First draft. This English translation was generated by
Claude Sonnet 4.6, critiqued by Claude Haiku 4.5, and adjudicated/corrected
once by Claude Sonnet 4.6. It is published for reading and review, not as a
final scholarly edition. Hippocratic medical recipes and treatments are
historical text, not medical advice.
ON SEED. ON THE NATURE OF THE CHILD. DISEASES, THE FOURTH.
Custom governs all things. The seed of the man comes from all the fluid present in the body, the most potent part being separated out. The evidence for this — that the most potent part is separated out — is the following: when we have intercourse and release even a little, we become weak.
[1]
This is how it stands. Veins and sinews extend from the whole body into the genitals; when these are rubbed and warmed and filled, something like an itch falls upon them, and pleasure and heat come to the whole body from this. As the genitals are rubbed and the man is moved, the fluid in the body is warmed and diffused and agitated by the movement and foams — just as all other fluids also foam when agitated. So in the man too the most potent and richest part is separated out from the foaming fluid and travels into the spinal marrow; for pathways reach into this from the whole body, and it diffuses from the brain into the loins and into the whole body and into the marrow, and from it pathways extend, so that fluid can come into it and pass away from it. When the seed has come into this marrow, it travels past the kidneys — for that is the route, through veins; and if the kidneys are ulcerated, blood sometimes passes along with it — and from the kidneys it travels through the middle of the testicles into the genitals; and it does not go by the same way as the urine, but has its own separate route close beside it.
Those who have nocturnal emissions have them for the following reason: when the fluid in the body is diffused and thoroughly warmed — whether by exertion or by something else — it foams; and as the most potent part is separated from it, visions present themselves such as occur during intercourse, since this fluid has the same quality as in one who is engaging in intercourse. But it is not my purpose here to discuss nocturnal emissions, what the whole condition amounts to, how much it brings about, and why it precedes intercourse. So much has been said by me on this point.
Eunuchs do not engage in intercourse for this reason: the passage of their seed is weakened, since the route lies through the testicles themselves; and fine, dense sinews extend from the testicles into the genitals, by which it is raised and lowered, and these are cut through in the cutting — which is why eunuchs are not serviceable. Of those whose testicles have been crushed, the passage of the seed is blocked; for the testicles become calloused, and the sinews, having grown hard and numb from the callous, are unable to extend and relax.
[2]
Those who have been cut beside the ears do engage in intercourse and emit seed, but little, weak, and barren; for the greater part of the seed travels from the head past the ears into the spinal marrow — and this passage, having become scarred by the cutting, has grown solid. In boys, the small veins, being narrow and full, prevent the seed from passing, and the itch does not come upon them in the same way; for this reason the fluid in the body is not agitated into the separation of seed. And in girls likewise, as long as they are young, the monthly discharge does not flow, for the same reason. But when both girl and boy grow, the veins that extend into the genitals of the boy and into the womb of the girl become easy-flowing and open-mouthed through growth, and a way and passage is made through narrow parts, and the fluid then acquires agitation — for it then has spaciousness in which to be agitated; and in the boy, when he is mature, the flow passes for this reason, and in the girl, the monthly discharge. These things have been shown by me in this way.
I declare that seed is separated out from the whole body — from the solid parts and from the soft parts, and from all the fluid in the body.
[3]
There are four forms of fluid: blood, bile, water, and phlegm. Man has these many forms innate in himself, and from them diseases arise. I have already explained these matters, and why diseases arise from them — or the separations that arise from diseases. So much has been said by me concerning seed: whence it comes, how and why; and for whom seed does not come, and why it does not come; and concerning the monthly discharge of girls.
I declare that in women, when the genitals are rubbed in intercourse and the womb is moved, something like an itch falls upon them and pleasure and warmth are furnished to the rest of the body.
[4]
The woman also releases fluid from her body — sometimes into the womb, which thus becomes moist, sometimes also outside, if the womb gapes more than is timely. She feels pleasure from the moment she begins intercourse throughout the whole time, until the man releases her. And if the woman is aroused to have intercourse, she releases before the man, and after that the woman no longer feels pleasure in the same way; but if she is not aroused, her pleasure ends together with the man's. It is as when someone pours cold water onto boiling water: the boiling stops. So too the seed falling from the man into the womb quenches the woman's heat and pleasure. The pleasure and heat flare up suddenly together when the seed falls into the womb, and then subside — just as when someone pours wine onto a flame: first the flame flares up and increases for a moment at the pouring of the wine, and then subsides. In the same way the woman's heat flares up toward the man's seed and then subsides. The woman feels pleasure much less intensely than the man in intercourse, but over a longer time than the man; the reason the man feels more pleasure is that the separation comes to him suddenly from the fluid, from a more violent agitation than occurs in the woman.
This too holds for women: if they have intercourse with men, they are in better health; if they do not, less so. For in intercourse the womb becomes moist and not dry — being excessively dry it contracts strongly, and contracting strongly it causes pain to the body. At the same time, intercourse, by warming and moistening the blood, makes an easier path for the monthly discharge; when the monthly discharge does not flow, the bodies of women become prone to sickness. Why they become prone to sickness will be stated by me in the diseases of women. So much has been said by me on this point.
When the woman has had intercourse, if she is not about to conceive, the seed from both parties flows out according to custom whenever the woman wishes; but if she is about to conceive, the seed does not flow out but remains in the womb.
[5]
For the womb, having received and closed, holds within itself — the mouth having been drawn together and contracted by the moisture — and what has come from the man and what has come from the woman are mixed together. And if the woman is experienced in childbirth and notices when the seed does not come out but remains inside, she will know the day on which she conceived. This too holds: sometimes what is released from the woman is more potent, sometimes weaker; and likewise what comes from the man. There is both female seed and male seed in the man, and likewise in the woman. The male is more potent than the female; for necessarily the offspring is generated from the more potent seed.
[6]
This too holds: if the more potent seed comes from both parties, a male is born; if the weaker, a female. Whichever prevails in quantity, that is what is born. For if the weaker seed is much greater in amount than the more potent, the potent is overcome and, mixed with the weak, turns into female; but if the potent is greater than the weak, and the weak is overcome, it turns into male. Just as if someone were to mix wax and fat together, making the fat the greater part, and melt them at a fire: while it is liquid, the prevailing element is not apparent; but when it solidifies, then it becomes visible that the fat prevails over the wax in quantity. So it is with male and female seed. The following offers evidence that in the woman as well as in the man there is seed of both female and male, visible in the outcomes: for many women have already borne daughters to their own husbands, but going to other men have borne sons; and those same men with whom the women bore daughters, when they came to intercourse with other women, produced male offspring; and those with whom male offspring were born, going to other women, produced female offspring.
[7]
This account will declare that both the man and the woman have female offspring-seed and male offspring-seed: with those with whom they bore daughters, the more potent was overcome, the weaker being greater in amount, and females were born; with those with whom they bore sons, the more potent prevailed and males were born. The more potent does not always come from the same man, nor is it always weak, but differs at different times. It is the same with the woman — so that one need not wonder that the same women and the same men produce both male and female offspring. The same holds for animals with regard to female and male seed. And in the seed itself — coming out from both the woman and the man from the whole body — weak seed comes from weak parts, and strong seed from strong parts; and this must necessarily be reproduced in the child.
[8]
And whatever part of the man's body contributes more to the seed than the woman's, that part will more closely resemble the father; and wherever the woman's body contributes more, that part will more closely resemble the mother. It is not possible for everything to resemble the mother and nothing the father, or the contrary, or to resemble neither at all; rather there is a necessity to resemble both in some respect, if indeed seed travels from both bodies into the child. Whichever parent contributes more to the resemblance and from more regions of the body, to that parent most of the features will resemble; and it sometimes happens that a daughter will mostly resemble her father more than her mother, and a son sometimes will mostly resemble his mother more than his father. These and so many are my evidences for the earlier account — that both in the woman and in the man there is the power to generate sons and daughters.
This too occurs: children are sometimes born thin and weak from a father and mother who are both stout and strong. If this happens when many children have already been born, it is clear that the embryo became sick in the womb, and from the mother — if the growth was going astray — because the womb was gaping more than was due, and for this reason it was born weak. Each living creature sickens according to its own strength.
[9]
But if all the children born are weak, the womb is to blame, being narrower than is due; for if it does not have spaciousness in which the embryo will be nourished, the embryo must necessarily come out thin, since it does not have the same spaciousness for growth. But if it has spaciousness and does not fall sick, it is reasonable that a large child should be born from large parents. This is how it stands — just as if someone were to place a cucumber that had already flowered but was newborn and still attached to its vine inside a ladle: it will be equal to and conforming with the hollow of the ladle. But if someone places it in a large vessel, of the kind that suitably holds a cucumber but is not many times larger than the natural size of the cucumber, the cucumber will be equal to and conforming with the hollow of the vessel; for it strives against the hollow of the vessel in its growth. And one may broadly say that all growing things are like this — however one constrains them. So too with the child: if it has spaciousness for its growth, it becomes larger; if it is cramped, smaller.
A child that is crippled in the womb I declare to have been crippled — either crushed — because the mother was struck on the embryo, or fell, or some other violent affliction befell the mother; if it is crushed, the child is crippled at that point. If the embryo is more severely crushed and the membrane surrounding it is ruptured, the embryo is destroyed. Or children are crippled in another way of this sort: when in the womb the space in the region where the crippling occurred is narrow, the body being moved in a narrow space must necessarily be crippled in that region — just as trees that are in the earth and have no spaciousness but are caught under a stone or something else, when they sprout, grow bent, or thick in one place and thin in another. So it is with the child too, if in the womb one part of its body is more cramped than another.
[11]
That healthy children are born from crippled persons, as for the most part happens — for the crippled person retains the same complement of parts as the healthy; but when some disease befalls it and of its fluid — from which the seed is produced — the four forms that exist by nature do not provide the whole seed, but the part corresponding to the crippled is weaker, it does not seem to me a wonder that it should also be crippled, as the parent was. So much has been said by me on this point. I will go back again to the account I was giving.
If seed from both parties remains in the womb of the woman, first it is mixed together — the woman not being still — and it gathers and thickens as it is warmed.
[12]
Then it holds pneuma, since it is in a warm place, and then because the mother breathes; and then when it is filled with pneuma, the pneuma makes a way for itself out through the middle of the seed, through which the pneuma exits. When a way has been made for the warm pneuma to go out, in turn it draws in other, cold air from the mother; and this it does throughout the whole time. For it is warmed since it is in a warm place; and it takes in cold from the mother's breathing. All things that are warmed hold pneuma. The pneuma bursts through and makes a way for itself and travels out; and the warming thing itself draws toward itself another cold pneuma through the rupture, on which it feeds. This happens also with wood and with leaves and with foods and with drinks, as many as are strongly heated. Burning wood will provide a way of understanding this: all wood will do this, but most especially green wood; for it releases pneuma at the cut, and when the pneuma passes out, it spirals around the cut — and we always see this happening. The inference about the pneuma is thus clear: that the pneuma, being hot in the wood, draws toward itself another cold one on which it feeds, and releases it from itself; for if it did not draw it toward itself, the pneuma would not spiral as it went out. For everything hot is fed by the cold in due measure; and when the fluid present in the wood has been thoroughly heated, it becomes pneuma and travels out; and as this warm thing in the wood exits, it draws toward itself another cold one on which it feeds. Green leaves also do this when they burn: they hold pneuma; then the pneuma bursts through and makes a way for itself and travels out spiraling — and traveling it makes a sound at the place where it takes in its breath. Pulse crops, grain, and tree fruits when heated hold pneuma and exit by making a rupture; and if they are moist, they release more pneuma and make a larger rupture. Why speak at length? For all things that are heated release pneuma and draw toward themselves another cold one by the same means, on which they feed. These are the necessities I have established beforehand: that the seed, being warmed in the womb, holds pneuma and releases it; and at the same time the seed also takes breath from the mother's breathing. For when the mother draws cold air into herself from the atmosphere, the seed gets a share of it; it is warm since it is in a warm place; and then it holds pneuma and releases it.
And the seed develops a membrane as it is inflated; for what is outside stretches around it, becoming continuous — since it is sticky — just as on bread being baked a thin, membrane-like layer forms on the surface: for the bread, being warmed and inflated, rises; and wherever it is inflated, there the membrane-like layer forms. On the seed, as it is warmed and wholly inflated, a membrane forms all around the outside; and at the middle of the seed a passage through the membrane is formed for the pneuma both inward and outward. At this point the thin part stands away from the membrane, and there is the least of the seed itself at these points; and this other seed is rounded within the membrane.
Moreover, I myself saw seed that had remained six days in the womb and then fell out; and what it appeared to me to be in my judgment at that time, I use as the basis for my inferences about the rest. How I saw the six-day-old seed I will describe.
[13]
A kinswoman of mine had a very valuable musician, who went with men; it was necessary that she not become pregnant, so that she would not be less valuable. This musician had heard what women say to one another: that when a woman is about to conceive, the seed does not come out but stays inside. Hearing this she understood it and was always watchful; and somehow she perceived that the seed had not come out, and told her mistress, and the account reached me. I heard it and told her to jump up and down on her heels, and when she had jumped seven times, the seed flowed out onto the ground and made a sound; and she seeing it gazed at it and was astonished.
What it was like I will tell: as if someone were to remove the outer shell of a raw egg, and the inner liquid showed through in the inner membrane. The appearance was something like that, so far as one can say. It was red and round; and within the membrane there appeared to be white thick fibers present, caught up in thick red serum, and around the membrane on the outside there were blood-suffusions; and at the middle of the membrane there stood away something thin which seemed to me to be the navel — and through it the breath first passed in and out; and the membrane extended from it encompassing the whole seed. Such was the six-day-old seed that I saw.
I will describe another means of discernment a little after this, visible to anyone wishing to know about this, and an evidence for my whole account that it is true — as far as one can speak truth about such a matter. So much has been said by me on this point.
That the seed is within a membrane, and has breath moving both inward and outward, and grows by the blood of the mother descending to the womb — for the monthly discharge does not flow when a woman has conceived, if the child is to be healthy, except in some cases where a little appears in the first month — but the blood descending from the whole body of the woman gathers in a circle around the membrane on the outside.
[14]
At the same time as the breath draws blood inward through the membrane, the matter congeals at the perforated and standing-away point and builds up what is going to become the living creature. When time passes, other membranes — thin and many — stretch inside the first membrane in the same manner as the first membrane was formed; these too are stretched from the navel, and have bonds linking them to one another. When this has now happened, as blood descends from the mother and congeals, flesh is formed; and at the middle of the flesh the navel stands apart, through which it breathes and takes on growth.
15 [5]
When a woman is pregnant, she does not suffer pain from the monthly discharge failing to flow, for this reason: the blood is not disturbed, going out in a mass each month; instead it flows quietly, little by little, without pain, day by day into the womb, and what is within the womb grows. It flows each day for this reason, and not all at once each month: because the seed lodged in the womb is always drawing from the body, as much as it has the power to draw. So too with the breath: at first the breath is small, and little blood flows from the mother; but when the breath becomes more, it draws the blood more strongly, and more comes down into the womb.
For women who are not pregnant, when the monthly discharge fails to flow, pain arises for this reason: first the blood is disturbed within the body each month, under this kind of necessity — because month differs greatly from month in both cooling and warming, and the woman's body perceives this (for it is more fluid than a man's); and when the blood is disturbed and fills the vessels, it departs from her, and somehow this was established in nature from the beginning. So that if the woman is emptied of blood she conceives; if she is full, she does not. For when the wombs and the vessels have been emptied of blood, women receive children within themselves; for after the purging of the monthly discharge women conceive most readily — the reason being what has been stated.
But when the blood is disturbed and separated out and does not pass outward, but passes into the womb, and the womb does not relax — then the womb, being warmed by the blood that lingers, furnishes heat to the rest of the body. And sometimes the womb also distributes blood into the vessels of the body, wherever the vessels, being filled, are in pain and cause swellings. And sometimes there is even danger of lameness from such a condition. And sometimes the wombs press against the bladder, squeezing and closing it, and cause strangury. And sometimes the wombs, being full of blood, fall against either the hip-bones or the loins and cause pain. And sometimes the blood has lingered five or six months and, having putrefied in the womb, becomes pus; and in some women this pus comes out through the genitals, and in others it forms in the groin like a swelling, and from there the pus that formed comes out. And many other such evils befall women when the monthly discharge is not purged. But why should I recount them here? They will be set out in the treatise on women's diseases. I will instead complete the account from where I left off.
When flesh has come into being, the membranes, as what is lodged in the womb grows, themselves grow and become pouched — most of all the outermost ones. And the blood that comes down from the mother, whatever the flesh draws in by breathing — if growth occurs and it is not serviceable — is separated off into the pouches of the membranes. And when the membranes have become pouched and have received the blood, it is then called the chorion.
16 [5]
These things I have set out to this point. The flesh, as it grows, is articulated by the pneuma, and within it each like comes to like: the dense to the dense, the rare to the rare, the fluid to the fluid. And each comes to its own place according to kinship — from what it came, and whatever came from dense things is dense, and whatever from fluid things is fluid; and all the rest comes about in the growth by the same account.
17 [5]
The bones are hardened, being congealed by heat; and they also put out branches like a tree; and both the inner and outer parts of the body are better articulated. The head becomes separated from the shoulders, and the upper arms and forearms from the sides; the legs are set apart from each other; the sinews shoot out around the natural joints and open their own mouths; the nose and ears stand apart within the flesh and are pierced; the eyes are filled with clear fluid; the genitals become evident as to which kind they are; the internal organs are differentiated; and now breath is drawn through the upper passages, through the mouth and the nostrils; the belly is inflated; the intestines, being inflated from above, take over the breath through the navel and diminish it; and a passage opens from the belly and intestines outward to the anus (κύσσαρος), and a passage outward to the bladder. Each of these things is differentiated by the breath; for being inflated they all separate according to kinship. For if one wished to attach a small tube to a bladder, and through the tube to put into the bladder earth, sand, and fine shavings of lead, and then pour in water and blow through the tube — first those materials will be mixed together with the water; then in time, as blowing continues, the lead will come to the lead, the sand to the sand, the earth to the earth. And if one allows them to dry and breaks open the bladder and looks, one will find like has come to like. In just this way the seed and the flesh are differentiated, and each like within it comes to like. These things I have set out to this point. And now a child has been formed and reaches this stage — the female at most within forty-two days, the male at most within thirty days; for it generally comes about within this period, or a little less or a little more, that these things are articulated.
18 [45]
For the purging that occurs in women after birth is, for the most part, in the case of a girl, forty-two days: that is the longest and the complete purging; but it would not be dangerous even in twenty-five days, if she is purged. In the case of a boy, the purging occurs in thirty days: that is the longest and the complete purging; but it would not be dangerous even in twenty days, if she is purged. In the last part of the period the least purging passes. In younger women it is purged in fewer days, in older women in more days. Women suffer most in childbirth and in the lochia who are giving birth for the first time; and those who have borne fewer children suffer more than those who have borne more.
The purgings that occur in women after birth come about for this reason: that in the period beforehand — up to forty-two days in the case of a girl, up to thirty days in the case of a boy — the least blood comes down to nourish the child; but from that time onward more comes until she gives birth. The purging must therefore be rendered back in the lochia and must pass outward in proportion to the days. The beginning of this comes about in the woman in labor as follows: the blood in the woman is disturbed and greatly heated by the vigorous movement of the child; being disturbed, it first comes out; then after the child, a thick blood-like ichor (ἰχὼρ παχὺς αἱματώδης); and this served as a guide for what followed, as water spread upon a table. Then after that, through all the days, the purging flows until the stated time — in amount an Attic kotyle and a half at first, or a little more or a little less, decreasing proportionally until it ceases. Blood flows as from a sacrificial animal, if the woman is healthy and is going to be healthy, and it congeals quickly; if the woman is not healthy and is not going to be healthy, the purging flows in lesser quantity and worse in appearance, and does not congeal quickly.
The matter stands thus: if a woman, while pregnant, has a disease that is not naturally consonant with the post-birth purging, she perishes. And if she is not purged in the preceding days straightway — whether healthy or not — but the purging rushes upon her, whether from drugs or spontaneously and suddenly, it will flow all at once in proportion to the days through which it did not flow. For if the lochia are not purged from the woman, a great illness will befall her, and she will risk dying, unless she is attended to quickly and the purging is again induced in her.
I have introduced these matters here for this purpose: to demonstrate that the longest differentiation of the limbs of children is, in the case of a girl, within forty-two days, and in the case of a boy within thirty days. The purging of the lochia gives evidence of this — that in the case of a girl it occurs within forty-two days, and in the case of a boy the longest is within thirty days. I intend now to state this a second time for the sake of clarity: I affirm it as a counter-demonstration, that to the seed lodged in the womb the least blood comes from the woman to the womb — in a woman carrying a female seed — within forty-two days; for within these days the limbs of the children are articulated. From that time onward more blood comes. And in the case of a boy the account runs correspondingly with the thirty days in the same way.
18 (50) [70]
Here is a further witness that these things are true: in the first days, when the seed falls into the womb, the least blood comes from the woman into the womb, then increasingly more. For if it came in a mass and in great quantity all at once, the seed would not be able to have breath, but would be suffocated by the coming of so much blood. The reverse is rendered back in the purging: the purging of the lochia flows most in the first days, then in decreasing amounts until it ceases.
Many women have already miscarried a boy shortly before thirty days, and it appeared unarticulated; but those miscarried after or at the thirty days appeared already articulated. And in the case of a girl, in proportion to the forty-two days — when miscarried, the articulation of the limbs is visible. Whether the child is miscarried before or after, this is how the articulation appears — by both account and necessity — in the case of a girl within forty-two days, in the case of a boy within thirty. For the miscarriages of children and the purgings of the lochia together give evidence of this.
The reason is that the female is congealed later and articulated later, because the seed of the female is weaker and more fluid than that of the male; and by this account it is necessary that the female be congealed later than the male. And the purging is therefore longer in the case of the female than in the case of the male. I will go back again to where I left off.
When the child has been articulated, the forms of the limbs — as it grows — the bones become somewhat harder and are hollowed; and this too occurs through the pneuma. Being hollow, they draw from the flesh the fattiest part of the bloody fluid (αἱμάλωψ).
19 [20]
In time the extremities of the bones put out their branches again, as the topmost tips of a tree are the last to put out branches; so too in the child the fingers of the hands and feet are separated from one another. And further at the extremities nails grow. For all the vessels of a human being end at the fingers of the feet and hands; and the thickest vessels in the body are those in the head, then those in the legs and upper arms and forearms, while in the feet and hands the vessels are finest, most dense, and most numerous, and the sinews finest, most dense, and most numerous, and the bones smallest in size — and in the fingers of the hands and feet this is especially the case. From the fingers, which have dense small bones and vessels and sinews in this way, the nails grow from them, fine and dense; and they cut off the ends of the vessels so that they no longer grow or project one beyond another. So one need not wonder that the nails, at the outermost part of the body, are densest — for they come from the densest parts.
At the same time as the nails, hair also takes root in the head. The nature of hair is as follows: hair grows greatest and most abundantly wherever the outer skin of the body is most porous and wherever the hair has a moderate moisture for its nourishment.
20 [5]
Where the outer skin becomes porous later, there too hair grows later — on the chin and the pubic region and wherever else. For together with the onset of seed the flesh becomes porous and the outer skin too, and the small vessels open their mouths more than in the time before; for when one is a child, with the small vessels being narrow, the seed does not make its way through them. And for girls the same account applies to the monthly discharge: at the same time a passage comes about for both the monthly discharge and the seed; and the pubic region of the boy and the girl becomes hairy when the outer skin has become porous. At the same time the hair has a moderate moisture for its nourishment and not less.
So too it is with the chin of a man: the outer skin becomes porous as the moisture makes its way into it from the head. For both in the act of intercourse and in the time between, the hair then has the most moderate moisture for its nourishment — especially when the time comes for the fluid descending from the head in intercourse to reach the chin, leaving the chest behind.
Evidence that hair grows where the outer skin is most porous: if one were to burn the outer skin and produce only a blister and let it heal, the outer skin having become dense at the scar will not put out hairs. Those who become eunuchs while still boys do not for this reason grow pubic hair or a beard, and they become smooth all over — because the passage for the seed, not having developed, does not make the outer skin porous over the entire skin; for the passage of the seed has been cut off, as I said a little earlier. And women too become smooth on the chin and body, because in their intercourse their fluid is not shaken in the same way as a man's and so does not make the outer skin porous.
Those who become bald are phlegmatic in nature; and in their head the phlegm, being shaken and heated together with intercourse, falls against the outer skin and burns the roots of the hairs, and the hairs fall out. Eunuchs for this reason do not become bald — because in them there is no strong movement, nor does phlegm heated in intercourse burn the roots of the hairs.
Gray hairs arise for this reason: as the fluid makes its way through the human body over a long time, the whitest part is separated out and falls toward the outer skin; and the hair, drawing a whiter moisture than before, becomes whiter; and the outer skin where the gray hairs are becomes whiter than the rest. And those who have some gray in their head from birth — in them the outer skin where the gray hairs are is whiter than the rest; for there the most white fluid is. The matter also stands thus: whatever moisture the flesh draws — whether white, reddish, or black — such also is the color the hair becomes. These things I have stated to this point.
I will return again to what remains in the account. When the extremities of the child's body have put out their shoots outward, and the nails and hair have taken root, then the child moves; and the time for this is three months for the male and four months for the female — for this is how it most generally comes about. There are some children, however, that move before this period.
21 [35]
The male moves earlier because it is stronger than the female; and the male is also congealed earlier, for it comes from a stronger and thicker seed. When the embryo has moved, then also the milk makes its sign in the mother: the breasts are raised and the nipples are turgid, yet the milk does not flow. In women of dense flesh the milk makes its sign and comes later; in those of porous flesh, earlier.
Milk comes about by the following necessity: when the womb, being swollen with the child, presses the belly of the woman, and the belly being full the pressing-out occurs, the fattiest part of foods and drinks is pressed through into the omentum and the flesh; just as if one were to anoint a hide with much oil and allow it to absorb, and when it has absorbed, one presses the hide, the oil would be pressed through the hide being squeezed — in just this way, when the belly has the fat within it from foods and drinks and is being pressed by the womb, the fat is pressed through into the omentum and the flesh. And if the woman is of porous flesh she perceives the pressing-through sooner; if not, later. And pregnant animals too, unless something is wrong, become fatter from the same drink and food for this reason; and similarly the woman.
From the fat, being heated through and being white, what is sweetened by the heat — being squeezed out by the warmth of the womb — comes to the breasts. And a little also comes to the womb through the same vessels; for the same and similar small vessels extend both to the breasts and to the womb. And when it reaches the womb, it takes on the appearance of milk, and the child benefits a little from it; while the breasts, receiving the milk, are raised as they fill. And when she gives birth, with a new movement arising, the milk flows to these breasts — if she nurses. For it is thus: when the breasts are being suckled, the small vessels to the breasts become more free-flowing; and becoming more free-flowing, they draw the fat from the belly and distribute it to the breasts. For indeed a man too, if he engages much in intercourse, the small vessels becoming more free-flowing bring on intercourse more.
The matter also stands thus: the nourishment and growth of children come about according to how what comes from the mother goes to the womb; and according to how the mother is in health or weakness, so too is the child.
22 [35]
Just as the things that grow in the earth are nourished from the earth, and however the earth stands, so too do the things growing in the earth stand — for when the seed is cast into the earth, it is filled with moisture from it; the earth holds within itself moisture of every kind, enough to nourish what grows there; and the seed, filled with moisture, swells up and puffs out. The lightest capacity in the seed is compelled by the moisture to gather and coil together. This capacity, coiled together by the pneuma (breath / moving air) and the moisture, becomes leaves and bursts open the seed; and the leaves emerge first, upward and outward. Once they have emerged, when the leaves can no longer be nourished by the moisture present within the seed, both the seed and the leaves split downward; and being pressed by the leaves, the seed releases downward the capacity that remains in it by reason of its heaviness; and the roots come to be from the leaves, stretched out downward. When what has grown is firmly rooted below and draws its nourishment from the earth, then everything else has been consumed and spent into what has grown, except for the husk, because it is the hardest part; and the husk in turn, rotting in the earth, becomes invisible. In time, branches grow out from some of the leaves. Since a plant comes from seed — from something fluid, so long as it is tender and watery, rushing upward and downward toward growth — it cannot put forth fruit; for it has no strong and rich capacity from which the seed will be coiled and compacted. But when, with time, what has grown becomes more solid and well-rooted, then it already has broad channels both upward and downward; and then what is drawn from the earth is no longer watery but thicker, richer, and more abundant. This, heated by the sun, boils up to the extremities, and fruit comes to be in accordance with its kindred nature, of the same kind as that from which it originated. And it comes to be in great quantity from a small amount for this reason: each of the growing things draws from the earth a capacity greater than that from which it came, and it boils up not in one place but in many. When the fruit has boiled up, it is nourished by the growing plant; for the growing plant, drawing from the earth, distributes to the fruit; and the sun concocts and solidifies the fruit, drawing toward itself from it what is more watery. So much have I said concerning the things that grow from seed out of earth and water. As for what grows from cuttings — trees come to be from trees in the following manner: the branch receives a wound at its lower end, the part toward the earth, where it was broken from the tree, and it is from there that the roots are sent out.
23 [25]
They are sent out in the following manner: when the cutting that is in the earth takes moisture from the earth, it swells and holds pneuma, but the part above the earth does not yet do so. The pneuma and the moisture, having coiled together the capacity in the lower part of the cutting — all that was heaviest — broke it out downward, and from it tender roots come to be. When it has taken hold below, then it draws moisture from the root and distributes it to the part above the earth; and then the upper part in turn swells and holds pneuma; and all the light capacity within the cutting, gathered together, becoming leaves, sprouts, and from then on makes its growth both upward and downward. So the opposite now comes about, comparing those from seed and those from a cutting, with respect to sprouting: from seed, the leaf first emerges upward, and then the roots are sent out downward; but the tree first roots, then puts out leaves. This is because within the seed itself there is a great quantity of moisture, and while it is all in the earth there is nourishment at first sufficient for the leaf, from which the leaf will be fed until it is rooted; but in the branch this does not happen, for there is no other source from which the first leaf will draw nourishment — the branch itself is just as the tree holds itself, and a great deal of it is above the earth, so that it could not be filled with moisture above the earth unless some great capacity came from below and delivered moisture to what is above. And so the cutting must first make nourishment for itself from the earth by means of its roots, and only then, drawing from the earth upward, give back, and set the leaves moving toward sprouting and growth. When the plant grows, it puts out branches by the following necessity, which I shall describe: when more moisture comes to it, drawn from the earth, under the pressure of the abundance it bursts wherever the moisture is most concentrated, and there the plant puts forth branches.
24 [5]
It grows both in breadth and upward and downward for this reason: that the lower part of the earth is warm in winter and cold in summer. This is because the earth is moist in winter from the water falling from the sky, and is compressed in on itself, since the moisture is heavier; it is denser for this reason and has no passage of pneuma through it at all — for the looseness in it is no longer great — and on this account the lower part of the earth is warm in winter. For indeed freshly heaped dung is warmer than when it lies loose, and in general things that are moist and compressed by their own weight heat up internally and are very quickly burned up and rot from the heat, for the pneuma does not pass through them, since they are dense; but if they are dry and lie loosely, they heat up and rot far less. So too wheat and barley, when they are damp and packed together, are warmer than if they were dry and lying loosely; and garments bound together and strongly wedged under hides are burned by themselves, as I have myself already seen, as if scorched by fire; and if one wishes to consider other things, one will find that all things compressed by their own weight are warmer than those lying loosely, for they cannot breathe in cold air from the winds. So too with the lower part of the earth — when it is full and compressed in on itself, being heavy and dense from the moisture, it heats up in winter; for there is no outlet for the warmth. But when water falls from the sky into it, whenever breath evaporates from it within the earth, it does not pass further, since the earth is dense; instead the breath comes back into the water. And on this account springs are warmer and larger in winter than in summer, because as the breath evaporates, it comes back into the water, since the earth is denser and does not let the pneuma pass through itself. And the water, being abundant, forces its way wherever it can and makes a broader passage for itself than if it were little; for water in the earth does not stand still but always moves downward. But if in winter the earth let the pneuma from the water pass through itself, less water would flow out of it, and springs would not be large in winter. All this has been said by me to show that the lower part of the earth is evidently warmer in winter than in summer. Now I wish to say that in summer the lower part of the earth is evidently colder than in winter: for in summer the earth is loose and light, since the sun strikes more forcefully and draws the moisture from it toward itself; the earth always holds more or less water within itself; and all our winds come from water. One may infer that this is so from the fact that winds always arise from all rivers and from clouds, and clouds are continuous water in the air.
25 [5]
And then the earth in summer is loose and light and holds water within itself; and the water flows toward the lower-lying parts; and as the water always moves, pneuma evaporates from it one after another; the pneuma that evaporates passes through the earth, which is light and loose, and makes cold in the earth, and the water itself is cooled along with it. The situation is like this: if someone were to press hard on water contained in a wineskin and make a passage for pneuma from the water by the prick of a needle or something slightly larger, and hang the skin and let it swing, no pneuma will pass through the puncture but rather water — for the water has no room through which to breathe out. This is how it is with water in the earth in winter. But if you make room for the water in the skin, and hang the skin and let it swing, pneuma will pass completely through the puncture — for there is room for the pneuma from the moving water to pass through the skin, and through this the pneuma passes completely through the puncture. This is how it is with water in the earth in summer: there is room for it, since the earth is loose and the sun draws the moisture from it toward itself; and the earth lets the pneuma through, which, being cold from the water, passes through the earth as it is loose and light — on this account the lower part of the earth is cold in summer, and the water is the cause of the pneuma in the earth being cold, and itself sends the pneuma into itself and into the earth. And at the same time, what is drawn up in the well always stirs the pneuma like a fan and causes it to provide cold to the water; while the water in summer that is not drawn up but stands still, being dense, does not receive the pneuma from the earth into itself equally, nor give back from itself into the earth; and at the same time, by reason of the sun and the air not being dispersed in the well but standing still, the surface of it is first warmed; then layer by layer it passes the warmth downward; and for this reason the water in summer that is not drawn up is warmer than what is drawn up. And deep springs are always cold in summer. And water drawn in winter from the warm earth is warm immediately, but when time passes it is cold, evidently because the air that is cold makes it so — for it is turned to air by the wind, and the pneuma filters through it; just as water drawn up in summer, when it is fetched, is immediately cold, then becomes warm for this reason: because the earth being loose and there being pneuma in it, it is cooled, but when time passes after drawing it is at rest and appears warm — for it is warmed by the air, which is warm, just as the water in the well that is not drawn up in summer becomes warm for this reason. This has been said by me to this point. I shall take up again that the lower part of the earth in summer is cold, and in winter warm, and above the earth it is the opposite of this; and it is necessary for the tree that not two warm influences come upon it at once, nor two cold ones at once, if it is to be healthy; but if warmth comes from above, cold must come to it from below, and again if cold comes from above, warmth must come to it from below.
26 [35]
Whatever the roots draw up, they give to the tree, and the tree to the roots. And so there comes to be a stewardship of both cold and warm — just as with a person, when foods that warm by being concocted enter the belly, there must be cooling delivered from the drink; so too with the tree there must be a giving back from below in exchange for above, and in turn. And the tree grows both upward and downward for this reason: that it has nourishment both from below and from above. And so long as it is very tender, it does not bear fruit; for it does not yet have a rich and thick capacity, such as is able to contribute to fruit. But when time passes, then the broad channels within it, drawing from the earth, produce in it a rich and thick flow; and the sun, diffusing this, causes it to boil up, being light, to the extremities and to bear fruit; and the sun carries off the thin moisture from the fruit, while concocting and warming the thick moisture, it sweetens it. Those trees that do not bear fruit do not have within them as much richness as will be given out into fruit. And the whole tree, when it is solidified with time and has taken firm hold below by its roots, stops growing in every direction. As for those cases where buds from other trees have been inserted into trees, and having become trees they live in the trees and bear fruit unlike those in which they are set — this comes about in the following way. What happens is that the bud first sprouts, since it had nourishment first from the tree from which it was taken, then from the one in which it was placed; when it has sprouted thus, it sends out from itself thin roots into the tree; and first it draws benefit from the moisture present in the tree in which it is placed; then, with time, it sends roots into the earth through the tree in which it was placed, and draws benefit from the earth drawing the moisture, and its nourishment comes from there. So one should not wonder that the inserted trees bear a different fruit, for they live from the earth. This has been said by me concerning trees and their fruits for this reason: that it was not possible for me to leave the account half-finished. I shall return again to the account for the sake of which these things about these matters have been said.
27 [5]
I assert that all the things that grow in the earth live from the moisture of the earth, and however the earth stands with respect to moisture within itself, so too the things growing stand. In the same way the child lives from the mother within the womb, and however the mother stands with respect to health, so too the child stands. [Note: the same framework of moisture, capacity, and nourishment now governs fetal development; what was 'moisture from the earth' becomes blood and nourishment from the mother.] And if someone wishes to think through from beginning to end what has been said about these things, he will find that the whole nature of the things growing from earth and the things from humans is alike. And this has been said by me to this point. The child within the womb holds its hands near its jaws and its head near its feet; and there is no precise way to determine — even if you were to see the child in the womb — whether it holds its head upward or downward. The membranes are stretched out from the navel, holding it fast.
29 [5]
Now I shall describe the distinction I said I would set out a little earlier, as visible as is possible to human understanding for anyone who wishes to know about this: that the seed is enclosed in a membrane, and at the center of it is the navel, and the seed first draws breath into itself and lets it out, and from the navel there are membranes; and the rest of the nature of the child, which I have described, you will find in this state entirely from beginning to end, as it has been shown in my account, if someone wishes to make use of the observations I am about to describe. For if someone wishes to take twenty eggs or more, placed under two hens or more, in order to hatch them, and beginning from the second day up to the last on which the egg hatches, removing and breaking open and examining one each day, he will find them having everything in accordance with my account — as one should compare the nature of a bird with the nature of a human. For that there are membranes stretched from the navel, and all the other things said about the child, you will find them so in the bird's egg from beginning to end; and indeed if someone has not yet seen it, he will marvel to find a navel present in a bird's egg. This is how these things stand, and this has been said by me in this way. When the time of birth comes for the woman, it happens that the child, moving and struggling with hands and feet, breaks one of the inner membranes; and once one is burst, the others already have less strength; and first those neighboring it burst; then the last one.
30 [45]
When the membranes have burst, the embryo is released from its bond and comes out, having been set in motion; for it has no more strength, now that the membranes have given way, and with these carried away, the womb also can no longer hold the child — for the membranes also take hold of the womb when they wrap around the child, not with much force. When the child moves forward, it forces open and widens the womb in its passage, since the womb is soft; it moves head-first, if it goes in the natural way — for the parts above the navel are heaviest to it by measure of weight. While in the womb it becomes more capable of the tearing of the membranes by the time of the tenth month, when birth arrives for the mother. But if the child suffers a violent shock, it comes out earlier than the appointed time with the membranes burst; and if the nourishment from the mother to the child ceases before that time, in this way too birth arrives earlier for the mother, and the child comes out in fewer than ten months. But as for those women who have seemed to carry longer than ten months — I have heard this many times — they were misled in the following manner, which I shall describe. When the womb takes in pneuma into itself from the belly producing flatulence and swells up, which does happen, the women then think they are pregnant; and if the monthly discharge, not flowing out, collects within the womb and remains there for some time, it continuously seeps into the womb, sometimes together with the pneuma from the belly, sometimes also when warmed; and then indeed the women think they are pregnant, since the monthly discharge is not flowing and the womb is raised. Then at some point the monthly discharge burst out of itself, or when other matters had come down from the body into the womb and carried down the earlier ones, and the flatulence came out, and for many women thereafter the womb immediately gaped and turned toward the female part; and at that point, joining with men, they took the seed into themselves on the same day or within a few days. Women who lack knowledge of these explanations and these events reckon that they became pregnant at the time when the monthly discharge was not flowing and the womb happened to be raised. That it is not possible to carry for longer than ten months I shall explain: the nourishment and growth coming from the mother are no longer sufficient for the child when ten months have passed and the embryo has grown; for it draws to itself the sweetest part from the blood, and at the same time also benefits a little from the milk; when these become scarcer for it and the child is well-grown, desiring more nourishment than is available, it struggles and breaks the membranes. This happens more to women giving birth for the first time; for the nourishment falls short for the children before reaching the sufficiency to last the ten months. It falls short for the following reason: among women, some purge sufficient monthly discharge, others less; if this always happens, it is natural to them and from the mother's side of the family. Those women who discharge little monthly blood — they, by providing scarcer nourishment to their children toward the end of the time, when the child is now well-grown, cause them to struggle and press to come out before ten months; for they discharge little blood.
30 (50) [95]
As happens for the most part, these women — those who discharge little in the way of monthly flows — tend also to have little milk; for they are drier and more compact in flesh. Now, as evidence for the account that the embryo is expelled when nourishment gives out — unless some violent injury befalls it — the following observation serves. The bird comes to be from the fresh egg in this way: when the mother settles upon it, the egg is warmed; and what is inside the egg is set in motion from the mother. As it warms, what is inside the egg takes in pneuma and draws in exchange another, cold current from the surrounding air through the shell of the egg; for the egg is porous enough to let a drawn breath, sufficient for the one within, pass through. The bird grows in the egg and is articulated joint by joint in the same and closely similar way as the child, as I have already said before. It comes to be from the yolk of the egg, while nourishment and growth come from the white that is in the egg. This has already been made plain to all who have given it their attention: when nourishment in the egg falls short for the chick, having nothing sufficient to live on, it moves vigorously inside the egg, seeking more nourishment, and the membranes burst all around; and when the hen perceives the chick moving vigorously, she pecks and chips it open. All this comes to pass within twenty days. And it is plain that things stand thus: for when the bird pecks at the shell of the egg, there is no moisture inside worth mentioning — it has been wholly used up into the chick. In the same way, when the child has grown, the mother can no longer provide sufficient nourishment; so the embryo, seeking more nourishment than is at hand, kicks and breaks the membranes, and once freed from its bond makes its way out; and this comes about within ten months at the longest. By this same account, birth also arrives for herd animals and wild animals within the time each one gives birth and no longer; for every living creature must have a time at which nourishment will become scarcer for the embryo and will give out, and birth will be at hand — those creatures that have less nourishment for their embryos give birth sooner, those with more, later. And so much have I said on this matter.
When the membranes burst around the child, if the inclination toward the head prevails, the woman gives birth easily; but if the child turns sideways or feet-first — and this does happen, if the inclination happens to have gone that way, or by reason of spaciousness in the womb, or if the mother has not kept still at the outset of labor — and if the child proceeds in that way, the woman will give birth with difficulty; and already many have perished, either the women themselves, or the children, or mothers and the children within them together. Among women in labor, those giving birth for the first time suffer most, on account of their inexperience of the pains, and they suffer throughout the whole body, but most of all in the loins and the hips — for their hips come apart; those more experienced in childbirth suffer less than first-time mothers, and those who have given birth many times suffer much less. If the embryo goes head-first, the head comes out first, then the other limbs following, and last the navel-cord; from the navel-cord the afterbirth is stretched. After this, a bloody watery discharge comes from the head and the rest of the body, separated off by force, effort, and heat, and it opened the way for the cleansing of the lochia; and after the discharge of this serum, the cleansing takes place over the period stated earlier.
30 (100) [5]
Both the breasts and all the other parts of women that are more fluid in nature give way and rupture — least of all at the first birth, then, as they experience more births, still more do they give way, as the vessels are emptied by the purgation of the lochia. So much have I said on this. Twins come to be from a single act of intercourse in this way: the womb has numerous recesses and bends, some more remote from, some nearer to, the opening; and those animals that bear many offspring have more recesses than those that conceive few; likewise sheep, wild animals, and birds.
31 [25]
When the seed happens to divide and reach two recesses, and the womb receives the seed, and neither of the two recesses relaxes into the other, then the seed, separated in each recess, is enveloped in membrane and quickened in the same way as has been described for a single one. As evidence that twins come to be from a single act of intercourse, the following observation serves: the dog and the sow and other animals that bear from a single act of intercourse both two and more young — and each of the young within the womb is in its own recess and membrane, and we ourselves see these things happening — give birth to all of them on the same day for the most part. In the same way, children born to a woman from a single coupling are each within their own recess and afterbirth, and she bears both on the same day, and one comes out first along with its afterbirth. As for the fact that male and female twins come to be, I hold that in woman and in man and in every animal there is within the seed both a weaker and a stronger element, and the seed does not flow forth all at once but is discharged in two or three surges; and it is not possible that all of it always be equally strong — what comes out first and what comes later. Into whichever of the two recesses the seed happens to enter thicker and stronger, there a male comes to be; into whichever it enters more fluid and weaker, there a female comes to be; if strong seed enters both, both become males; if weak seed enters both, both become females. This account, thus stated, comes to its completion. For the coming-to-be of the human being, the seed, having come from all the parts of the man and the woman and having fallen into the woman's womb, was congealed; and in the course of time a human-shaped nature came to be from it.
32 [5]
Both the woman and the man have four forms of fluid in the body, from which the diseases arise — all those diseases that do not arise from violence. These forms are: phlegm, blood, bile, and the watery kind (ὕδρωψ); and from these no small and no weakest part comes together into the seed, and since the living creature has come to be, it has within itself, in accordance with its parents, that same number of forms of fluid, both healthy and disease-prone. I will set forth how, within each of these forms, more and less of each comes to be in the body, and how disease arises from this; and that diseases reach their crisis on odd-numbered days; and what the beginnings of diseases are; and what each of them, working upon the body, brings on disease; and what is the shivering-with-fever that arises from the same cause, and why the fever falls upon one after it. I wish first to set forth how bile and blood and the watery kind and phlegm become more and less, from foods and drinks, in the following way: the belly (koilíe) is for the body the source of everything when it is full; when it becomes empty it draws benefit from the body as it melts.
33 [20]
There are also four other sources, from which each of these flows into the body once they have received it from the belly, and these, when they in turn are emptied, draw benefit from the body; the body itself also draws when the belly has something in it. For blood, the heart is the source; for phlegm, the head; for water, the spleen; for bile, the region upon the liver. These four are the sources of these fluids, apart from the belly; and of these the most hollow are the head and the spleen, for there is in them the greatest space — but concerning this I will set it out more clearly a little later. And this also is so: in all foods and drinks there is something of the bilious, and something of the watery kind, and something of the blood-like, and something of the phlegmatic — more in one, less in another; which is why what is eaten and drunk differs from one thing to another in respect of health. So much have I said on this. When a person eats or drinks, the body draws into itself from the belly the moisture described above, and the sources draw through the vessels from the belly — the like moisture draws the like — and distribute it to the body, just as in plants the like moisture draws the like from the earth. For the earth holds within itself capacities of all kinds and without number.
34 [40]
For of all things that grow in it, it provides to each a moisture like itself — just as the plant itself has, by kinship, a like moisture — and each draws from the earth nourishment of the same kind as it itself is: for the rose draws from the earth a moisture such as the rose itself is in its capacity, and garlic draws from the earth a moisture such as garlic itself is in its capacity, and all the other growing things each draw from the earth according to their own nature; for if this were not so, growing things would not turn out resembling their seeds. Whichever of the things growing in the earth has, by kinship, much more moisture than is needed, that plant falls ill; whichever has less than is fitting, that one withers. If from the beginning the plant lacks the moisture it draws by kinship, it cannot even sprout; and what makes this intelligible is the following: if a plant does not have moisture according to its nature, it does not sprout at all. For the land of Ionia and the Peloponnese is not at all badly situated with regard to the sun and the seasons, so that the sun could suffice for the growing things there; yet nonetheless it has not been possible, though many have tried, for silphion to grow either in Ionia or in the Peloponnese — whereas in Libya it grows of itself. For neither in Ionia nor in the Peloponnese is there the kind of moisture to nourish it. And that there are many other things which regions cannot cultivate, despite the sun being sufficient, while other regions grow them of themselves, the following also invites consideration — something I am about to say — how greatly two plots of land lying very close together can differ in the pleasantness of their wine, though the sun serves them equally. For in one piece of ground there is a moisture such as will yield sweet wine, while in another there is not. And there are also quite a few wild plants growing in a place, which, if transplanted the distance of a fathom, you would no longer find growing; for the ground when transplanted to does not have the same moisture as that ground provided for those wild plants. These plots differ — some being more violet-scented, some more fluid, some sweeter, some drier, some rougher, others differing in countless other ways — for there are countless capacities in the earth, and for these reasons the first kinds to grow from the earth grew no two alike, save those that were kindred. All of these seem to me to be wild; human beings tamed them by working them so as to bear fruit according to each seed; for the like moisture draws the like from the earth, and by these things each grows and is nourished; and none of the growing things is like another, since no two draw equal or similar moisture from the earth. Each of the growing things that are eaten and drunk draws many capacities from the earth into itself; and in everything there is something of the phlegmatic and something of the blood-like. I have therefore been led to this necessity: that from foods and drinks as they pass into the belly, the body draws, through the sources I have named, the like moisture draws the like through the vessels. And I will set out another sign that each draws according to what has been said, and at the same time will explain whence phlegm arises in the body.
35 [30]
When someone eats cheese or anything sharp, or eats or drinks anything phlegmatic, immediately it rushes up to the mouth and the nostrils — and we all see this happening. From this one should draw the inference I am about to state. I hold that of whatever phlegmatic element is in the food or drink, once that has passed into the belly, part the body draws into itself, and part the head — being hollow and sitting on top like a cupping-cup — draws the phlegm, since it is sticky; and one part follows the other through to the head. The fresh phlegm newly generated from the food stays in the head, while the old phlegm, in proportion to the increase of the new, is forced out by it; and for this reason when someone eats or drinks anything phlegmatic, the person coughs up phlegm. This also is the case: if, after someone has eaten or drunk something phlegmatic, it does not come back out while more has been generated — neither by way of the mouth nor by way of the nostrils — it must either stay in the head, or descend into the body from the head, or arrive at the belly. The best outcome would be if it arrived at the belly; for then it would be expelled with the feces — if it were much and fluid, it would moisten the feces; if little, it would produce no effect. If it remained in the head, it would cause much suffering to the head when present in the vessels; if little, it would produce no such effect, though it would leave some sign, greater or lesser. If it arrives in the body, there it is mixed with the rest of the moisture; and if the phlegm is much, it would immediately disturb the body; if little, it would not disturb it — the body being large — unless some further beginning should remain and another be added. But in time, if further phlegm is generated, it would cause harm; if however the body works it through via the bladder and the belly and carries these things out, no harm would come from it. In this account it has been set forth how the head draws phlegm from the belly — the like comes to the like — and at the same time I have stated how and why phlegm increases in a person from foods and drinks. Now I will speak about bile: how and why it becomes more in the body, and how the region upon the liver draws it into itself.
36 [30]
The matter stands thus: when a person eats and drinks what is bitter or otherwise bilious and light, and more bile is generated upon the liver, immediately the liver gives pain — what children call the 'heart' (kardia) — and we have seen this happening, and it is plain to us that it arose from the food or drink. For the body draws into itself from the foods the entire moisture described; and the region upon the liver likewise draws into itself whatever bilious element is present there; and if bile suddenly becomes much, the person feels pain in the liver, and more is generated from the bowel — for as this happens, the old bile, on account of the abundance, passes into the belly, and from this gripes come to the belly, and what is in it is discharged — some by way of the bladder, some by way of the belly — and in this way the least harm is done to the person, and the pains cease. If neither of these things happens, the old bile first moves into the body and is distributed through it; and if it is much, mixed with the rest of the fluid it immediately gives a sign; if little, it would not disturb the body — the body being large — unless some other beginning were also forming. In time, if further bile is generated, it harms the person more; but if none is generated, it would filter through the body so that the bile — and all bilious things — are expelled. For some of what is eaten and drunk acts as a remedy against others; in the same way the other things that are harmful — when one thing entering the belly displaces another, it filters out what is responsible by its own capacity, and the person is unharmed. But when fresh bile is generated in the body from what falls into the belly, disease arises from it. In this account I have shown how and why bile becomes more in the body from foods and drinks, and that the region upon the liver draws into itself, by likeness, what is bilious from foods and drinks. Now I will speak about the watery kind (ὕδρωψ): how and why it becomes more in the body, and how the spleen draws it into itself.
37 [20]
I hold that when a person drinks more, both the body and the spleen draw water into themselves from the belly; and if the spleen draws more than is fitting, the person immediately feels pain — and those among people who have splenic trouble perceive this happening. When the spleen has drawn, it is best if the old water already in the spleen is filtered off through the bladder or the belly, and these are thus cleared out; for the water is not purged from the spleen by way of the upper passages, save only as much as is present in the vessels leading from the spleen — but the sole purging is into the belly and into the bladder. If these are not flowing freely and the water is not filtered out, the water passes from the spleen downward; there it mixes with the rest of the moisture; and if it is little, it would not disturb the body, but would be filtered from the body into the bladder and into the belly through the vessels — for there are many vessels stretching down from this point, which draw into themselves from the lower regions when they have become drier than they were before. But if more water keeps being generated, and the belly and the bladder do not filter it outward, the spleen swells, and the lower parts of the body become painful. I have said this — how and why water becomes more in the body from drink, and how the spleen draws. Now I will speak about blood: how and why it becomes more in the body.
38 [25]
When a person drinks or eats what is blood-like, both the whole body draws into itself, and the heart draws the blood-like element into itself; and when it draws more, no pain arises in the heart from this — for the heart is something solid and dense, and for this reason it does not suffer pain; and from it the thick vessels called the jugular vessels stretch out, into which, if more is added, the blood-like element is quickly distributed, and these, filling up, quickly give it to the head and to the body; and when something blood-like is eaten or drunk, immediately the jugular vessels swell up and the face flushes. When more blood than is sufficient is added to the heart and the body from foods and drinks and mixed with the rest of the fluid — if it does not pass out through the belly or through the bladder — mixed with the rest of the moisture in the body it causes pain; but if only a little is added, it would not disturb the body, but in time is distributed from it into the belly or by way of the nostrils, and some is filtered outward and they are unharmed; but if from a small amount a greater one arises, it becomes disease-prone. How blood becomes more has now been explained by me. These four — blood, bile, phlegm, and the watery kind (ὕδρωψ) — it has been set out for all of them how and why each becomes more in the body from foods and drinks. That they do arise from these, the following is a sign: if a person eats little and drinks little, this brings on no disease. So much have I said on this; and I have touched on showing to the attentive reader how these things become less — I will make this clearer a little later. The sources I have named, when they are full, are always giving to the body; when they find themselves empty, they draw back from it; and the belly does the same.
39 [5]
For it stands thus, as if someone were to pour water into three or more bronze vessels, set them on the most level ground he could find, and having fitted them together as well as possible, were to arrange them with pipes fitted into the holes — and then were to pour water quietly into one of the bronze vessels until all of them become full from the water. For from the one it will flow into the other vessels until those others too are full. And when the bronze vessels are full, if someone draws off water from one of them, the water will flow back again into that one vessel in return, and the vessels will be empty once more, just as they received it.
So indeed it stands also in the body. For when food and drink fall into the belly, the body draws benefit from the belly and is filled along with the springs; and when the belly is emptied, the moisture is given back again in return, just as the one bronze vessel received from the others.
For there are vessels running through the whole body, some thinner, some thicker, many and close-set; and these, so long as the person lives, stand open and both receive and release fresh moisture; but when he dies, they close and become narrow.
So long then as the person lives, the body draws benefit from the belly whenever it has something in itself; and the springs draw benefit and, being filled, distribute to the body. For if the body did not draw from the moisture of the belly, but only the springs did, or if they did not give it to the body, the body would not have sufficient nourishment, but less. For the springs would no longer be distributing their nourishment through to the body.
And if these springs did not exist, when we eat and drink we would not recognize clearly either what is pleasant or what is unpleasant, by the following necessary process which I am about to explain. These regions, being smaller and lying inside the rest of the body, always interpret to the rest of the body — even before each thing makes its way in, each according to its own capacity — what among the things eaten and drunk is of a bile-like character, what is of a phlegm-like character, what is of a blood-like character, and what is of a water-like character. For whichever of these comes to be more than the right measure in both drinks and foods, those things do not become pleasant; but those things which the body most lacks in these respects are pleasant.
And if one of the springs is deficient in food and drink, in accordance with this the body also will draw the moisture from them until it becomes less than the right measure; at that point the person longs to eat or drink something of such a kind as will fill that portion and bring it into balance with the others. And for this reason, after eating or drinking much, we sometimes long for a particular food or drink, and we would not gladly eat anything else except what we long for; but when we have eaten and the moisture in the springs and in the body is brought into balance as much as is achievable, then the longing ceases for him.
And so much has been said by me on this. There is also this: that into the region over the liver, bile alone is separated out from foods and drinks. For the small vessels, being weak and narrow, cannot draw the other moisture which is thicker and heavier; and at the same time there is not room enough for the other moisture to be in this region. Furthermore, this region is naturally most habitual and congenial to bile, and for this reason no other disease comes to be in it except what people call heartburn.
40 [25]
The head, the heart, and the spleen each partake of all the moisture. Each, if it is not diseased, partakes most of what is natural to it among those mentioned: the head of phlegm, the heart of blood, the spleen of water. The vessels draw into themselves some of the other moisture as well, being wide and thick and coiling; so that when they draw, one part of the other moisture follows another.
Close to the heart are the jugular vessels, being thick, into which what exceeds the right measure is quickly distributed; and these distribute it to the rest of the body. At the same time the heart itself is solid and dense, so that it does not fall sick from the moisture, and for this reason no disease comes to be in the heart.
But the head and the spleen are most prone to disease. For they fall sick from what is naturally in them, whenever more than the right measure accumulates; and they fall sick from the other moisture as well. For there are thick and numerous vessels leading into them, and they themselves are very full of vessels and hollow within, so that there is room enough in them for the other moisture as well, which passes in little by little and mingles with what is naturally there — just as in a large vessel there is much more room than in a small one, so it stands also with the head or the spleen. For the roominess of these regions is greatest within them. And if the vessels there are filled full of moisture, disease arises in them from that.
These things have been said by me on this point now. I wish to set forth more clearly how each kind of this moisture becomes less in the body.
41 [10]
I have shown that four fluids, being present, harm the person, and that there are four springs for them; and I say there are four things by means of which the person is cleansed of each of these. These are: the mouth, the nostrils, the rectum, and the urethra. And whenever one of the harmful fluids becomes more than usual, if the person is cleansed of it through one of these, no disease presses upon him from it. And if the belly is not full, as the body melts, moisture flows down from it into the belly, and passes out through one of these passages, and by this means the fluid becomes less in the body.
For the body, as I have also said before, gives to the belly when it is empty, and draws benefit from it when it is full. These things have been said by me, both how and why the things that harm the person become less. And now I will say how and why the person is in health.
42 [10]
When he has eaten and drunk and the moisture reaches the body — having been mingled in the manner described both with the other moisture in the body and with that in the spring — on the one hand, on the day on which it arrives it remains in the body; on the other hand, on the next day another moisture is added to it. These are two days; and there are two moistures in the body: for one of the two moistures there are two days, and for the other there is one day.
The one that has remained behind stays in the body, being thick; but the other, having been concocted by the warmth, is dispersed, and becoming thin it arrives on the next day into the belly, having been driven out throughout all that time by the new moisture. Having come into the belly it concocts the food in that place, and from itself makes blood in the body; but having stayed, it has over time become foul-smelling.
On the third day it goes out together with the excrement and the urine, being in quantity equal to, comparable to, and balanced with its own whole bulk; and even if some part of it remains, the moisture nevertheless stays in the body in accordance with the account given. On the third day there also flows down from the body onto the belly more moisture, and what is left over — having become more foul-smelling from the other — flows in excess; and it carries down the food that has been concocted and whatever is diseased in the body, and then comes together again. And salty urine signals that it is carrying down from the body what is diseased.
The food passes through on the next day, the moisture on the third day. In this way health comes about. And these things have been said, how and why persons are in health.
If this moisture were to pass out in part on the following day, the food would not go out from us from the belly having become foul-smelling in the same way, but rather as if boiled; and the urine would resemble the drink; and the body would be always emptied; and the person would constantly need, whenever he had gone to stool and urinated, to drink and eat immediately in proportion to what he had evacuated, if he were to have strength — with no sufficient moisture remaining in the body, but going out with the excrement the next day or the same day. And if he had eaten something, well and good; but if not, having been emptied he would be without strength and could not become well-nourished, if the moisture were to go out on the following day. For sufficient moisture is not left behind in the body.
43 [5]
As it is, when we have gone to stool we move easily, and we endure for two days without eating anything, to remain and do something, and we do not become entirely without strength from emptiness in that time. For the moisture remaining in the body provides the strength.
And these things have been said by me, both how and why it is not possible for the moisture that has come from nourishment to leave the body on the same day, and not even on the following day.
I say moreover that if the moisture remains in the body more than three days, or if another arrives in great quantity as the vessels fill up and warm and become distended, it signals an evil to the person, either a greater one or a lesser one — lesser and later in winter, greater and sooner in summer.
44 [25]
These things have been said by me, what comes to happen if the moisture remains in the body. And if the food were to pass through the body, it would not give us enough benefit from the moisture to be sufficient; and people would be thin and weak. As it is, while the foods and drinks remain — for as long a time as they stay — the body draws benefit quietly, drawing from the belly, and is filled.
These things have been said by me, both how and why the food cannot go out on the same day.
If the food remains in the belly longer than the necessary time and other food falls into it, the body may become filled; and when the vessels are pressed by the fullness, warmth and pain may come upon the body — sooner in summer, later in winter. For in summer what surrounds the person is warm, and draws warmer pneuma into itself; and if, with the belly still warm, pneuma warmer than the right measure comes upon the person, it is no wonder that the person comes to be in fever from such a thing. In winter, when the cold draws pneuma into itself, the body of the person could much better bear up against the fullness when he evacuates a little.
These things have been said by me, what comes to happen if the food remains in the belly too long a time. And I have touched upon setting forth everything about the moisture and the eating — the difference of the longer and the shorter time, why persons fall sick. I will make this clearer as time goes on.
I will go back again to speak about health: that the body of the person draws benefit from moisture coming from foods and drinks, and in the healthy person the foods and the moisture go out according to the account given.
45 [40]
If more moisture goes out than came in from food and drink, the person becomes thin. And more goes out than came in for the following reason: if the person is at rest and not laboring hard, there is something bad in the body, but because of the other healthy condition being great it does not press severely; and the bad thing is of this kind: when one of the four things arising in the body comes on in excess — not by much — the body is warmed quietly, so as not to press hard, and melts into the belly, and makes food unpleasant to the person. And if one moisture is more than another, fever comes to the person from this. But about this I will set forth more precisely a little later.
There are also times when a person becomes thin even though the food is pleasant, the cause being the same. When these things happen, more moisture goes out than is being laid down; and for this reason it befalls the person who is at rest to become thin.
When persons are laboring hard, the body is also warmed; for from the labor the body being warmed, the moisture in it is also dispersed, and becomes thin; becoming useless it flows down both into the belly and into the bladder, and these filter it out; and some of it evaporates outward through the inner rarefaction; and some of it, remaining behind and becoming sweat, goes out through the body.
Likewise the exercises of the young accomplish the same thing as hard labor.
If the moisture is less than what had previously gone out, and no other comes in yet from drinks and additionally from foods, the person becomes thin for these reasons; and less comes in if he is not able to eat anything else.
And with respect to enduring labor, what becomes less differs from one person to another in comparison to the earlier labor or exercise.
Good condition arising from eating comes about for the following reason: when it dries out in the time of the moisture, and during the earlier labor one moisture sometimes goes out more than another, and one comes to dominate the others strongly — this is fullness (πληθώρη). If it is dominated strongly by many, fire arises from such a condition; if by few, little. And the body is able to bear up against it in this way, with more moisture being in it, [so that on the same day] it is freed from the warmth. For the body is warmed by the fire. And if the troubling thing is small, it lets it go on the third day in the same manner, holding it continuously for the two days; and if it is more, on the fifth day, holding it for the four days in due proportion. In this way diseases are decided by days, when the fire lets go.
In the odd-numbered days too the person both becomes healthy and dies; and why, I will explain a little later. Now I will say why the fire lets go.
46 [35]
I say that if fire takes hold of the person from the body, the troubling moisture must necessarily leave the body on the third day, or on some other of the odd-numbered days, in accordance with the account given before. For it does not go out before another good moisture comes to it from the belly. For on the middle day and on the following day the body draws from the belly whatever it released into itself on the previous day, unless the belly should filter it through and acquire another moisture; and this becomes bad for the person.
But if the fire lets go on the third day, it lets go by the same means by which it was said to let go on the same day. And so it comes about that fire arising from the body lets go on the third day. I say also that if it lets go on the fifth day, and if on the seventh, and if on the ninth, it lets go by the same means as the tertian goes out. For the nourishment of the fire is in the regions of the kind I spoke of a little earlier; for when the larger amount of moisture prevailed, the person was relieved.
Fire lets go on the odd-numbered days for the following reason: on the even-numbered days the body draws from the belly, and on the odd-numbered days it releases; and the belly filters outward in the healthy person.
By this necessity diseases are decided on the odd-numbered days. And in this account the person who had fever became healthy.
I say also that those who are sick suffer most on the odd-numbered days, and this happens in due proportion for the following reason. The person is disturbed whenever he is in fever; and the sign of this is that shivering runs through the body now and again; and this would not happen in this way if the fluid were not being disturbed and separated from itself — now more, now less — and did not dominate now one thing, now another. It is most disturbed on the odd-numbered days, when he is sick, and shivering occurs most at that time.
For it stands thus: from the troubling fluid something is pushed out of the body, overcome by the newest moisture, and passes into the lower belly; and the belly is additionally warmed together with the troubling fluid it receives into itself more than in the time before. This happens especially at the crisis of the disease. And if the body releases into the belly little by little and the troubling thing is not great, the belly and the body are able to bear up against the warmth at the crisis, and the person becomes healthy when the troubling moisture has gone out and the nourishment that fed the fire has been consumed, and the healthy moisture prevails. In this account the person who had fallen sick became healthy through the causes stated before.
Now I will say why persons die on the odd-numbered days.
47 [10]
I say that if the troubling thing in the body is great, it is disturbed more than is right, and it passes wholly into the belly; and the body being unable to bear up against the warmth draws benefit, and foul odor must arise concerning the breath; and the body being unable, through weakness — since all the fluid has become diseased — to draw the breathing so that what is in the belly may be cooled, all the vital part of the fluid evaporates outward, and in this way the person dies.
For the healthy moisture does not prevail; but all of it, being carried up by the diseased fluid which is great, consumed by the fire, has evaporated away.
So it is that the suffering is greatest on the odd-numbered days — this every person who has ever had any experience knows.
Moreover, that the fluid is disturbed on these same days, the following is a sign: those patients who were already being held by continuous fire and were given a drug on the even-numbered days — these were not excessively purged. But those who were given a strong drug on the odd-numbered days were purged to excess, and many died from being over-purged.
The physicians of old erred most in this very thing: they gave drugs on the odd-numbered days and killed people, not knowing that the matter stands in this way. For the fluid in the body of the sick person is more disturbed on the odd-numbered days, seeing that the body releases its moisture into the belly; and if someone disturbs still further what is already disturbed by throwing in a drug, it is no wonder that the person perishes from such things.
Wounds also become inflamed most on these days; for the fluid goes into all the vessels when it is disturbed, and fills them; and when the disease comes to the wound, if it is cared for and the pus has an outlet, being pushed out by the fluid that has come in the disturbance, the wound is cleansed outward. But if it is not cared for, the pus having no outlet, remaining there together with what has come down, causes pain and lifts the flesh around the wound. And from that point, if the wound is in the legs, the vessels that are in the junctions of the legs are raised; if in the hands, those in the junctions of the hands; and from this, swellings in the groin arise.
48 [25]
In those persons in whom fire falls while nothing else bad is present in the person, it falls from what is fattier than the right measure; and the vessels, being filled, produce pain and warmth in the wound. What has been warmed also warms the rest of the body; and the warming comes to the wounds in this way. For the body and the wounds are warmed by the agitation of the fluid, and hard labor produces the same thing.
Wounds become free of inflammation (i.e., lose their inflammatory heat) on the fifth day, and in due proportion with these days — as the wounds may have magnitude — on the third, fifth, seventh, ninth, and eleventh day. Then, when the first cycle has been completed, the beginning of the second is the third day again, which is the fourteenth from the first; and the largest of them become free of inflammation on the fourteenth day.
This account will show that diseases are decided on the odd-numbered days, and that in the healthy person the moisture goes out on the third day and the excrement on the second day; and these facts, being on the third day, confirm one another that it stands so.
Thus has this whole account of mine been brought to its peak. Now I wish to say more precisely why persons fall sick; and I will say together with this account what the origins of diseases are, and what each of them produces.
49 [5]
I maintain that if foods linger beyond the proper time, already having undergone pepsis, and the person is not purged, and further foods come on top, the body, being filled by the moisture of the earlier food and the new, grows heated, and fever arises for the person from this. The fever arising in this way is neither intractable nor severe, so long as the moisture troubling us is roughly balanced in quantity, being only slightly in excess; for if this is how it stands, and someone is quite strong and applies the fitting measures, he becomes well. But from all this moisture one disease alone arises, and it has seven signs: a cough seizes him — faint and dry — and the belly becomes hard, since the stool is retained within; and he feels heaviness in the head, and vomits, and has fever, and the urine does not pass properly. These are the seven signs of this disease arising from the total moisture. But if, when the stool is not passing through, one moisture prevails over the others, the person will manage much better. And if someone with fever arising from the total moisture does not apply the fitting measures, the disease will be carried around for as long as it has mastery over the moistures, in the following way: as the body heats, the watery element — which is most hostile to fire — evaporates through the body most of all; and what is left is the oily and light element, which is bile-like and is best suited as nourishment for fire. It evaporates in this way: just as if someone poured water and fat into a bronze vessel and kindled many logs beneath it for a long time — the water would be greatly diminished, for it would evaporate out of the vessel; while the fat would be only slightly diminished — because water, on account of its looseness, can be thinned by fire and, becoming light, can evaporate, whereas fat, being cohesive and dense, cannot be thinned, nor can it evaporate in the same way as water. So too it is in the human being: the dropsical element, as the body heats, evaporates outward; but the bile-like element, being cohesive and dense, cannot evaporate through being thinned in the same way; and the bile-like element, being left behind, causes the body to heat more; for nourishment for the fire becomes more plentiful and better, and spreading through the body or taking hold, it strengthened the disease beyond what it was before. And all this has been said about what the person suffers if he is not purged and cared for. But if the disease does not master them by sheer quantity — whether it has become great all at once or is collected little by little — and the rest of the body is in pain, the person, because of strength, bears this up until some beginning supervenes; and if the excess fluid that has formed is not purged out of the person, disease arises from that point in the following way.
50 [30]
There are three origins from which diseases arise. The first has already been set out by me — what sorts of things it produces in the body; for I have shown how and why, if a person is not purged, he falls ill. The second is if conditions from the sky turn out to be unsuitable and contrary to diaita. The third is if something violent befalls; and by violent I mean a fall, a wound, a blow, toil, and anything else of that sort. Of these origins, violence is the greatest — when it is great; when small, it is not the greatest. The second is if the person is not purged. The third is if conditions from the sky are unsuitable for health. One must therefore be on guard against all of these. Each of them produces the following in the body, as I will explain. If a wound is sustained, clearly the flesh has been cut through and a sore has resulted; this I call a disease. If a bruise results from being struck or from a fall or from suffering something else of that kind, and swelling occurs — the blood, immediately heated by the violence and having flooded into the opened veins, being unable to find an exit on account of its quantity, was compressed, and the swelling arose for this reason and persists until it is purged according to what has been said regarding the places, or until a passage is made for the blood — whether by surgical intervention or not — through the swelling itself, either through suppuration in time or not. And toil produces the following: whenever people are subjected to toil, wherever the blood is most affected by the toil, there it fixes and heats, and pain arises from this. If the toil does prevail over these and produces a very great quantity, and the belly and bladder cannot filter off the quantity rapidly, fever would come on from this. And if the prior moisture is in balance, not at all; but if during the toil the greatest portion of moisture remains in the body, that portion prevails. This has been said by me about violence, what it works in the body. And these two origins — violence and excess of repletion, if people are not purged — heat the bodies. The unsuitable influence from the sky, when it has arisen within the person, gains mastery over some of the fluid and heats it toward disease, or chills it, whichever happens to occur; and I will speak first about how it heats.
51 [45]
I maintain, then, that if there is already something morbid in the person — of the kind I spoke of before — and the conditions from the sky become unsuitable, and the person is heated, then all the fluid in the body, being heated, is thrown into turmoil — and this is what the violence does; and if the person is purged while it is being thrown into turmoil, whatever is in excess of due measure is separated off. This resembles what the Scythians do with mare's milk: they pour the milk into hollow wooden vessels and shake it; as it is agitated it foams and separates, and the fat portion, which they call butter, rises to the surface, being light; the heavy and thick portion settles to the bottom, and when they have separated it off they dry it; when it has set and dried, they call it hippake; and the whey of the milk is in between. So too in the human being: when all the fluid in the body is thrown into turmoil, all things separate according to the principles I have described — the bilious part rises to the surface, for it is lightest; second comes the blood; third the phlegm; the heaviest of these fluids is the dropsical element. This being so, whatever is in greatest quantity in the disease, at the onset of the turmoil, makes its way to the place where it is most abundant; and in the turmoil, as room opens up, it circulates in a separated state and heats the body, or, taking hold somewhere in the body together with the other fluid present in that other place, it causes pain and heat. What is being heated in turn heats the rest of the body, and from this fever arises — arising more from bile and phlegm and from blood, for these are hottest; and if any of these takes hold somewhere in the body, for the most part the disease is named and takes its designation from that place. From the dropsical element no fever arises that is very strong or long-lasting, for the dropsical element is not good nourishment for fire. And so much has been said on this. Before the turmoil takes place, the excess fluid has no way to withdraw but circulates up and down mixed with the other fluid; for all things are full; in the turmoil, room is vacated; one part is vacated more than another, and the more abundant element takes possession of the place; the foreign element does not mingle with the rest, if it has taken firm hold, until it is equalized in strength; it can be equalized, and whatever from it would return to the disease — until the place is purged, whatever form the purging takes. If what is afflicted is great, it draws upon and consumes what was previously healthy, and the person dies in this manner: for if the disease no longer has sufficient nourishment, it draws upon further, and what is in the afflicted place consumes the fluid in it; it first takes what is near, then spreads to what is further, until everything is consumed and there is no longer nourishment in the body — and the nourishment of a person is the light fluid. Just as at first decay came about little by little, especially where there is most heat, then when the nourishment there is no longer sufficient for the decay, it spreads from the healthy neighboring part outward through the body until it has rotted all the fleshy matter; and when it has spread through all of it, the nourishment is used up by the decay: so too with the disease — beginning from that place, when the nourishment there is no longer sufficient, it spreads forward beginning from what is nearest; for when it has spread through all, the nourishment is consumed by the disease, and no further healthy part holds its ground, and if this occurs, the person dies.
51 (50) [75]
Furthermore, in the turmoil, when this element takes hold of more space and does not fix in place but circulates, it no longer mingles with the rest, but is consumed into the disease, if purging does not occur; then the veins are overfilled, and being very full they do not let it out of themselves until room is made for them. Just as when someone is struck hard, blood runs under the blow — since the veins have been emptied by the blow — and when the flesh is as full as a sponge, it no longer lets it go but holds it within itself until some of it is vacated in some part; for when it has gathered, the blood blocks its own passage by sheer quantity. As if someone filled a narrow-mouthed leather flask with oil and turned it upside down mouth-downward straight, even if he did this, the oil could not flow out of it — for the oil chokes the passage, being so much and pressing all together upon it; but if someone tilts the flask, the choking at the mouth is freed, and the oil will flow out of it; and the same would happen with water on a flat surface. So too when the excess fluid in the body takes hold of a place during the turmoil and fills the veins, it no longer departs from them until the place where it is has become vacant, as the nourishment is consumed by the disease. And this has been said by me about when certain conditions are present in the body from which diseases arise, and as other things grow in excess, and how the origins bring about heat and turmoil, leading the fluid into disease. Now I will speak of the things from the sky, if they arise unsuitably and grow in the body, what they produce and when they prevail over the fluid in the body.
52 [5]
I maintain that some of the moisture in the person contracts and thickens — when it melts until it gives rise to disease — while some expands and separates. This condition too resembles milk: when someone drops rennet into milk, a chilling that comes over the milk itself thickens the milk and makes it cohere, and around the thickened mass is the whey; so too in the person, when a disease-causing chill comes on, the fluid contracts and thickens; and around the dropsical element itself there is still the rest of the fluid, which, however much more there is throughout the rest of the body, is mixed in with it. But if it comes into the belly, it disturbed the stool and produced gripping in the belly and passed out, doing no great harm; if it does not come into the belly, it fixes somewhere in the body where it finds the most room. It circulates, having found room for itself, and of the dropsical element, what is separated out from the contraction — being coldest and heaviest in the body — travels downward, and circulating around the bones and around the sinews (neura), brings the body further into inflammation; and it is clear that around the sinews and most of all around the bones, the dropsical element is what produces the chilling. For it is in the bony parts of the body that the person shivers most, and the hairs stand upright as the skin contracts and becomes drier than before, since the dropsical element has left there and collected around the bones. From that point on, only the place where it is at first is unable to produce chilling, and from this the shivering also arises. The rest of the fluid, thickened in the most equal degree, is partly throughout the whole body; and the excess of it — if the belly does not happen to be full and there is only a little of the troubling element — sometimes comes into the belly and did no great harm, and sometimes did not bring on fever, and sometimes brought on one that was faint and harmless, and the troubling element passed out with the stool. But if the belly, being full, contains a large quantity of the troubling element, there is danger that some disease arises from it, if the harmful thing takes hold somewhere — against a rib, or against a visceral organ, or heats together with something elsewhere, where it first stirred things up. That one, not much overcome by the heat — having been subdued by the dropsical element, being around the bones and near the marrow — over time presses further inward: first into the very place itself, then into what is near it, and then spreads to what is further, and the belly takes it up, being warm; and then both the belly and the afflicted part heat more. The thick fluid, as it is heated, is dispersed first in the part nearest to the afflicted spot; being dispersed, it mingles with the afflicted dropsical element, and then the body has become emptier in the contraction, and the shivering persists until the dropsical element is mingled with the other fluid. And fever is generated in this way: the afflicted parts, having taken hold against a part of the body and heating, compel the body to receive fire into itself; and heated by both the afflicted part and the belly, it gains the upper hand over the rest of the dropsical element, and so the fire follows the chill when the excess fluid takes hold somewhere in the body.
53 [5]
But if it circulates, the fever after the chill arises in the following way: it circulates, being especially distressed around the belly — both upper and lower — for that is where the greatest room is; and as it circulates, the nearby parts are first heated — the viscera and what is in the belly, toward warmth; then the rest of the fluid, being dispersed, also partakes of the warmth, and mingles with the dropsical element, and the fever after the shivering arises here, when the afflicted element circulates rather than taking hold somewhere in the body. This has been said by me: how the morbid shivering arises, and when and how and by what necessity the fever falls upon after it, and what are the origins of diseases, and what disease each of them brings into the body, and how and why diseases are resolved on the odd days, and by what people are healthy and by what they fall ill, and how bile and phlegm become more and less, and many other things that are naturally in the body I have demonstrated — as many as this account permitted — and these having been said, this is complete. Now I will speak about flat worms; for I maintain they come to be in the child while it is still in the womb. For it is not the case, once the child has come out of the womb, that the stool has had sufficient time in the belly to putrefy and linger so that a living creature of such great size is formed in it; for the person always passes the previous day's stool every day, if he is going to be healthy; and such a creature would not come to be even if the person had not passed stool for many days.
54 [45]
Many things come to be in the child while it is still in the womb, in the following way: when fiery pus is generated from milk and blood putrefying together and increasing, since this is sweet, a living creature is generated there; and round worms are also generated there in the same way. A sign that this is so: when children are born, the women give them to eat the same medications, so that the stool passes out of the intestine and does not become scorched, and at the same time the intestine is widened; and when they administer the dose, indeed many of the children have passed both round and flat worms together with the first stool; and if they do not pass stool, they also develop in the bellies. The round ones reproduce, but the flat ones no longer do. And yet people say they do reproduce; for the person who has the flat worm passes stool containing, from time to time, something resembling cucumber seed alongside the stool, and there are those among people who have said these are offspring of the worm; but those who say such things seem to me to speak incorrectly; for such numbers of young could not arise from a single creature, nor is there room in the intestine to nourish offspring. In the child growing from the womb, the worm in the intestine also grows from what enters the belly, and becomes equal in length to the intestine — in some by puberty, in some later, in some a little earlier. And when it has become equal to the intestine, it grows along with it in like manner, and however much more there is, it is separated off from the rectum along with the stool and falls out like cucumber seed, often even larger pieces; and in some, when they are walking or undergoing toil and the belly is being heated, it comes down, and what has grown out protrudes from the rectum, does the same thing, and is either separated off from the rectum or goes back again. The evidence that it does not reproduce but stands as I describe is this: when someone treats the person for the worm and gives a medicinal drink — if the person happens to be well prepared — the whole worm comes out, having become round like a ball, and the person becomes well; but if he goes straight to the medication, a length of two or three cubits, or even much more, breaks off from the worm, and when it breaks off, for a long time the signs do not appear with the stool, but afterward it grows again; and these are observations showing that the worm does not reproduce but breaks off in pieces. Its appearance is like a white scraping of intestine. The signs it presents: from time to time the person passes stool resembling cucumber seed, and when the person is fasting, from time to time it rushes toward the liver and causes pain; and sometimes saliva flows into the mouth when it rushes toward the liver, and sometimes not; and in some it produces speechlessness when it falls forcefully against the liver, and a great deal of saliva flows very strongly from the mouth, and a little later it stops, and a great deal of gripping comes about in the belly from time to time; and sometimes pain falls in the region of the back, for it takes hold there too.
54 (50) [5]
Sometimes these are the signs of the flat worm; and the following also occurs: the one who has this creature, over the whole of his life, would not suffer anything very dreadful from it, but when he falls ill he recovers only with difficulty; for the worm too takes a share of what enters the belly. If then he is cared for in the proper manner, he becomes well; if he is not cared for, it does not come out on its own — yet it does not bring death, but grows old alongside him. This has been said by me concerning the flat worm: where it comes from, its signs, and the signs of the disease. Concerning the stone: the origin of the disease arises from milk, when the child is nursing milk that is not pure; and the milk becomes impure in the nurse when she uses phlegm-laden foods and foods and drinks that are not clean; for everything that falls into the belly contributes to the milk.
55 [45]
This too holds in the following way: if the wet-nurse is not healthy, but is bilious, or dropsical in character, or bloody, or phlegmatic, the milk becomes bad for the child — for the nurse's body and belly together make the milk poor, and whatever the nurse has most of in herself she draws most of into the milk. And if the child suckles from the nurse milk that is not clean but bilious, as I said, the child becomes sickly and weak, and is troubled most by its present condition, so long as it suckles bad and disease-ridden milk. And when the child suckles milk that is not clean but earthy and phlegmatic, and the child has the blood-vessels that stretch from the belly toward the bladder wide and drawing, and the drink and the milk pass under the nurse's influence into the belly of the child — whatever is drawn from the belly from the milk, everything in like manner that the vessels are able to push through into the bladder — and if there is anything unclean in the milk, what settles in the bladder becomes a stone in the following way.
Just as when impure water is stirred in a cup or a bronze vessel and then settles, a great deal of sediment forms in the middle — so too in the bladder from the urine, when it is not clean. And it is not voided through urination, being lodged in the hollow, and especially when gathered, it does not pass through the urinary passage on account of pain. And it congeals because of the phlegm, which is raw — for the phlegm mixed into the sediment acts as a glue for it — and at first a small scum forms on top, then the incoming sandy matter accumulates, with the phlegm present in the bladder from the milk serving as glue, and it grows; and whatever liquid forms on the adhesion is urinated out. Then the sediment is solidified or becomes stone-like — just as iron comes to be from stones and earth fired together, and at the first casting into the fire the stones and earth are bonded together with the slag, and when it is cast into the fire a second and a third time the slag flows out melted from the iron, and what has been produced is visible to sight; and the iron remains in the fire and contracts as the slag gives way, and becomes solid and dense — so too with the sediment in the bladder: with the phlegm acting as glue, what is melted by the urine is voided, while the sediment contracts and becomes dense and solidifies like iron.
And when it has contracted and solidified, it is shaken up and down in the bladder and causes pain by striking the bladder, and carries off something from it when it strikes and scrapes hard; and what is carried off makes the incoming sandy matter congeal still further; and the stone forms in this way from the milk in the bladder.
Sometimes a blockage forms at the genitals, or some other obstruction arises from this stone; for at times, when the child tries to urinate, the stone quickly blocks the urethra. And if, when the child is already growing, a stone forms from earth-eating, the pain is not present before the child takes up food on its own.
So much has been said by me on this matter. The disease has five signs: whenever the child wants to urinate, it is in pain; and the urine flows out little by little, as in cases of strangury; and it is somewhat bloody, as the bladder has been ulcerated by the stone; and the bladder is inflamed — though this last is not visible. A sign, however, is the foreskin; and sometimes sandy matter is voided through urination.
55 (50) [5]
Such things as I shall describe are voided through urination. Sometimes two stones or even more — each one small — form by the same method as the one I have described. It also comes about through the following: when the stone has consolidated and the sand that has formed separately comes to settle in the bladder, if the stone does not take the sand up into itself but the sand becomes too heavy and too abundant to congeal onto it, in this way two stones form; and more form by the same method; and when they knock against each other in the agitation, sandy matter is chipped off around the edges and voided through urination. There are also times when sand comes down into the bladder and does not congeal onto anything.
Certain people say that what is drunk goes to the lung, and from there into the rest of the body; but those who say this are discredited by what I am about to say: that the lung is hollow and a pipe is attached to it. If the lung were not hollow and the pipe were not attached to it, living creatures would not be able to voice sound; for we speak by means of the lung because it is hollow and the pipe is joined to it. The lips and tongue articulate the sound. This matter has been set out more fully by me in the treatise on peripneumonia.
56 [45]
I shall oppose those who hold that drink is carried to the lung. The matter stands thus: the drink goes into the belly, and from the belly the rest of the body draws its share. One must attend to what I am about to say. I set out the following observations from experience that the drink does not go to the lung but to the belly.
If the drink went to the lung, whenever the lung became full, a person would not, I maintain, be able to breathe easily or to voice sound — for there would be nothing to resonate when the lung is full. That is one observation.
Next, if the drink went to the lung, the food in us, being dry, would not be concocted in the same way. Those are two observations.
And the purgative drugs, when we drink them, pass out through the belly. This too holds in the same way: all drugs that are purging — whether upward or downward or both — do the same thing: they all burn greatly, and the strong ones, if they happen to touch any of the soft parts of the body, cause ulceration; and the milder ones cause irritation of the skin wherever it is smeared. If any of these drugs were to go to the lung, it seems to me it would do great harm; for the phlegm from the head causes ulceration in a very short time — for the lung is a delicate and porous thing, and if ulcerated, that person will be in a bad way for many reasons.
The belly, however, is not ulcerated by the drug, because it is a tough thing, like leather; indeed most of the Libyans among their livestock use the hides as garments and the bellies as bags — for the belly is a tough thing.
Moreover, when people are well-soaked with dark wine, they pass dark stools. All these are observations. And when we eat garlic or any other strongly odored food, we void urine that smells of the food.
These are the observations. One may also consider the following point I am about to make: if someone were to drink a kykeon or slurp boiled barley-meal or something else of that kind, and this were to go to the lung, I think the person would not live even a short time; for when even a little phlegm goes to the lung or its pipe, a great and violent coughing-fit and convulsion follow. If indeed a person does live after drinking the kykeon or slurping the barley-meal, then as the slurped food is being concocted — I think there would be great and violent heat in the body and great pain, so that the person would not pass stools normally, if it had gone to the lung.
Those are seven observations. Then, how would milk nourish children if it were to go toward the lung? That is another observation for me; and I would not have brought such an observation into my argument at all, were it not that a great many people believe that drink goes to the lung, and it is necessary, against what is strongly held, to bring many observations from experience, if one intends to persuade through one's own arguments someone unwilling to turn away from their prior opinion.
56 (50) [5]
And for this reason drink does not go to the lung but to the belly: because the gullet of a person is always gaping open, touching it, and the drink goes into that, and at the same time it lies over the pipe of the lung like an ivy leaf, so that it would not let anything slip past in the act of swallowing, if the drink were going into it.
So much has been said by me on these matters. The drink goes into the belly, and when it is full, the spleen receives from it and gives to the blood-vessels and to the omentum and to what is lower down — to the scrotum and to the legs and to the feet; and when disease supervenes, it passes in large quantities of water through the belly, and there is always influx to the spleen from the drink whenever a person drinks.
57 [45]
In this disease it comes about that there is no fever, unless there is some burning in the belly, or when the person is thirsty and the bladder and the belly are not filtering properly, and the person does not follow a suitable diaita (regimen / ordering of life). The spleen, being somewhat diseased, draws from the belly from the drink; the disease sets in; the scrotum becomes transparent; the collar-bones and the neck and the chest become wasted — for they are consumed by this disease and flow down into the belly; the lower parts are full of water; the belly takes in no food; sometimes it holds very tight, sometimes it runs; and the bladder does not filter properly. For the most part, shivering darts through the body now and then; fever sometimes seizes them; and the face becomes swollen in some cases, not in others. In some the shins actually break down when the disease becomes prolonged, and water flows from there; sleeplessness falls upon them, and weakness of the body and especially of the loins; and whenever they eat or drink even slightly more than they can bear, the spleen is pained, and the pneuma (breath / moving air) is always expelled in rapid, frequent bursts. These are the signs of dropsy.
There is also the kind limited to the belly alone, with or without fever taking hold — the abdomen becomes large, and the legs are not filled with water, and the upper parts of the body become thin. In those who are in this state all the signs are milder, and at the same time water does not also supervene in the legs, and the suffering is proportionally less. Dropsy limited to the belly alone comes about for this reason: when a gathering occurs and no passage toward what is below is established at the outset, but the gathered fluid is cut off in the small vessels, having no outlet either upward or downward, it holds its position.
Just as if someone were to take a large vessel with a small mouth and quickly invert it, and then quietly remove what was covering the mouth — if he did this, the water would not flow out; for it has no air-passage, but is closed off by the pneuma within; for the pneuma enclosed within fills the vessel and pushes back against the pneuma outside, and the water has no outlet because of the pneuma filling the vessel while at the same time the air presses down from outside. But if one were to tilt the vessel quietly or make a hole in the bottom, the pneuma would exit from the vessel; and as the pneuma exits, the water too passes out.
So too with dropsy: if an air-passage forms either upward or downward through the small vessels at the start of the disease, the dropsy goes to the legs and to the feet; but if not, it circulates in that very place around the belly.
So much has been said by me on these matters. Dropsy also forms in women — in the womb, and in the belly, and in the legs — and the other signs are the same. An account of it has been set out by me in the treatise on women's diseases. These three forms of the diseases arising from dropsy. All the diseases become severe quickly, and all increase quickly; they become still more severe if the body, wasted from one disease, passes into this one. If the disease seizes the person quickly, he dies, since the disease has become most long-lasting; and when the belly also becomes loose, he dies very quickly, still aware and still conversing.
57 (50)
So much has been said by me on dropsy — both whence it arises and what its signs are.