cold phlegm descends upon the lung or the heart, the blood is chilled. The veins, being forcibly chilled, near the lung and heart, throb; and the heart palpitates, so that of necessity the shortness of breath falls upon them and the orthopnoea. 6 For the pneuma cannot enter as much as it wants, until the phlegm that has flowed in is overcome and, having been warmed through, is dispersed into the veins; then the palpitation and shortness of breath cease. How quickly it ceases depends on the amount: if more flows down, more slowly; if less, faster. And if the downflows are more frequent, the seizures come more frequently; if not, more rarely. These are the things that happen when the flow goes toward the lung and the heart. But if it goes into the belly, diarrheas take hold. If these passages are blocked, and the downflow moves into the veins I mentioned before, the person becomes voiceless and is choked, foam flows from the mouth, the teeth are clenched, the hands are convulsed, the eyes are twisted, the person is without understanding; and in some the excrement is passed downward. This happens sometimes on the left side, sometimes on the right, sometimes on both. 7 How each of these things happens, I will explain. The person is voiceless when the phlegm comes down suddenly into the veins and cuts off the air, and does not allow it to pass into the brain, or into the hollow veins, or into the cavities, but blocks off the breathing. For when a person takes the pneuma through the mouth and the nostrils, it goes first to the brain, then the greatest part to the belly, and some to the lung, and some to the veins. From there it is distributed to the other parts through the veins. And however much goes into the belly, that cools the belly and does nothing else of consequence. But the air going to the lung and the veins contributes by entering the cavities and the brain, and so provides understanding and movement to the limbs — so that when the veins are shut off from the air by the phlegm and do not admit it, the person is rendered voiceless and without understanding. The hands become powerless and are convulsed, because the blood is stilled and not dispersed as it is accustomed to be. The eyes are twisted, because the small veins are shut off from the air and throb. Foam comes out from the mouth from the lung: for when the pneuma does not enter it, the lung froths and wells up as though dying. The excrement passes out by force under the pressure of suffocation; the suffocation comes when the liver and the belly press upward against the diaphragm and the gullet of the stomach is cut off. This happens when the pneuma does not enter the mouth in its usual amount. The person kicks with his feet when the air is shut in the limbs and cannot force its way out through the phlegm; rushing through the blood up and down, it produces convulsions and pain, and so the kicking follows. All these things happen when cold phlegm flows in alongside the blood, which is warm: it chills and stops the blood. If the flow is great and dense, it kills immediately — for it overcomes the blood with cold and coagulates it. If it is less, it first prevails by blocking the breathing; then in time, when it is scattered through the veins and mixed with the much warm blood, if it is overcome in this way, the veins receive the air and understanding returns. And as for those small children who are seized by this disease — the greater part die, if the flow comes on in great volume and from a southern wind; for the small veins cannot admit the phlegm because of its thickness and quantity, but the blood is chilled and coagulates, and so they die. 8 But if the flow is small and moves into both veins or into those on one side, they survive with signs left upon them — the mouth or eye or neck or hand is drawn aside, wherever the small vein, filled with phlegm, has been overcome and dried up. In that small vein that damaged part of the body will necessarily be weaker and more deficient. But over a longer time this generally proves beneficial; for the person is no longer subject to seizures once the sign has appeared — owing to the necessity that the remaining veins are damaged by this constraint and are partly dried up, so that they do admit the air but the downflow of phlegm no longer runs into them in the same way; yet the limbs will likely be weaker, since the veins have been damaged. Those in whom the flow that runs alongside is northerly and very small and moves to the right side survive without visible signs; but there is danger of it growing together and being augmented if they are not treated with suitable measures. Such, then, or something very close to it, is how things go with children. In older people the disease does not kill when it comes on, nor does it distort them; for the veins are hollow and full of warm blood, which the phlegm cannot overcome or chill the blood to the point of coagulation; instead, the phlegm is itself overcome and quickly mixed in with the blood. So the veins receive the air, understanding returns, and the signs I described are less severe because of the strength. 9 In the oldest, when this disease comes on, it kills or causes paralysis for this reason: the veins are empty, and the blood is scant and thin and watery. So if much flows down and it is winter, it kills — for it has suffocated the breathing passages and coagulated the blood, if the downflow occurs on both sides. If it occurs on one side only, it causes paralysis — for the blood, being thin and cold and scanty, cannot overcome the phlegm; instead, it is itself overcome and coagulated, so that those parts through which the blood has been destroyed become without power. The flow moves more to the right than to the left, because the veins there are more hollow and more numerous than on the left — for they stretch from the liver and from the spleen. 10 In children most of all, the phlegm flows down through melting — when the head has been thoroughly warmed, whether by the sun or by fire, and then the brain shudders suddenly; for at that point the phlegm is separated out. It melts from the heat and liquefaction of the brain; it is separated out from the cooling and condensation, and so flows down. This is the occasion for some; but for others it happens when, after northerly winds, a south wind suddenly takes over: it loosens and relaxes the brain that had been condensed and was strong, doing so all at once, so that the phlegm floods, and in this way the downflow occurs. The flowing-down also occurs from no apparent cause, when fear arises — if a child is frightened by someone crying out, or also when in the midst of crying it cannot quickly catch the pneuma again, as happens with children often. Whenever any of these things happened to the child, the body shuddered at once, it became voiceless and did not draw in the pneuma, but the pneuma stilled, and the brain condensed, and the blood stopped, and in this way the phlegm was separated out and flowed down. These are the occasions of the seizure for children at the outset. For older persons, winter is most hostile: whenever the head and brain are thoroughly warmed beside a great fire, and then one comes into the cold and shivers, or even goes from cold into warmth and sits beside a fire, the same thing happens, and in this way one becomes seized according to what has been said before. There is also great danger of suffering the same thing in spring, if the head is exposed to the sun; in summer, least of all, for abrupt changes do not occur then. Whenever twenty years have passed, this disease no longer takes hold, unless it has been a companion since childhood — then it takes hold in few people or in none at all; for the vessels are full of blood, and the brain has condensed and is firm, so that the phlegm does not flow down onto the vessels; and if it does flow down, it does not prevail over the blood, since the blood is plentiful and warm. But in the person in whom it has grown up together and been nourished together since childhood, it has become habitual for him to suffer this at the changes of the winds and to become seized for the most part, especially in southerly winds; and release becomes difficult. For the brain has become more moist than is its nature and floods with phlegm, so that the downflows come more frequently and the phlegm can no longer be separated out nor the brain dried out, but remains soaked through and wet. 11 One might know this most clearly from sheep that are seized by this disease, and especially from goats — for these are seized most frequently. If you cut open the head, you will find the brain moist, abounding in fluid, and foul-smelling; and in this you will plainly recognize that it is not a god that is ravaging the body, but the disease. It is the same way with a human being: when the disease has run its time, it is no longer curable; for the brain is eaten through by the phlegm and melts, and what melts becomes water, and this surrounds the brain on the outside and washes around it; and because of this they become seized more frequently and more easily. This is why the disease is long-lasting: because the fluid that flows in is thin on account of its abundance, and is immediately mastered by the blood and warmed through. Those already long habituated to the disease perceive beforehand when they are about to be seized, and flee from other people — toward home if home is near them, or if not, to the most deserted place, where fewest people are likely to see them fall — and immediately covers himself. This he does out of shame at the affliction, not out of fear, as most people suppose, of the divine. 12 Little children at first fall wherever they happen to be, out of unfamiliarity; but once they have been seized repeatedly, as soon as they sense it coming they flee to their mother or to whatever other person they know best, out of dread and fear of the affliction — for as children they do not yet know shame. I say that seizures occur during the changes of the winds for these reasons, and most in southerly winds, then in northerly, then in the remaining winds; these are those of the winds that are strongest and most opposed to one another in their position and in their force. 13 The north wind condenses the air and separates out from it what is turbid and cloudy, making it bright and clear; it does the same in the same way for everything else, beginning from the sea and the other waters — for it separates out from all of them the moisture and darkness, and from human beings themselves as well; that is why it is the most healthful of the winds. The south wind does the contrary: first it begins to melt and dissolve the air that has been condensed, for which reason it does not blow hard straightaway but first brings calm, since it cannot immediately prevail over the air, which was previously dense and condensed, but dissolves it in time. It does this same thing also to the earth, the sea, the rivers, the springs, the wells, and all things that grow and in which moisture is present — and moisture is present in everything, in one more and in another less. All these things feel the effect of this wind: from bright they become murky, from cold warm, from dry moist; and whatever vessels of wine or other liquid are stored in buildings or underground, all of these feel the south wind and change their form into another appearance; and the sun, the moon, and the stars it renders far dimmer than their nature. Since then, even though these are so great and powerful, it prevails over them to such a degree and causes the body to be affected and to change with the shifts of these winds, it is inevitable that in southerly winds the brain dissolves and becomes waterlogged and the vessels become more slack, while in northerly winds the healthiest part of the brain condenses, and the most disease-ridden and moist part is separated out and washes around on the outside — and in this way the downflows occur at the changes of these winds. So this disease arises and flourishes from what comes and what departs, and is in no way more intractable to treat or to know, and no more divine, than the other diseases. People must know that our pleasures, our joys, our laughter, and our amusements arise from nowhere else but the brain, as do our griefs, our pains, our despondencies, and our lamentations. 14 With this above all we think and understand and see and hear and distinguish the shameful and the beautiful, the bad and the good, the pleasant and the unpleasant — judging some of these by convention, perceiving others by what is advantageous, and by it also discerning pleasures and unpleasantnesses according to circumstances — and the same things do not please us at all times. With this same organ we also go mad and are beside ourselves, and terrors and fears come upon us — some by night, some by day — and dreams and untimely wanderings, and cares that do not reach their mark, and unknowing of things established, and unfamiliarity and inexperience. All these things we suffer from the brain, whenever it is not healthy but has become hotter than its nature, or colder, or moister, or drier, or has undergone some other condition contrary to its nature that it was not accustomed to. We go mad from moisture: whenever the brain is moister than its nature, it must move, and when it is moving neither vision can be steady nor hearing, but one sees and hears different things at different times, and the tongue speaks such things as one sees and hears at each moment; but as long as the brain is still, so long the person thinks clearly. The corruption of the brain comes from phlegm and from bile; you will recognize each kind thus: those who go mad from phlegm are quiet and do not shout or make commotion; those who go mad from bile are noisy and violent and not still, but always doing something unseasonable. 15 If then they go mad continuously, these are the occasions for them; but if terrors and fears come upon them, it is due to a shifting of the brain: it changes position when it is heated; it is heated by the bile, whenever it rushes toward the brain along the blood-bearing vessels from the body; and the fear persists until it retreats again toward the vessels and the body, and then it stops. One is distressed and nauseated when the brain is unseasonably cooled and condensed contrary to habit; this it suffers from phlegm; and from this very affliction one also forgets. By night one shouts and screams whenever the brain is suddenly heated through; this happens in those who are bilious, not in the phlegmatic; the brain is also heated through when much blood comes upon it and boils up. Much blood comes through the aforesaid vessels whenever a person happens to be watching a fearful dream and is in the grip of fear; just as indeed even when awake the face flushes most, and the eyes redden, when one is afraid and the mind intends to do something harmful — so too one suffers the same in sleep; but when one wakes and collects oneself, and the blood is scattered back into the aforesaid vessels, it stops. In accordance with these things I judge the brain to have the greatest power in the human being: for it is the interpreter for us of what comes from the air, when it happens to be healthy; and it is the air that provides it with understanding. 16 The eyes, ears, tongue, hands, and feet carry out whatever the brain recognizes; for understanding is shared with the whole body insofar as it partakes of the air. But the brain is what transmits comprehension: for when a person draws pneuma into himself, it arrives first at the brain, and in this way the air is scattered throughout the rest of the body, leaving in the brain its own peak and whatever is intelligent and possesses judgment. For if it arrived at the body first and at the brain only later, having left the discernment in the flesh and in the vessels, it would go to the brain warm and no longer pure, but mixed with the moisture from the flesh and the blood, so as to be no longer exact. This is why I say the brain is what interprets comprehension. 17 The phrenes, however, have their name by chance and by convention, but not according to the nature of things; and I for my part do not know what power the phrenes have such as to think and understand — except that when a person is overjoyed unexpectedly or is distressed, they throb and leap because of their thinness and because they are most tautly stretched in the body, and they have no hollow into which to receive either good or bad when it strikes, but they are thrown into commotion by both of these on account of the weakness of their nature. They in fact perceive nothing before other parts within the body — they merely bear this name and this attribution in vain, just as the parts near the heart that are called 'ears' contribute nothing toward hearing. Some say that we think with the heart, and that this is what grieves and takes thought; but this is not so. Rather it contracts just as the phrenes do, and more, for these same reasons: for vessels run to it from the whole body converging, and it has them enclosed so as to feel whenever any pain or tension occurs in the person — for indeed when distressed the body must shudder and grow tense, and when overjoyed the same thing happens — because the heart especially feels this, and so do the phrenes. Yet neither of them has any share in understanding; the brain is the cause of all these things. For just as it is the first of the things within the body to perceive the air's understanding, so too whenever a stronger change comes about in the air through the seasons, and the air itself becomes different from itself, the brain first perceives it; this is also why I say that the sharpest, greatest, deadliest, and most difficult-to-discern diseases fall upon it, to those without experience. This disease, the one called sacred, arises from the same occasions as the rest: from what comes and what departs, cold, sun, and winds that shift and never stop. 18 These things are divine — so that one should not, making no distinction, consider this disease more divine than the other diseases, but all things are divine and all things are human. Each thing has its own nature and its own power, and nothing is without resource or without remedy; most things are curable by these same means from which they also arise — for one thing is nourishment to another, and to another destruction. The physician must therefore know how, by discerning the right moment for each, to give nourishment to one thing and increase it, and to take away from another and diminish it. In this disease as in all others, one must not increase the diseases, but hasten to wear them down by applying to each disease what is most hostile to it, not what is friendly and familiar to it — for under familiarity it flourishes and grows, while under the hostile it wastes and is dimmed. Whoever understands such change in human beings and is able by means of diaita to make a person moist and dry, warm and cold — that person would cure this disease too, if he discerned the right moments of what is beneficial, without ritual purifications, magical rites, and all other such base craft.