18. With regard to these symptoms, in the first place those are most obvious of which we have all often had experience. Thus, then, in such of us as have a coryza and defluction from the nostrils, this discharge is much more acrid than that which formerly was formed in and ran from them daily; and it occasions swelling of the nose, and it inflames, being of a hot and extremely ardent nature, as you may know, if you apply your hand to the place; and, if the disease remains long, the part becomes ulcerated although destitute of flesh and hard; and the heat in the nose ceases, not when the defluxion takes place and the inflammation is present, but when the running becomes thicker and less acrid, and more mixed with the former secretion, then it is that the heat ceases. But in all those cases in which this decidedly proceeds from cold alone, without the concourse of any other quality, there is a change from cold to hot, and from hot to cold, and these quickly supervene, and require no coction. But all the others being connected, as I have said, with acrimony and intemperance of humors, pass off in this way by being mixed and concocted.
19. But such defluxions as are determined to the eyes being possessed of strong and varied acrimonies, ulcerate the eyelids, and in some cases corrode the cheeks and parts below the eyes upon which the flow, and even occasion rupture and erosion of the tunic which surrounds the eyeball. But pain, heat, and extreme burning prevail until the defluxions are concocted and become thicker, and concretions form about the eyes, and the coction takes place from the fluids being mixed up, diluted, and digested together. And in defluxions upon the throat, from which are formed hoarseness, cynanche, erysipelas, and pneumonia, all these have at first saltish, watery, and acrid discharges, and with these the diseases gain strength. But when the discharges become thicker, more concocted, and are freed from all acrimony, then, indeed, the fevers pass away, and the other symptoms which annoyed the patient; for we must account those things the cause of each complaint, which, being present in a certain fashion, the complaint exists, but it ceases when they change to another combination. But those which originate from pure heat or cold, and do not participate in any other quality, will then cease when they undergo a change from cold to hot, and from hot to cold; and they change in the manner I have described before. Wherefore, all the other complaints to which man is subject arise from powers (qualities?). Thus, when there is an overflow of the bitter principle, which we call yellow bile, what anxiety, burning heat, and loss of strength prevail! but if relieved from it, either by being purged spontaneously, or by means of a medicine seasonably administered, the patient is decidedly relieved of the pains and heat; but while these things float on the stomach, unconcocted and undigested, no contrivance could make the pains and fever cease; and when there are acidities of an acrid and æruginous character, what varieties of frenzy, gnawing pains in the bowels and chest, and inquietude, prevail! and these do not cease until the acidities be purged away, or are calmed down and mixed with other fluids. The coction, change, attenuation, and thickening into the form of humors, take place through many and various forms; therefore the crises and calculations of time are of great importance in such matters; but to all such changes hot and cold are but little exposed, for these are neither liable to putrefaction nor thickening. What then shall we say of the change? that it is a combination (crasis) of these humors having different powers toward one another. But the hot does not lose its heat when mixed with any other thing except the cold; nor again, the cold, except when mixed with the hot. But all other things connected with man become the more mild and better in proportion as they are mixed with the more things besides. But a man is in the best possible state when they are concocted and at rest, exhibiting no one peculiar quality; but I think I have said enough in explanation of them.
20. Certain sophists and physicians say that it is not possible for any one to know medicine who does not know what man is [and how he was made and how constructed], and that whoever would cure men properly, must learn this in the first place. But this saying rather appertains to philosophy, as Empedocles and certain others have described what man in his origin is, and how he first was made and constructed.[365] But I think whatever such has been said or written by sophist or physician concerning nature has less connection with the art of medicine than with the art of painting. And I think that one cannot know anything certain respecting nature from any other quarter than from medicine; and that this knowledge is to be attained when one comprehends the whole subject of medicine properly, but not until then; and I say that this history shows what man is, by what causes he was made, and other things accurately. Wherefore it appears to me necessary to every physician to be skilled in nature, and strive to know, if he would wish to perform his duties, what man is in relation to the articles of food and drink, and to his other occupations, and what are the effects of each of them to every one. And it is not enough to know simply that cheese is a bad article of food, as disagreeing with whoever eats of it to satiety, but what sort of disturbance it creates, and wherefore, and with what principle in man it disagrees; for there are many other articles of food and drink naturally bad which affect man in a different manner. Thus, to illustrate my meaning by an example, undiluted wine drunk in large quantity renders a man feeble; and everybody seeing this knows that such is the power of wine, and the cause thereof; and we know, moreover, on what parts of a man’s body it principally exerts its action; and I wish the same certainty to appear in other cases. For cheese (since we used it as an example) does not prove equally injurious to all men, for there are some who can take it to satiety without being hurt by it in the least, but, on the contrary, it is wonderful what strength it imparts to those it agrees with; but there are some who do not bear it well, their constitutions are different, and they differ in this respect, that what in their body is incompatible with cheese, is roused and put in commotion by such a thing; and those in whose bodies such a humor happens to prevail in greater quantity and intensity, are likely to suffer the more from it. But if the thing had been pernicious to the whole nature of man, it would have hurt all. Whoever knows these things will not suffer from it.
21. During convalescence from diseases, and also in protracted diseases, many disorders occur, some spontaneously, and some from certain things accidentally administered. I know that the common herd of physicians, like the vulgar, if there happen to have been any innovation made about that day, such as the bath being used, a walk taken, or any unusual food eaten, all which were better done than otherwise, attribute notwithstanding the cause of these disorders, to some of these things, being ignorant of the true cause but proscribing what may have been very proper. Now this ought not to be so; but one should know the effects of a bath or a walk unseasonably applied; for thus there will never be any mischief from these things, nor from any other thing, nor from repletion, nor from such and such an article of food. Whoever does not know what effect these things produce upon a man, cannot know the consequences which result from them, nor how to apply them.
22. And it appears to me that one ought also to know what diseases arise in man from the powers, and what from the structures. What do I mean by this? By powers, I mean intense and strong juices; and by structures, whatever conformations there are in man. For some are hollow, and from broad contracted into narrow; some expanded, some hard and round, some broad and suspended,[366] some stretched, some long, some dense, some rare and succulent,[367] some spongy and of loose texture.[368] Now, then, which of these figures is the best calculated to suck to itself and attract humidity from another body? Whether what is hollow and expanded, or what is solid and round, or what is hollow, and from broad, gradually turning narrow? I think such as from hollow and broad are contracted into narrow: this may be ascertained otherwise from obvious facts: thus, if you gape wide with the mouth you cannot draw in any liquid; but by protruding, contracting, and compressing the lips, and still more by using a tube, you can readily draw in whatever you wish. And thus, too, the instruments which are used for cupping are broad below and gradually become narrow, and are so constructed in order to suck and draw in from the fleshy parts. The nature and construction of the parts within a man are of a like nature; the bladder, the head, the uterus in woman; these parts clearly attract, and are always filled with a juice which is foreign to them. Those parts which are hollow and expanded are most likely to receive any humidity flowing into them, but cannot attract it in like manner. Those parts which are solid and round could not attract a humidity, nor receive it when it flows to them, for it would glide past, and find no place of rest on them. But spongy and rare parts, such as the spleen, the lungs, and the breasts, drink up especially the juices around them, and become hardened and enlarged by the accession of juices. Such things happen to these organs especially. For it is not with the spleen as with the stomach, in which there is a liquid, which it contains and evacuates every day; but when it (the spleen) drinks up and receives a fluid into itself, the hollow and lax parts of it are filled, even the small interstices; and, instead of being rare and soft, it becomes hard and dense, and it can neither digest nor discharge its contents: these things it suffers, owing to the nature of its structure. Those things which engender flatulence or tormina in the body, naturally do so in the hollow and broad parts of the body, such as the stomach and chest, where they produce rumbling noises; for when they do not fill the parts so as to be stationary, but have changes of place and movements, there must necessarily be noise and apparent movements from them. But such parts as are fleshy and soft, in these there occur torpor and obstructions, such as happen in apoplexy. But when it (the flatus?) encounters a broad and resisting structure, and rushes against such a part, and this happens when it is by nature not strong so as to be able to withstand it without suffering injury; nor soft and rare, so as to receive or yield to it, but tender, juicy, full of blood, and dense, like the liver, owing to its density and broadness, it resists and does not yield. But flatus, when it obtains admission, increases and becomes stronger, and rushes toward any resisting object; but owing to its tenderness, and the quantity of blood which it (the liver) contains, it cannot be without uneasiness; and for these reasons the most acute and frequent pains occur in the region of it, along with suppurations and chronic tumors (phymata). These symptoms also occur in the site of the diaphragm, but much less frequently; for the diaphragm is a broad, expanded, and resisting substance, of a nervous (tendinous?) and strong nature, and therefore less susceptible of pain; and yet pains and chronic abscesses do occur about it.
23. There are both within and without the body many other kinds of structure, which differ much from one another as to sufferings both in health and disease; such as whether the head be small or large; the neck slender or thick, long or short; the belly long or round; the chest and ribs broad or narrow; and many others besides, all which you ought to be acquainted with, and their differences; so that knowing the causes of each, you may make the more accurate observations.
24. And, as has been formerly stated, one ought to be acquainted with the powers of juices, and what action each of them has upon man, and their alliances towards one another. What I say is this: if a sweet juice change to another kind, net from any admixture, but because it has undergone a mutation within itself; what does it first become?—bitter? salt? austere? or acid? I think acid. And hence, an acid juice is the most improper of all things that can be administered in cases in which a sweet juice is the most proper. Thus, if one should succeed in his investigations of external things, he would be the better able always to select the best; for that is best which is farthest removed from that which is unwholesome.
ON AIRS, WATERS, AND PLACES.
THE ARGUMENT.
Dr. Coray, in his excellent edition of this treatise, divides it into six chapters, as follows: first, the Introduction (from § 1–3) comprehends some general observations on the importance of cultivating a knowledge of the effects which the different seasons, the winds, the various kinds of water, the situation of cities, the nature of soils and the modes of life, exercise upon the health, and the necessity of a physician’s making himself well acquainted with all these matters, if he would wish to practise his profession successfully. The author insists, with particular earnestness, on the utility of studying the constitution of the year and the nature of the seasons, and refutes the opinions of those persons, in his days, who held that a knowledge of all these things belongs to meteorology rather than to medicine. The second chapter (§ 3–7) treats of climate, and the diseases prevalent in localities characterized by their exposure to particular winds. Those winds being peculiar to Greece, their names occasion some trouble in order to understand them correctly, and we shall give below a summary of what the modern Greek Coray says in illustration of them. This part of the present treatise appears to have been highly elaborated, and contains much important information. The third chapter (§ 7–10) treats of the various kinds of water, and their effects in different states of the human constitution. The remarks contained here are of an eminently practical nature, and evidently must have been the results of patient observation and experiment, so that, even at the present day, it would be difficult to detect our author in a single error of judgment. In this place he has occasion to deliver his opinions on the formation of urinary calculi, which he does at considerable length; and I may be permitted to remark, whatever may be thought of his etiology of the disease, it will be admitted that his theory is plausible, and the best that could well have been framed in the state of knowledge which then prevailed on that subject. Indeed, even at the present day, it must be allowed that this is a dark subject; we have acquired, it is true, many new and curious facts connected with the minute structure of these concretions, but it can hardly be affirmed that we have been able to evolve from them any general principles, or certain rules of practice. In the fourth chapter (§ 10–12), the nature of the seasons is treated of, and their influence on the health circumstantially stated. Some of the observations contained in this part of the work are remarkable for their acuteness and originality, such as the following, that, in estimating the effects of a season on the health, we ought to take into account the seasons which preceded it. This is well expressed by Celsus, as follows: “neque solum interest quales dies sint sed etiam quales præcesserint.” (Præfat.) See also Hippocrates (de Humoribus, § 8); and Coray (ad h. 1. § cix.) It will be seen in our annotations that a considerable number of the Aphorisms are abstracted from this part of the present treatise. In the fifth chapter (§ 12–17), the effects of climate and the institutions of society on the inhabitants of Asia are treated of at considerable length. Our author, in this place, evinces a great acquaintance with human life, and a most philosophical spirit in contemplating the subject which he is handling. Indeed few works in any language display so much accurate observation and originality of thought. The varieties of disposition, and of intellectual and moral development among mankind, are set down as being derived, in a great measure, from differences of climate and modes of government. Thus the Asiatics are of an effeminate and slavish disposition, because they live in a soft climate, on a rich soil, where they are little exposed to hardships or labor, and under a despotic form of government, which arrests the development of their mental energies.[369] This part also contains some interesting observations on the Macrocephali and the inhabitants of Phasis. In the sixth and last chapter (§ 17 to the end), the peculiar traits of the European character, as connected with climate and institutions, are described in a very interesting manner. Here the observations on the Amazons, Sauromatæ, and Scythians are well deserving of an attentive perusal, and more particularly the description of the disease induced by continual riding on horseback, the probable nature of which we shall consider presently. Here, too, are given our author’s remarks on diseases supposed to be divine, which, as we have stated in the Preliminary section on his life, evince a wonderful exemption from the superstitious belief of his age, and indicate an extraordinary depth of thought.