The genuine works of Hippocrates, Vol. 1 (of 2)

by Hippocrates

9. One may derive information from the regimen of persons in good health what things are proper; for if it appear that there is a great difference whether the diet be so and so, in other respects, but more especially in the changes, how can it be otherwise in diseases, and more especially in the most acute? But it is well ascertained that even a faulty diet of food and drink steadily persevered in, is safer in the main as regards health than if one suddenly change it to another. Wherefore, in the case of persons who take two meals in the day, or of those who take a single meal, sudden changes induce suffering and weakness; and thus persons who have not been accustomed to dine, if they shall take dinner, immediately become weak, have heaviness over their whole body, and become feeble and languid, and if, in addition, they take supper, they will have acid eructations, and some will have diarrhœa whose bowels were previously dry, and not having been accustomed to be twice swelled out with food and to digest it twice a day, have been loaded beyond their wont. It is beneficial, in such cases, to counterbalance this change, for one should sleep after dinner, as if passing the night, and guard against cold in winter and heat in summer; or, if the person cannot sleep, he may stroll about slowly, but without making stops, for a good while, take no supper, or, at all events, eat little, and only things that are not unwholesome, and still more avoid drink, and especially water. Such a person will suffer still more if he take three full meals in the day, and more still if he take more meals; and yet there are many persons who readily bear to take three full meals in the day, provided they are so accustomed. And, moreover, those who have been in the habit of eating twice a day, if they omit dinner, become feeble and powerless, averse to all work, and have heartburn; their bowels seem, as it were, to hang loose, their urine is hot and green, and the excrement is parched; in some the mouth is bitter, the eyes are hollow, the temples throb, and the extremities are cold, and the most of those who have thus missed their dinner cannot eat supper; or, if they do sup, they load their stomach, and pass a much worse night than if they had previously taken dinner. Since, then, an unwonted change of diet for half a day produces such effects upon persons in health, it appears not to be a good thing either to add or take from. If, then, he who was restricted to a single meal, contrary to usage, having his veins thus left empty during a whole day, when he supped according to custom felt heavy, it is probable that if, because he was uneasy and weak from the want of dinner, he took a larger supper than wont, he would be still more oppressed; or if, wanting food for a still greater interval, he suddenly took a meal after supper, he will feel still greater oppression. He, then, who, contrary to usage, has had his veins kept empty by want of food, will find it beneficial to counteract the bad effects during that day as follows: let him avoid cold, heat, and exertion, for he could bear all these ill; let him make his supper considerably less than usual, and not of dry food, but rather liquid; and let him take some drink, not of a watery character, nor in smaller quantity than is proportionate to the food, and on the next day he should take a small dinner, so that, by degrees, he may return to his former practice. Persons who are bilious in the stomach bear these changes worst, while those who are pituitous, upon the whole, bear the want of food best, so that they suffer the least from being restricted to one meal in the day, contrary to usage. This, then, is a sufficient proof that the greatest changes as to those things which regard our constitutions and habits are most especially concerned in the production of diseases, for it is impossible to produce unseasonably a great emptying of the vessels by abstinence, or to administer food while diseases are at their acme, or when inflammation prevails; nor, on the whole, to make a great change either one way or another with impunity.[552]

10. One might mention many things akin to these respecting the stomach and bowels, to show how people readily bear such food as they are accustomed to, even if it is not naturally good, and drink in like manner, and how they bear unpleasantly such food as they are not accustomed to, even although not bad, and so in like manner with drink; and as to the effects of eating much flesh, contrary to usage, or garlic, or asafœtida, or the stem of the plant which produces it, or things of a similar kind possessed of strong properties, one would be less surprised if such things produce pains in the bowels, but rather when one learned what trouble, swelling, flatulence, and tormina the cake (maza) will raise in the belly when eaten by a person not accustomed to it; and how much weight and distention of the bowels bread will create to a person accustomed to live upon the maza; and what thirst and sudden fullness will be occasioned by eating hot bread, owing to its desiccant and indigestible properties; and what different effects are produced by fine and coarse bread when eaten contrary to usage, or by the cake when unusually dry, moist, or viscid; and what different effects polenta produces upon those who are accustomed and those who are unaccustomed to the use of it; or drinking of wine or drinking of water, when either custom is suddenly exchanged for the other; or when, contrary to usage, diluted wine or undiluted has been suddenly drunk, for the one will create water-brash in the upper part of the intestinal canal and flatulence in the lower, while the other will give rise to throbbing of the arteries, heaviness of the head, and thirst; and white and dark-colored wine, although both strong wines, if exchanged contrary to usage, will produce very different effects upon the body, so that one need the less wonder that a sweet and strong wine, if suddenly exchanged, should have by no means the same effect.

11. Let us here briefly advert to what may be said on the opposite side; namely, that a change of diet has occurred in these cases, without any change in their body, either as to strength, so as to require an increase of food, or as to weakness, so as to require a diminution. But the strength of the patient is to be taken into consideration, and the manner of the disease, and of the constitution of the man, and the habitual regimen of the patient, not only as regards food but also drink. Yet one must much less resort to augmentation, since it is often beneficial to have recourse to abstraction, when the patient can bear it, until the disease having reached its acme and has become concocted. But in what cases this must be done will be afterwards described. One might write many other things akin to those which have been now said, but there is a better proof, for it is not akin to the matter on which my discourse has principally turned, but the subject-matter itself is a most seasonable proof. For some at the commencement of acute diseases have taken food on the same day, some on the next day; some have swallowed whatever has come in their way, and some have taken cyceon.[553] Now all these things are worse than if one had observed a different regimen; and yet these mistakes, committed at that time, do much less injury than if one were to abstain entirely from food for the first two or three days, and on the fourth or fifth day were to take such food; and it would be still worse, if one were to observe total abstinence for all these days, and on the following days were to take such a diet, before the disease is concocted;[554] for in this way death would be the consequence to most people, unless the disease were of a very mild nature. But the mistakes committed at first were not so irremediable as these, but could be much more easily repaired. This, therefore, I think a strong proof that such or such a draught need not be prescribed on the first days to those who will use the same draughts afterwards. At the bottom, therefore, they do not know, neither those using unstrained ptisans, that they are hurt by them, when they begin to swallow them, if they abstain entirely from food for two, three, or more days; nor do those using the juice know that they are injured in swallowing them, when they do not commence with the draught seasonably. But this they guard against, and know that it does much mischief, if, before the disease be concocted, the patient swallow unstrained ptisan, when accustomed to use strained. All these things are strong proofs that physicians do not conduct the regimen of patients properly, but that in those diseases in which total abstinence from food should not be enforced on patients that will be put on the use of ptisans, they do enforce total abstinence; that in those cases in which there should be no change made from total abstinence to ptisans, they do make the change; and that, for the most part, they change from abstinence to ptisans, exactly at the time when it is often beneficial to proceed from ptisans almost to total abstinence, if the disease happen to be in the state of exacerbation.[555] And sometimes crude matters are attracted from the head, and bilious from the region near the chest, and the patients are attacked with insomnolency, so that the disease is not concocted; they become sorrowful, peevish, and delirious; there are flashes of light in their eyes, and noises in their ears; their extremities are cold, their urine unconcocted; the sputa thin, saltish, tinged with an intense colour and smell; sweats about the neck, and anxiety; respiration, interrupted in the expulsion of the air,[556] frequent and very large; expression of the eyelids dreadful; dangerous deliquia; tossing of the bedclothes from the breast; the hands trembling, and sometimes the lower lip agitated. These symptoms, appearing at the commencement, are indicative of strong delirium, and patients so affected generally die, or if they escape, it is with a deposit, hemorrhage from the nose, or the expectoration of thick matter, and not otherwise. Neither do I perceive that physicians are skilled in such things as these; how they ought to know such diseases as are connected with debility, and which are further weakened by abstinence from food, and those aggravated by some other irritation; those by pain, and from the acute nature of the disease, and what affections and various forms thereof our constitution and habit engender, although the knowledge or ignorance of such things brings safety or death to the patient. For it is a great mischief if to a patient debilitated by pain, and the acute nature of the disease, one administer drink, or more ptisan, or food, supposing that the debility proceeds from inanition. It is also disgraceful not to recognize a patient whose debility is connected with inanition, and to pinch him in his diet; this mistake, indeed, is attended with some danger, but much less than the other, and yet it is likely to expose one to much greater derision, for if another physician, or a private person, coming in and knowing what has happened, should give to eat or drink those things which the other had forbidden, the benefit thus done to the patient would be manifest. Such mistakes of practitioners are particularly ridiculed by mankind, for the physician or non-professional man thus coming in, seems as it were to resuscitate the dead. On this subject I will describe elsewhere the symptoms by which each of them may be recognized.

12. And the following observations are similar to those now made respecting the bowels. If the whole body rest long, contrary to usage, it does not immediately recover its strength; but if, after a protracted repose, it proceed to labor, it will clearly expose its weakness. So it is with every one part of the body, for the feet will make a similar display, and any other of the joints, if, being unaccustomed to labor, they be suddenly brought into action, after a time. The teeth and the eyes will suffer in like manner, and also every other part whatever. A couch, also, that is either softer or harder than one has been accustomed to will create uneasiness, and sleeping in the open air, contrary to usage, hardens the body. But it is sufficient merely to state examples of all these cases. If a person having received a wound in the leg, neither very serious nor very trifling, and he being neither in a condition very favorable to its healing nor the contrary, at first betakes himself to bed, in order to promote the cure, and never raises his leg, it will thus be much less disposed to inflammation, and be much sooner well, than it would have been if he had strolled about during the process of healing; but if upon the fifth or sixth day, or even earlier, he should get up and attempt to walk, he will suffer much more then than if he had walked about from the commencement of the cure, and if he should suddenly make many laborious exertions, he will suffer much more than if, when the treatment was conducted otherwise, he had made the same exertions on the same days. In fine, all these things concur in proving that all great changes, either one way or another, are hurtful. Wherefore much mischief takes place in the bowels, if from a state of great inanition more food than is moderate be administered (and also in the rest of the body, if from a state of great rest it be hastily brought to greater exertion, it will be much more injured), or if from the use of much food it be changed to complete abstinence, and therefore the body in such cases requires protracted repose, and if, from a state of laborious exertion, the body suddenly falls into a state of ease and indolence, in these cases also the bowels would require continued repose from abundance of food, for otherwise it will induce pain and heaviness in the whole body.

13. The greater part of my discourse has related to changes, this way or that. For all purposes it is profitable to know these things, and more especially respecting the subject under consideration,—that in acute diseases, in which a change is made to ptisans from a state of inanition, it should be made as I direct; and then that ptisans should not be used until the disease be concocted, or some other symptom, whether of evacuation or of irritation, appear in the intestines, or in the hypochondria, such as will be described. Obstinate isomnolency impairs the digestion of the food and drink, and in other respects changes and relaxes the body, and occasions a heated state, and heaviness of the head.[557]

14. One must determine by such marks as these, when sweet, strong, and dark wine, hydromel, water and oxymel, should be given in acute diseases.[558] Wherefore the sweet affects the head less than the strong, attacks the brain less, evacuates the bowels more than the other, but induces swelling of the spleen and liver; it does not agree with bilious persons, for it causes them to thirst; it creates flatulence in the upper part of the intestinal canal, but does not disagree with the lower part, as far as regards flatulence; and yet flatulence engendered by sweet wine is not of a transient nature, but rests for a long time in the hypochondria. And therefore it in general is less diuretic than wine which is strong and thin; but sweet wine is more expectorant than the other. But when it creates thirst, it is less expectorant in such cases than the other wine, but if it do not create thirst, it promotes expectoration better than the other. The good and bad effects of a white, strong wine, have been already frequently and fully stated in the disquisition on sweet wine; it is determined to the bladder more than the other, is diuretic and laxative, and should be very useful in such complaints; for if in other respects it be less suitable than the other, the clearing out of the bladder effected by it is beneficial to the patient, if properly administered. There are excellent examples of the beneficial and injurious effects of wine, all which were left undetermined by my predecessors. In these diseases you may use a yellow wine, and a dark austere wine for the following purposes: if there be no heaviness of the head, nor delirium, nor stoppage of the expectoration, nor retention of the urine, and if the alvine discharges be more loose and like scrapings than usual, in such cases a change from a white wine to such as I have mentioned, might be very proper. It deserves further to be known, that it will prove less injurious to all the parts above, and to the bladder, if it be of a more watery nature, but that the stronger it is, it will be the more beneficial to the bowels.

15. Hydromel, when drunk in any stage of acute disease, is less suitable to persons of a bilious temperament, and to those who have enlarged viscera, than to those of a different character; it increases thirst less than sweet wine; it softens the lungs, is moderately expectorant, and alleviates a cough; for it has some detergent quality in it, whence it lubricates the sputum.[559] Hydromel is also moderately diuretic, unless prevented by the state of any of the viscera. And it also occasions bilious discharges downwards, sometimes of a proper character, and sometimes more intense and frothy than is suitable; but such rather occurs in persons who are bilious, and have enlarged viscera. Hydromel rather produces expectoration, and softening of the lungs, when given diluted with water.[560] But unmixed hydromel, rather than the diluted, produces frothy evacuations, such as are unseasonably and intensely bilious, and too hot; but such an evacuation occasions other great mischiefs, for it neither extinguishes the heat in the hypochondria, but rouses it, induces inquietude, and jactitation of the limbs, and ulcerates the intestines and anus. The remedies for all these will be described afterwards. By using hydromel without ptisans, instead of any other drink, you will generally succeed in the treatment of such diseases, and fail in few cases; but in what instances it is to be given, and in what it is not to be given, and wherefore it is not to be given,—all this has been explained already, for the most part. Hydromel is generally condemned, as if it weakened the powers of those who drink it, and on that account it is supposed to accelerate death; and this opinion arose from persons who starve themselves to death, some of whom use hydromel alone for drink, as fancying that it really has this effect. But this is by no means always the case. For hydromel, if drunk alone, is much stronger than water, if it do not disorder the bowels; but in some respects it is stronger, and in some weaker, than wine that is thin, weak, and devoid of bouquet. There is a great difference between unmixed wine and unmixed honey, as to their nutritive powers, for if a man will drink double the quantity of pure wine, to a certain quantity of honey which is swallowed, he will find himself much stronger from the honey, provided it do not disagree with his bowels, and that his alvine evacuations from it will be much more copious. But if he shall use ptisan for a draught, and drink afterward hydromel, he will feel full, flatulent, and uncomfortable in the viscera of the hypochondrium; but if the hydromel be taken before the draught, it will not have the same injurious effects as if taken after it, but will be rather beneficial. And boiled hydromel has a much more elegant appearance than the unboiled, being clear, thin, white, and transparent, but I am unable to mention any good quality which it possesses that the other wants. For it is not sweeter than the unboiled, provided the honey be fine, and it is weaker, and occasions less copious evacuations of the bowels, neither of which effects is required from the hydromel. But one should by all means use it boiled, provided the honey be bad, impure, black, and not fragrant, for the boiling will remove the most of its bad qualities and appearances.

16. You will find the drink, called oxymel, often very useful in these complaints, for it promotes expectoration and freedom of breathing. The following are the proper occasions for administering it. When strongly acid it has no mean operation in rendering the expectoration more easy, for by bringing up the sputa, which occasion troublesome hawking, and rendering them more slippery, and, as it were, clearing the windpipe with a feather, it relieves the lungs and proves emollient to them; and when it succeeds in producing these effects it must do much good. But there are cases in which hydromel, strongly acid, does not promote expectoration, but renders it more viscid and thus does harm, and it is most apt to produce these bad effects in cases which are otherwise of a fatal character, when the patient is unable to cough or bring up the sputa. On this account, then, one ought to consider beforehand the strength of the patient, and if there be any hope, then one may give it, but if given at all in such cases it should be quite tepid, and in by no means large doses. But if slightly acrid it moistens the mouth and throat, promotes expectoration, and quenches thirst; agrees with the viscera seated in the hypochondrium, and obviates the bad effects of the honey; for the bilious quality of the honey is thereby corrected. It also promotes flatulent discharges from the bowels, and is diuretic, but it occasions watery discharges and those resembling scrapings, from the lower part of the intestine, which is sometimes a bad thing in acute diseases, more especially when the flatulence cannot be passed, but rolls backwards; and otherwise it diminishes the strength and makes the extremities cold, this is the only bad effect worth mentioning which I have known to arise from the oxymel. It may suit well to drink a little of this at night before the draught of ptisan, and when a considerable interval of time has passed after the draught there will be nothing to prevent its being taken. But to those who are restricted entirely to drinks without draughts of ptisan, it will therefore not be proper at all times to give it, more especially from the fretting and irritation of the intestine which it occasions, (and these bad effects it will be the more apt to produce provided there be no fæces in the intestines and the patient is laboring under inanition,) and then it will weaken the powers of the hydromel. But if it appears advantageous to use a great deal of this drink during the whole course of the disease, one should add to it merely as much vinegar as can just be perceived by the taste, for thus what is prejudicial in it will do the least possible harm, and what is beneficial will do the more good. In a word, the acidity of vinegar agrees rather with those who are troubled with bitter bile, than with those patients whose bile is black; for the bitter principle is dissolved in it and turned to phlegm, by being suspended in it; whereas black bile is fermented, swells up, and is multiplied thereby: for vinegar is a melanogogue. Vinegar is more prejudicial to women than to men, for it creates pains in the uterus.

17. I have nothing further to add as to the effects of water when used as a drink in acute diseases; for it neither soothes the cough in pneumonia, nor promotes expectoration, but does less than the others in this respect, if used alone through the whole complaint. But if taken intermediate between oxymel and hydromel, in small quantity, it promotes expectoration from the change which it occasions in the qualities of these drinks, for it produces, as it were, a certain overflow. Otherwise it does not quench the thirst, for it creates bile in a bilious temperament, and is injurious to the hypochondrium; and it does the most harm, engenders most bile, and does the least good when the bowels are empty; and it increases the swelling of the spleen and liver when they are in an inflamed state; it produces a gurgling noise in the intestines and swims on the stomach; for it passes slowly downwards, as being of a coldish and indigestible nature, and neither proves laxative nor diuretic; and in this respect, too, it proves prejudicial, that it does not naturally form fæces in the intestines: and, if it be drunk while the feet are cold, its injurious effects will be greatly aggravated, in all those parts to which it may be determined. When you suspect in these diseases either strong heaviness of the head, or mental alienation, you must abstain entirely from wine, and in this case use water, or give weak, straw colored wine, entirely devoid of bouquet, after which a little water is to be given in addition; for thus the strength of the wine will less affect the head and the understanding: but in which cases water is mostly to be given for drink, when in large quantity, when in moderate, when cold, and when hot; all these things have either been discussed already or will be treated of at the proper time. In like manner, with respect to all the others, such as barley-water, the drinks made from green shoots, those from raisins, and the skins of grapes and wheat, and bastard saffron, and myrtles, pomegranates, and the others, when the proper time for using them is come, they will be treated of along with the disease in question, in like manner as the other compound medicines.[561]

18. The bath is useful in many diseases, in some of them when used steadily, and in others when not so. Sometimes it must be less used than it would be otherwise, from the want of accommodation; for in few families are all the conveniences prepared, and persons who can manage them as they ought to be. And if the patient be not bathed properly, he may be thereby hurt in no inconsiderable degree, for there is required a place to cover him that is free of smoke, abundance of water, materials for frequent baths, but not very large, unless this should be required. It is better that no friction should be applied, but if so, a hot soap (smegma)[562] must be used in greater abundance than is common, and an affusion of a considerable quantity of water is to made at the same time and afterwards repeated. There must also be a short passage to the basin, and it should be of easy ingress and egress. But the person who takes the bath should be orderly and reserved in his manner, should do nothing for himself, but others should pour the water upon him and rub him, and plenty of waters, of various temperatures, should be in readiness for the douche, and the affusions quickly made;[563] and sponges should be used instead of the comb (strigil), and the body should be anointed when not quite dry. But the head should be rubbed by the sponge until it is quite dry; the extremities should be protected from cold, as also the head and the rest of the body; and a man should not be washed immediately after he has taken a draught of ptisan or a drink; neither should he take ptisan as a drink immediately after the bath. Much will depend upon whether the patient, when in good health, was very fond of the bath, and in the custom of taking it: for such persons, especially, feel the want of it, and are benefited if they are bathed, and injured if they are not. In general it suits better with cases of pneumonia than in ardent fevers; for the bath soothes the pain in the side, chest, and back; concocts the sputa, promotes expectoration, improves the respiration, and allays lassitude; for it soothes the joints and outer skin, and is diuretic, removes heaviness of the head, and moistens the nose. Such are the benefits to be derived from the bath, if all the proper requisites be present; but if one or more of these be wanting, the bath, instead of doing good, may rather prove injurious; for every one of them may do harm if not prepared by the attendants in the proper manner. It is by no means a suitable thing in these diseases to persons whose bowels are too loose, or when they are unusually confined, and there has been no previous evacuation; neither must we bathe those who are debilitated, nor such as have nausea or vomiting, or bilious eructations; nor such as have hemorrhage from the nose, unless it be less than required at that stage of the disease, (with those stages you are acquainted:) but if the discharge be less than proper, one should use the bath, whether in order to benefit the whole body or the head alone. If then the proper requisites be at hand, and the patient be well disposed to the bath, it may be administered once every day, or if the patient be fond of the bath there will be no harm, though he should take it twice in the day. The use of the bath is much more appropriate to those who take unstrained ptisan, than to those who take only the juice of it, although even in their case it may be proper; but least of all does it suit with those who use only plain drink, although, in their case too it may be suitable; but one must form a judgment from the rules laid down before, in which of these modes of regimen the bath will be beneficial, and in which not. Such as want some of the requisites for a proper bath, but have those symptoms which would be benefited by it, should be bathed; whereas those who want none of the proper requisites, but have certain symptoms which contra-indicate the bath, are not to be bathed.