De Medicina

4 I have next to speak of those who have some parts of the body weak. He whose head is infirm ought, after he has digested well, to rub it gently in the morning with his own hands; never if possible cover it with a wrap; have it shaved to the skin. It is well to avoid moonlight, and especially before the actual conjunction of the moon and sun, and to walk nowhere after dinner. If he has retained his hair, he should comb it every day, walk much, but, if possible, not under cover nor in the sun; everywhere, however, he should avoid the sun's blaze, especially after taking food and wine; undergo anointing rather than affusion, but that never before a flaming fire, on occasion before a brazier. If he goes owing to the bath he should first sweat for a while, in the tepidarium, wrapped up, and then undergo anointing there; next pass into the calidarium; after a further sweat he should not go down into the hot bath, but have himself sluiced freely from the head downwards, first with hot, next with tepid, then with cold water, which should be poured for longer on the head than upon other parts, after which it should be rubbed for a while, lastly wiped dry and anointed. Nothing is so

5 Nor indeed is it only those who are troubled by a weakness of the head that find the use of cold water beneficial, but also those who suffer with persistent running from the eyes, choked nostrils and running from the nose, and tonsillar maladies. In these cases, not only is the head to be douched every day, but also the face bathed with abundance of cold water; especially should this be carried out by all those benefited by it, whenever the south wind renders the weather more oppressive. And whereas

6 But one who is often troubled by an urgent motion should exercise his upper parts at handball and the like; walk on an empty stomach, avoid the sun and continual bathing; undergo anointing even without sweating, not make use of multifarious foods, least of all stews or pulse or greens, and of those things which pass through quickly; in a word, to avoid all things which are digested slowly. Especially advantageous are: venison and hard fish and meat of domestic animals roasted. It is never expedient to drink wine treated with sea-water, nor indeed thin or sweet wine, but that which is dry and fuller-bodied, and not too old. If one desires to use honeyed wine, it should be made from boiled honey. Cold drinks are to be used whenever possible, so long as they do not disturb the bowels. When anything in the dinner is felt to disagree, he should provoke a vomit, repeating it the next day; on the third day should be eaten a small quantity of bread soaked in wine with the addition of grapes preserved in a jar or in must which has been boiled down and such like; then he should return to his accustomed habit; but he must always rest after the meal,

7 When the more lax intestine, which they name colon, tends to be painful, and when it is nothing more than an inflation of a sort, the aim should be to promote digestion; to practise reading aloud and other exercises; to use a hot bath, also hot food and drink, and in short, to avoid all manner of cold, all sweets and pulse, and whatever else tends to flatulence.

8 But if anyone suffers from his stomach, he should read out loud, and after the reading take a walk, then exercise himself at handball and at drill or at anything else which brings the upper part of the body into play; on an empty stomach he should not drink water but hot wine; if he digests readily he should take two meals a day; drink light and dry wine, and after a meal drinks should preferably be cold. Weakness of the stomach is indicated by pallor, wasting, pain over the heart, nausea, and involuntary vomiting, headache when the stomach is empty; where these symptoms are absent, the stomach is sound. Nor must one absolutely trust those of our patients who when very unwell have conceived a longing for wine or cold water, and in backing up their desires, lay the blame on their perfectly innocent stomach. But those who digest slowly, and whose parts below the ribs on that account become inflated, or who on account of heat of some kind become thirsty at night, may drink before going to bed three or four cupfuls of wine through a fine reed. Also, to counter slow digestion, it is well to read aloud, next to take a walk, then to be either anointed or laved, taking care to

9 When sinews tend to become painful, as is common in foot or hand ache, the affected part should be exercised as far as possible, even exposing it to work or to cold, unless when pain is increasing. Rest in the open air is best. Venery is always inimical; an in all other bodily affections, digestion is a necessity, for indigestion is most harmful, and whenever the body is attacked, the faulty part feels it most.

But just as digestion has to do with all sorts of troubles, so has cold with some, heat with others; each person should be guided by his own bodily habit. Cold is inimical to the aged, and to the thin; to wounds, to the parts below the ribs, intestines, bladder, ears, hips, bladebones, genitals, bones, teeth, sinews, womb, brain. It renders the skin pale, dry, hard, black; from it are developed shiverings and tremors. But cold is beneficial to the young and to stout people; in cold weather, with due precautions, the mind is more vigorous and the digestion better. Cold water affusion is of service, not only to the head, but also to the stomach, and to painful joints not accompanied by ulcerations, also for those who are too rubicund, when pain is absent. But heat benefits all that cold harms, such as dimness of eyesight when there is neither pain nor lacrimation, also contracted sinews, and particularly

10 There are also observances necessary for a healthy man to employ during a pestilence, although in spite of them he cannot be secure. At such a time, then, he will do well to go abroad, take a voyage; when this cannot be, to be carried in a litter, walk in the open before the heat of the day, gently, and to be anointed in like manner; further as stated above he should avoid fatigue, indigestion, cold, heat, venery, and keep all the more to rule, should he feel any bodily oppression. At such a time he should not get up early in the morning nor walk about barefoot, and least so after a meal or bath. Neither on an empty stomach nor after a meal should he provoke a vomit, or set up a motion; indeed if the bowels tend to be loose, they are to be restrained. The fuller his habit of body, the more abstinence; he should avoid the bath, sweating, a midday siesta, and in any case if food has been taken previously; at such times, however, it is better then to take only one meal a day, and that a moderate one, lest indigestion be provoked. He should drink, one day water, the next day wine; if he observes these rules, there should be the least possible alteration as to the rest of his accustomed dietary. Such then are the things

Of impending disorders there are many signs, in explaining which I shall not hesitate to make use of the authority of ancient men, and especially of Hippocrates; for although more recent practitioners have made some changes in methods of treatment, they allow none the less that the ancients prognosticated best. Before I note, however, those preceding symptoms which suggest fear of disease, it does not seem unfitting to set out: the seasons of the year (1, 1‑2), the sorts of weather (1, 3‑4), periods of life and temperaments which may be in particular safe or open to risks (1, 5), and what kind of disorders is most to be apprehended in each (1, 6‑23). Not that men may not sicken and die at any season, in any sort of weather, at any age, whatever their temperament, from any kind of disease, but since certain kinds occur less . . . but some kinds occur more often, so it is of use that everyone should recognize against what, and when, he should be most on his guard.

1 So then spring is the most salubrious, next after it comes winter; summer is rather more dangerous than salubrious, autumn is by far the most dangerous. But as regards weather the best is that which is settled, whether cold or hot, the worst that which is the most changeable, and that is why autumn brings down the greatest number. For generally about midday there is heat, but at night and in the early morning, cold, as also in the evening. Thus the body, relaxed by the preceding summer, and now by the midday heat, is caught by the sudden cold. But while this chiefly occurs at this season, so whenever the like happens harm is done.

In settled weather fine days are the most salubrious, rainy better than foggy or cloudy days; and in winter the best days are those in which there is an entire absence of wind, in summer those in which westerly winds blow. As for the other winds, the northerly are more salubrious than those from the sunrising or south; nevertheless, these vary somewhat according to the character of the district. For almost everywhere wind when coming from inland is salubrious, and injurious when from the sea. And not only is health more assured in settled weather, but pre-existing diseases also, if there have been any, are milder and more quickly terminated. But the worst weather for the sick man is that which has

The middle period of life is the safest, for it is not disturbed by the heat of youth, nor by the chill of age. Old age is more exposed to chronic diseases, youth to acute ones. The square-built frame, neither thin nor fat, is the fittest; for tallness, as it is graceful in youth, shrinks in the fulness of age; a thin frame is weak, a fat one sluggish.

In spring those diseases are usually to be apprehended which are stirred up anew by movement of humor. Consequently there tend to arise runnings from the eyes, pustules, haemorrhages, congestions in the body, which the Greeks call apostemata, black bile which they call μελανχολίαν, madness, fits, angina, choked nostrils, runnings from the nose. Also those diseases which affect joints and sinews, being at one time troublesome, at another quiescent, then especially both begin and recur.

But summer, while not wholly exempt from most of the foregoing maladies, adds to them fevers whether continued or ardent or tertian, vomitings, diarrhoeas, earaches, oral ulcerations, cankers which occur on other parts but especially upon the pudenda, and whatever exhausts the patient by sweating.

In autumn there is scarcely one of the foregoing which does not happen; but at this season in addition there arise irregular fevers, splenic pain, subcutaneous dropsy, consumption, called by the Greeks phthisis, urinary difficulty, which they call strangury, the

Winter provokes headache, coughs, and all the affections which attack the throat, and the sides of the chest and lungs.

Of the various sorts of weather, the north wind excites cough, irritates the throat, constipates the bowels, suppresses the urine, excites shiverings, as also pain of the lungs and chest. Nevertheless it is bracing to a healthy body, rendering it more mobile and brisk. The south wind dulls hearing, blunts the senses, produces headache, loosens the bowels; the body as a whole is rendered sluggish, humid, languid. The other winds, as they approximate to the north or south wind, produce affections corresponding to the one or other. Moreover, any hot weather inflates the liver and spleen, and dulls the mind; the result is that there are faintings, that there is an outburst of blood. Cold on the other hand brings about: at times tenseness of sinews which the Greeks call spasmos, at times the rigor which they call tetanos, the blackening of ulcerations, shiverings in fevers. In times of drought there arise acute fevers, runnings from the eyes, dysenteries, urinary difficulty, articular pains. In wet weather there occur chronic fevers, diarrhoeas, angina, canker,

As regards the various times of life, children and

2 Now antecedent to illness, as I have stated above, certain signs arise, all of which have this in common, that the body becomes altered from its accustomed state, and that not only for the worse, but it may be even for the better. Hence when a man has become fatter and better looking and with a higher colour, he should regard with suspicion these gains of his for, because they can neither remain in the same state nor advance further, as a rule they fall back in a sort of collapse. Still it is a worse sign when anyone, contrary to his habit, becomes thinner, and loses his colour and good looks; for when there is a superfluity of flesh there is something for the disease to draw upon; when there is a deficiency, there is nothing to hold out against the disease itself. Further, there should be apprehension at once: if the limbs become heavier, if frequent ulcerations arise, if the body feels hotter

3 But when fever has actually seized upon a man, it may be known that he is not in danger: if he lies upon his side, whether on his right or left, just as suits him, with his legs a little drawn up, as is generally the way with a healthy person when lying

4 On the contrary there is danger of a severe disease: when the patient lies on his back with his arms and legs outstretched; when at the onset of an acute disease, especially in lung troubles, he wants to sit up; when he is worn down by insomnia even if he gets some sleep in the day-time, in which case to sleep between ten o'clock in the morning and night is worse than from early morning till ten o'clock. The worst, however, is if he gets sleep neither by day nor by night; for this generally cannot happen unless there is continuous pain. It is not a good sign, however, to be oppressed beyond measure by sleep, and it is the worse the more that somnolence continues day and night. It is also evidence of a serious malady: when the breathing is forcible and quick, when the patient begins to have shiverings from the sixth day, to spit up pus, to expectorate it with difficulty, to have continuous pain, to bear up against the disease with difficulty, to toss the arms and legs, to shed tears involuntarily, to have sticky humor adhering to the teeth, the skin about the navel and the pubes wasted; the parts below the ribs inflamed, painful, hard, tumid, tense and this more on the right than on the left side; the greatest danger, however, is if in that region the

5 After such signs the only thing to pray for is that the disease may be a long one, for so it must be unless it kills. Nor is there any other hope of life in grave illnesses except that the patient may avoid the attack of the disease by protracting it, and that it may be prolonged for sufficient time to afford opportunity for treatment. At the onset, however, there are certain signs from which it is possible to conclude that the disease, even if it be not fatal, nevertheless is going to last rather a long time: when in fevers which are not acute a cold sweat breaks out over the head and neck only, or when there is general sweating without the fever subsiding, or when the patient is at one time cold, at another time hot, or his colour changes from moment to moment, or when in the course of fever there is a congestion in some part, which does not lead the way to recovery, or when the patient wastes a little for a considerable time, again if the urine is at one time clear and limpid, at another time has some sediment which is slimy, white or red, or if there

6 But among the foregoing signs, though there are indeed grounds for fear, still there is hope left: however, that the last stage has now been reached is indicated by the nose becoming pointed, the temples sunken, the eyes hollowed, the ears cold and flaccid with the tips drooping slightly, the skin of the forehead hard and tight: the aspect is dusky or very pallid, and much more so when there has been no preceding insomnia, nor diarrhoea, nor loss of appetite. From which causes these appearances at times arise, but only last one day: and so when they last longer death is indicated. In the case of long-standing disease, when such signs have lasted for the third day, death is at hand, and the more so if besides this the eyes also shun the light and shed tears, and are reddened where they should be white, and the veins in them are pale, and phlegm floating in them comes to stick to the angles and one eye becomes smaller than the other, and either both are deep-sunken, or more tumid, and the eyelids are not closed in sleep, but some of the white of the eyes appears between them — always provided that this has not been occasioned by fluid motions; the same is the case when the eyelids become pale and a similar pallor renders colourless the lips and nostrils; so also when the lips and nostrils and eyes and eyebrows or any one of them become distorted; and the patient owing to weakness either hears not or sees not. Death is likewise denoted: when the patient lies on his back with his knees bent; when he keeps on slipping down towards the foot of the bed; when he uncovers his arms and legs and tosses them

I know that on this point someone may question me:— if there are such sure signs of approaching death, how is it that patients who have been deserted by their medical attendants sometimes recover? And rumour has spread it about that some have revived whilst being carried out to burial. Democritus, indeed, a man justly renowned, even held that the signs of life having ended, upon which practitioners had relied, were not sufficiently sure; much more did he not admit that there could be any sure signs of approaching death. In answer to these I shall not even assert that some signs, stated as approximately certain, often deceive inexperienced practitioners, but not good ones; for instance Asclepiades, when he met the funeral procession, recognized that a man who was being carried out to burial was alive; and it is not primarily a fault of the art if there is a fault on the part of its professor. But I shall more modestly suggest that the art of medicine is conjectural, and such is the characteristic of a conjecture, that though it answers more frequently, yet it sometimes deceives. A sign therefore is not to be rejected if it is deceptive in scarcely one out of a thousand cases, since it holds good in countless patients. I state this, not merely in connexion with noxious signs, but as to salutary signs as well; seeing that hope is disappointed now and again, and that the patient dies whom the practitioner at first deemed safe; and further that measures proper for curing now and again make a change into something worse. Nor, in the face of such a variety of temperaments, can