Just as agriculture promises nourishment to healthy bodies, so does the Art of Medicine promise health to the sick. Nowhere is this Art wanting, for the most uncivilized nations have had knowledge of herbs, and other things to hand for the aiding of wounds and diseases. This Art, however, has been cultivated among the Greeks much more than in other nations — not, however, even among them from their first beginnings, but only for a few generations before ours. Hence Aesculapius is celebrated as the most ancient authority, and because he cultivated this science, as yet rude and vulgar, with a little more than common refinement, he was numbered among the gods. After him his two sons, Podalirius and Machaon, who followed Agamemnon as leader to the Trojan War, gave no inconsiderable help to their comrades. Homer stated, however, not that they gave any aid in the pestilence or in the various sorts of diseases, but only that they relieved wounds by the knife and by medicaments. Hence it appears that by them those parts only of the Art were attempted, and that they were the oldest.
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From the same authority, indeed, it can be learned that diseases were then ascribed to the anger of the immortal gods, and from them help used to be sought; and it is probable that with no aids against bad health, none the less health was generally good because of good habits, which neither indolence nor luxury had vitiated: since it is these two which have afflicted the bodies of men, first in Greece, and later amongst us; and hence this complex Art of Medicine, not needed in former times, nor among other nations even now, scarcely protracts the lives of a few of us to the verge of old age.
Therefore even after these I have mentioned, no distinguished men practised the Art of Medicine until literary studies began to be pursued with more attention, which more than anything else are a necessity for the spirit, but at the same time are bad for the body. At first the science of healing was held to be part of philosophy, so that treatment of disease and contemplation of the nature of things began through the same authorities; clearly because healing was needed especially by those whose bodily strength had been weakened by restless thinking and night-watching. Hence we find that many who professed philosophy became expert in medicine, the most celebrated being Pythagoras, Empedocles and Democritus. But it was, as some believe, a pupil of the last, Hippocrates of Cos, a man first and foremost worthy to be remembered, notable both for professional skill and for eloquence, who separated this branch of learning from the study of philosophy. After him
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Diocles of Carystus, next Praxagoras and Chrysippus, then Herophilus and Erasistratus, so practised this art that they made advances even towards various methods of treatment.
During the same times the Art of Medicine was divided into three parts: one being that which cures through diet, another through medicaments, and the third by hand. The Greeks termed the first Διαιτητικήν, the second Φαρμακευτικήν, the third Χειρουργίαν. But of that part which cured diseases by diet those who were by far the most famous authorities, endeavouring to go more deeply into things, claimed for themselves also a knowledge of nature, without which it seemed that the Art of Medicine would be stunted and weak. After them first of all Serapion, declaring that this kind of reasoning method was in no way pertinent to Medicine, based it only upon practice and upon experience. To him followed Apollonius and Glaucias, and somewhat later Heraclides of Tarentum, and other men of no small note, who in accordance with what they professed called themselves Empirici (or Experimentalists). Thus this Art of Medicine which treats by diet was also divided into two parts, some claiming an Art based upon speculation, others on practice alone. But after those mentioned above no one troubled about anything except what tradition had handed down to him until Asclepiades changed in large measure the way of curing. Of his successors, Themison, late in life, diverged from Asclepiades in some respects. And it is through these men in particular that this health-giving profession of ours has grown up.
Since of the divisions of the Art of Medicine, the
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one which heals diseases, as it is the most difficult, is also the most famous, we must speak about it first. And because there is a primary difference of opinion, so holding that the sole knowledge necessary is derived from experience, others propounding that practice is not efficient enough except after acquiring a reasoned knowledge of human bodies and of nature, I must indicate which are the principal statements on either side, so that I may the more easily interpose my own opinion also.
They, then, who profess a reasoned theory of medicine propound as requisites, first, a knowledge of hidden causes involving diseases, next, of evident causes, after these of natural actions also, and lastly of the internal parts.
They term hidden, the causes concerning which inquiry is made into the principles composing our bodies, what makes for and what against health. For they believe it impossible for one who is ignorant of the origin of diseases to learn how to treat them suitably. They say that it does not admit of doubt that there is need for differences in treatment, if, as certain of the professors of philosophy have stated, some excess, or some deficiency, among the four elements, creates adverse health; or, if all the fault is in the humours, as was the view of Herophilus; or in the breath, according to Hippocrates; or if blood is transfused into those blood-vessels which are fitted for pneuma, and excites inflammation
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which the Greeks term φλεγμόνην, and that inflammation effects such a disturbance as there is in fever, which was taught by Erasistratus; or if little bodies by being brought to a standstill in passing through invisible pores block the passage, as Asclepiades contended — his will be the right way of treatment, who has not failed to see the primary origin of the cause. They do not deny that experience is also necessary; but they say it is impossible to arrive at what should be done unless through some course of reasoning. For the older men, they say, did not cram the sick anyhow, but reasoned out what might be especially suitable, and then put to the test of experience what conjecture of a sort had previously led up to. Again they say that it makes no matter whether by now most remedies have been well explored already . . . if, nevertheless, they started from a reasoned theory; and that in fact this has also been done in many instances. Frequently, too, novel classes of disease occur about which hitherto practice has disclosed nothing, and so it is necessary to consider how such have commenced, without which no one among mortals can possibly find out whether this rather than that remedy should be used; this is the reason why they investigate the occult causes.
But they call evident those causes, concerning which they inquire, as to whether heat or cold, hunger or surfeit, or such like, has brought about the commencement of the disease; for they say that he will be the one to counter the malady who is not ignorant of its origin.
Further, they term natural actions of the body, those by which we draw in and emit breath, take in
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and digest food and drink, as also those actions through which food and drink are distributed into every part of the members. Moreover, they also inquire why our blood-vessels now subside, now swell up; what is the explanation of sleep and wakefulness: for without knowledge of these they hold that no one can encounter or remedy the diseases which spring up in connexion with them. Among these natural actions digestion seems of most importance, so they give it their chief attention. Some following Erasistratus hold that in the belly the food is ground up; others, following Plistonicus, a pupil of Praxagoras, that it putrefies; others believe with Hippocrates, that food is cooked up by heat. In addition there are the followers of Asclepiades, who propound that all such notions are vain and superfluous, that there is no concoction at all, but that material is transmitted through the body, crude as swallowed. And on these points there is little agreement indeed among them; but what does follow is that a different food is to be given to patients according as this or that view is true. For if it is ground up inside, that food should be selected which can be ground up the most readily; if it putrefies, that which does so most expeditiously; if heat concocts it, that which most excites heat. But none of these points need be inquired into if there be no concoction but such things be taken which persist most in the state in which they were when swallowed. In the same way, when breathing is laboured, when sleep or wakefulness disturbs, they deem him able to remedy it who had understood beforehand how these same natural actions happen.
Moreover, as pains, and also various kinds of
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diseases, arise in the more internal parts, they hold that no one can apply remedies for these who is ignorant about the parts themselves; hence it becomes necessary to lay open the bodies of the dead and to scrutinize their viscera and intestines. They hold that Herophilus did this in the best way by far, when they laid open men whilst alive — criminals received out of prison from the kings — and while these were still breathing, observed parts which beforehand nature had concealed, their position, colour, shape, size, arrangement, hardness, softness, smoothness, relation, processes and depressions of each, and whether any part is inserted into or is received into another. For when pain occurs internally, neither is it possible for one to learn what hurts the patient, unless he had acquainted himself with the position of each organ or intestine; nor can a diseased portion of the body be treated by one who does not know what that portion is. When a man's viscera are exposed in a wound, he who is ignorant of the colour of a part in health may be unable to recognize which part is intact, and which part damaged; thus he cannot even relieve the damaged part. External remedies too can be applied more aptly by one acquainted with the position, shape and size of the internal organs, and like reasonings hold good in all the instances mentioned above. Nor is it, as most people say, cruel that in the execution of criminals, and but a few of them, we should seek remedies for innocent people of all future ages.
On the other hand, those who are called "Empirici" because they have experience, do indeed accept evident causes as necessary; but they contend
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that inquiry about obscure causes and natural actions is superfluous, because nature is not to be comprehended. That nature cannot be comprehended is in fact patent, they say, from the disagreement among those who discuss such matters; for on this question there is no agreement, either among professors of philosophy or among actual medical practitioners. Why, then, should anyone believe rather in Hippocrates than in Herophilus, why in him rather than in Asclepiades? If one wants to be guided by reasoning, they go on, the reasoning of all of them can appear not improbable; if by method of treatment, all of them have restored sick folk to health: therefore one ought not to derogate from anyone's credit, either in argument or in authority. Even philosophers would have become the greatest of medical practitioners, if reasoning from theory could have made them so; as it is, they have words in plenty, and no knowledge of healing at all. They also say that the methods of practice differ according to the nature of localities, and that one method is required in Rome, another in Egypt, another in Gaul; but that if the causes which produce diseases whether everywhere the same, the same remedies should be used everywhere; that often, too, the causes are apparent, as, for example, of ophthalmia, or of wounds, yet such causes do not disclose the treatment: that if the evident cause does not supply the knowledge, much less can a cause which is in doubt yield it. Since, therefore, the cause is as uncertain as it is incomprehensible, protection is to be sought rather from the ascertained and explored, as in all the rest of the Arts, that is, from what experience has taught in the actual course of treatment: for
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even a farmer, or a pilot, is made not by disputation but by practice. That such speculations are not pertinent to the Art of Medicine may be learned from the fact that men may hold different opinions on these matters, yet conduct their patients to recovery all the same. This has happened, not because they deduced lines of healing from obscure causes, nor from the natural actions, concerning which different opinions were held, but from experiences of what had previously succeeded. Even in its beginnings, they add, the Art of Medicine was not deduced from such questionings, but from experience; for of the sick who were without doctors, some in the first days of illness, longing for food, took it forthwith; others, owing to distaste, abstained; and the illness was more alleviated in those who abstained. Again, some partook of food whilst actually under the fever, some a little before, others after its remission, and it went best with those who did so after the fever had ended; and similarly some at the beginning adopted at once a rather full diet, others a scanty one, and those were made worse who had eaten plentifully. When this and the like happened day after day, careful men noted what generally answered the better, and then began to prescribe the same for their patients. Thus sprang up the Art of Medicine, which, from the frequent recovery of some and the death of others, distinguished between the pernicious and the salutary.
It was afterwards, they proceed, when the remedies had already been discovered, that men began to discuss the reasons for them: the Art of Medicine was not a discovery following upon reasoning, but after the discovery of the remedy, the reason for it was
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sought out. They ask, too, does reasoning teach the same as experience? If the same, it was needless; if something else, then it was even opposed to it: nevertheless, at first remedies had to be explored with the greatest care; now, however, they have been explored already; there were neither new sorts of diseases to be found out, nor was a novel remedy wanted. For even if there happened nowadays some unknown form of malady, nevertheless the practitioner had not to theorize over obscure matters, but straightway would see to which disease it came nearest, then would make trial of remedies similar to those which have succeeded often in a kindred affection, and so through its similarities find help; that is not to say that a practitioner had no need to take counsel, and that an irrational animal was capable of exhibiting this art, but that these conjectures about concealed matters are of no concern because it does not matter what produces the disease but what relieves it; nor does it matter how digestion takes place, but what is best digested, whether concoction comes about from this cause or that, and whether the process is concoction or merely distribution. We had no need to inquire in what way we breathe, but what relieves laboured breathing; not what may move the blood-vessels, but what the various kinds of movements signify. All this was to be learnt through experiences; and in all theorizing over a subject it is possible to argue on either side, and so cleverness and fluency may get the best of it; it is not, however, by eloquence but by remedies that diseases are treated. A man of few words who learns by practice to discern well, would make an altogether better practitioner than he who, unpractised, over-cultivates his tongue.
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Now the matters just referred to they deem to be superfluous; but what remains, cruel as well, to cut into the belly and chest of men whilst still alive, and to impose upon the Art which presides over human safety someone's death, and that too in the most atrocious way. Especially is this true when, of things which are sought for with so much violence, some can be learnt not at all, others can be learnt even without a crime. For when the body had been laid open, colour, smoothness, softness, hardness and all similars would not be such as they were when the body was untouched; because bodies, even when uninjured yet often change in appearance, they note, from fear, pain, want of food, indigestion, weariness and a thousand other mediocre affections; it is much more likely that the more internal parts, which are far softer, and to which the very light is something novel, should under the most severe of woundings, in fact mangling, undergo changes. Nor is anything more foolish, they say, than to suppose that whatever the condition of the part of a man's body in life, it will also be the same when he is dying, nay, when he is already dead; for the belly indeed, which is of less importance, can be laid open with the man still breathing; but as soon as the knife really penetrates to the chest, by cutting through the transverse septum, a sort of membrane which divides the upper from the lower parts (the Greeks call it dia/fragma), the man loses his life at once: so it is only when the man is dead that the chest and any of the viscera come into the view of the medical murderer, and they are necessarily those of a dead, not of a living man. It follows, therefore, that the medical man just plays the cut-throat, not that he learns
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what our viscera are like when we are alive. If, however, there be anything to be observed whilst a man is still breathing, chance often presents it to the view of those treating him. For sometimes a gladiator in the arena, or a soldier in battle, or a traveller who has been set upon by robbers, is so wounded that some or other interior part is exposed in one man or another. Thus, they say, an observant practitioner learns to recognize site, position, arrangement, shape and such like, not when slaughtering, but whilst striving for health; and he learns in the course of a work of mercy, what others would come to know by means of dire cruelty. That for these reasons, since most things are altered in the dead, some hold that even the dissection of the dead is unnecessary; although not cruel, it is none the less nasty; but all that is possible to come to know in the living, the actual treatment exhibits.
Since all these questions have been discussed often by practitioners, in many volumes and in large and contentious disputations, and the discussion continues, it remains to add such views as may seem nearest the truth. These are neither wholly in accord with one opinion or another, nor exceedingly at variance with both, but hold a sort of intermediate place between divers sentiments, a thing which may be observed in most controversies when men seek impartially for truth, as in the present case. For as regards the causes which either favour health or excite disease, how breath is drawn in or food distributed, not even philosophers attain to full knowledge, but seek it out by conjecture. But where there is no certain knowledge about a thing, mere opinion about it cannot find a certain remedy.
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And it is true that nothing adds more to a really rational treatment than experience. Although, therefore, many things, which are not strictly pertinent to the Arts as such, are yet helpful by stimulating the minds of those who practise them, so also this contemplation of the nature of things, although it does not make a practitioner, yet renders him more apt and perfected in the Art of Medicine. And it is probable that Hippocrates, Erasistratus and certain others, who were not content to busy themselves over fevers and ulcerations, but also to some extent searched into the nature of things, did not by this become practitioners, but by this became better practitioners. But reasoning is necessary to the Art of Medicine, not only when dealing with obscure causes, or natural actions, but often . . . for it is an art based on conjecture. However, in many cases not only does conjecture fail, but experience as well; and at times, neither fever, nor appetite, nor sleep follow their customary course. More rarely, yet now and again, a disease itself is new. That this does not happen is manifestly untrue, for in our time a lady, from whose genitals flesh had prolapsed and become gangrenous, died in the course of a few hours, whilst practitioners of the highest standing found out neither the class of malady nor a remedy. I conclude that they attempted nothing because no one was willing to risk a conjecture of his own in the case of a distinguished personage, for fear that he might seem to have killed, if he did not save her;
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yet it is probable that something might possibly have been thought of, had no such timidity prevailed, and perchance this might have been successful had one but tried it. In this sort of practice similarity is not always of service, and when it does prove serviceable, nevertheless there has been a process of reasoning, in the theorizing over similar classes of diseases and of remedies, as to which is the best remedy to use. When, therefore, such an incident occurs, the practitioner ought to arrive at something which may answer, even if perhaps not always, yet nevertheless more often than not. He will see, however, every novel plan, not from hidden things, for these are dubious and unascertainable, but from those which can be explored, that is, from evident causes. For what matters is this: whether fatigue or thirst, whether heat or cold, whether wakefulness or hunger, whether abundance in food or wine, whether intemperance in venery, has produced the disease. Nor should there be ignorance of the sick man's temperament; whether his body is rather humid or rather dry, whether his sinews are strong or weak, whether he is frequently or rarely ill; and when ill whether so severely or slightly, for a short or long while; the kind of life he has lived, laborious or quiet, accompanied by luxury or frugality. From such and similar data, one may often deduce a novel mode of treatment.
None the less the foregoing statements ought not to be passed by as if they did not admit of controversy. For Erasistratus himself has affirmed that diseases were not produced by such causes, since other persons, and even the same person at different times, were not rendered feverish by them. Further,
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certain practitioners of our time, following, as they would have it appear, the authority of Themison, contend that there is no cause whatever, the knowledge of which has any bearing on treatment: they hold that it is sufficient to observe certain general characteristics of diseases; that of these there are three classes, one a constriction, another a flux, the third a mixture. For the sick at one time excrete too little, at another time too much; again, from one part too little, from another too much; and these classes of diseases are sometimes acute, sometimes chronic, at times on the increase, at times constant, at times diminishing. Once it has been recognized, then, which it is of these, if the body is constricted, it has to be relaxed; if suffering from a flux, that has to be controlled; if a mixed lesion, the more severe malady must be countered first. Moreover, there must be treatment of one kind for acute diseases, another kind for chronic ones, another for increasing, stationary, or for those already tending to recovery. They hold that the Art of Medicine consists of such observations; which they define as a sort of way, which they name μέθοδοσ, and maintain that medicine should examine those characteristics which diseases have in common. They do not want to be classed with reasoners from theory, nor with those who look to experience only; for in so naming themselves Methodici, they dissent from the former because they are unwilling that the Art should consist in conjecture about hidden things, and from the latter because they think that in the observation of experience there is little of an Art of Medicine.
As relates to Erasistratus, in the first place the
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actual evidence is against his opinion, because seldom does a disease occur unless following upon one of these; secondly, it does not follow that what has done no harm to one patient, or to that same patient upon one occasion, may not harm another patient, or the same one at another time. For it is possible that there are certain underlying conditions in the body, whether related to infirmity, or to an actual affection of some kind, which either are not present in another person, or were not existent in that patient on another occasion, and which of themselves are not enough to constitute a disease, yet they may render the body more liable to other injurious affections. But if Erasistratus had been sufficiently versed in the study of the nature of things, as those practitioners rashly claim themselves to be, he would have known also that nothing is due to one cause alone, but that which is taken to be the cause is that which seems to have had the most influence. Indeed it is possible that when one cause acts alone, it may not disturb, yet when acting in conjunction with other causes it may produce a very great disturbance. Moreover, even Erasistratus himself, who says that fever is produced by blood transfused into the arteries, and that this happens in an over-replete body, failed to discover why, of two equally replete persons, one should lapse into disease, and the other remain free from anything dangerous; and that clearly happens every day. Hence, however true this transfusion, one can learn that it does not occur of itself when there is bodily fullness, but when there is added something else.
But disciples of Themison, if they hold their
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precepts to be of constant validity, are reasoners even more than anybody else; for if a man des not hold all the tenets that another reasoner approves, he does not forthwith have to assume a different name for his art, if (and this is the essential point) he does rely not only on written authority, but also upon reasoning from theory. But if, which is nearer to the truth, the Art of Medicine admits of scarcely any universal precepts, reasoners are in the same position as those who depend upon experience alone, all the more because whether the disease has braced or relaxed is what the most uninstructed can see. But if a remedy which loosens a body braced up, or tightens a loosened body, has been deduced by a reasoning from theory, the practitioner is a reasoner; if (as the man who denies himself to be a reasoner must admit) he acts from experience, he is an Empiric. Thus according to Themison, knowledge of a disease is outside the Art, and medicine is confined to practice; nor has there been added anything to what Empirics profess, but something taken away; for reasoners from theory gaze about over a multiplicity of matters, Empirics look to circumstances the most simple, and nothing more than commonplaces. For in like manner those who treat cattle and horses, since it is impossible to learn from dumb animals particulars of their complaints, depend only upon common characteristics; so also do foreigners as they are ignorant of reasoning subtleties look rather to common characteristics of disease. Again, those who take charge of large hospitals, because they cannot pay full attention to individuals, resort to these common characteristics.
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I vow, the ancients knew all this, but were not content therewith; therefore even the oldest authority, Hippocrates, said that in healing it was necessary to take note both of common and of particular characteristics. Indeed these very Methodici, even within their professed limitations, cannot be consistent; for there are divers kinds of constricting and relaxing diseases, those in which there is a flux being the more easy to observe. For it is one thing to vomit blood, another bile, another food; it is one thing to suffer from diarrhoea, another from dysentery; one thing to be relaxed through sweating, another to be wasted by consumption. Humour may break out into particular parts, such as the eyes or the ears; from a risk of this kind there is no human member free. No one of these occurrences is treated in the same way as another.
Hence the Art descends straight down from a consideration of the common characteristics of a flux to the particular case. Moreover, because the same remedies do not meet with success in all, even of similar cases, additional knowledge of peculiarities in such a case is often necessary. Although certain things act upon the bowels in most cases, whether as astringents or as laxatives, yet there are to be found some in whom the same thing acts differently than it does in others. In such instances, therefore, investigation of particular characteristics is salutary, that of common characteristics the reverse. Moreover, a reckoning up of the cause often solves the malady. Thus Cassius, the most ingenious practitioner of our generation, recently dead, in a case suffering from fever and great thirst, when he learnt that the man had begun to feel oppressed after intoxication,
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administered cold water, by which draught, when by the admixture he had broken the force of the wine, he forthwith dispersed the fever by means of a sleep and a sweat. He, as a practitioner, provided an opportune remedy, not out of consideration whether the man's body was constricted or relaxed, but from what had happened beforehand to cause it. Besides, according to these very authorities there are particulars relating to locality and to season. When they are discussing what should be done by men in health, they prescribe the avoidance of cold, heat, surfeit, fatigue, venery, especially in sickly localities and seasons; in such places and seasons rest is to be taken, particularly when one feels a sense of oppression, and neither the stomach is to be disturbed by an emetic, nor the bowels by a purge. Such generalities are indeed true: none the less they descend from them to certain particular characteristics, unless they would persuade us that climate and season are to be taken into consideration by those in health but not by the sick, the very persons in whom all such observance is by so much the more necessary, the more that their weakness is liable to all attacks. Nay, even in the same patient, the particular characteristics of a disease are very various, and those who have been treated for a time in vain by the ordinary remedies have been often restored by contrary ones. And in the giving food too there are many distinctions to be noted; I will content myself with one instance. For hunger is more easily borne by an adult than by a boy, more easily in a dense than in a thin atmosphere, more easily in winter than in summer, more easily by one accustomed to a single meal than by one used in addition to one at midday,
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more easily when sedentary than when in active exercise; and often it is necessary to hurry on the meal in the case of one who is intolerant of hunger. Hence I conjecture that he who is not acquainted with the peculiar characteristics has merely to consider the general ones; and he who can become acquainted with peculiarities, whilst insistent upon them, ought not to neglect generalities as well; and consequently, presuming their state to be equal, it is more useful to have in the practitioner a friend rather than a stranger.
Therefore, to return to what I myself propound, I am of opinion that the Art of Medicine ought to be rational, but to draw instruction from evident causes, all obscure ones being rejected from the practice of the Art, although not from the practitioner's study. But to lay open the bodies of men whilst still alive is as cruel as it is needless; that of the dead is a necessity for the learner, who should know positions and relations, which the dead body exhibits better than does a living and wounded man. As for the remainder, which can only be learnt from the living, actual practice will demonstrate it in the course of treating the wounded in a somewhat slower yet much milder way.
With these premises I will first speak of how those in health should act (Book I), than I will pass on to what pertains to diseases (Book II, 1‑8), and to their treatments (Book II, 9‑33).
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1 A man in health, who is both vigorous and his own master, should be under no obligatory rules, and have no need, either for a medical attendant, or for a rubber and anointer. His kind of life should afford him variety; he should be now in the country, now in town, and more often about the farm; he should sail, hunt, rest sometimes, but more often take exercise; for whilst inaction weakens the body, work strengthens it; the former brings on premature old age, the latter prolongs youth.
It is well also at times to go to the bath, at times to make use of cold waters; to undergo sometimes inunction, sometimes to neglect that same; to avoid no kind of food in common use; to attend at times a banquet, at times to hold aloof; to eat more than sufficient at one time, at another no more; to take food twice rather than once a day, and always as much as one wants provided one digests it. But whilst exercise and food of this sort are necessities, those of the athletes are redundant; for in the one class any break in the routine of exercise, owing to necessities of civil life, affects the body injuriously, and in the other, bodies thus fed up in their fashion age very quickly and become infirm.
Concubitus indeed is neither to be desired overmuch, nor overmuch to be feared; seldom used it
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braces the body, used frequently it relaxes. Since, however, nature and not number should be the standard of frequency, regard being had to age and constitution, concubitus can be recognized as harmless when followed neither by languor nor by pain. The use is worse in the day-time, and safer by night; but care should be taken that by day it be not immediately followed by a meal, and at night not immediately followed by work and watching. Such are the precautions to be observed by the strong, and they should take care that whilst in health their defences against ill-health are not used up.
2 The weak, however, among whom are a large portion of townspeople, and almost all those fond of letters, need greater precaution, so that care may re-establish what the character of their constitution or of their residence or of their study detracts. Anyone therefore of these who has digested well may with safety rise early; if too little, he must stay in bed, or if he has been obliged to get up early, must go to sleep again; he who has not digested, should lie up altogether, and neither work nor take exercise nor attend to business. He who without heartburn eructates undigested food should drink cold water at intervals and none the less exercise self-control.
He should also reside in a house that is light, airy in summer, sunny in winter; avoid the midday sun, the morning and evening chill, also exhalations from rivers and marshes; and he should not often expose himself when the sky is cloudy to a sun that breaks through . . ., lest he should be affected alternately by cold and heat — a thing which excites
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particularly choked nostrils and running colds. Much more indeed are these things to be watched in unhealthy localities, where they even produce pestilence.
He can tell that his body is sound, if his morning urine is whitish, later reddish; the former indicates that digestion is going on, the latter that digestion is complete. On waking one should lie still for a while, then, except in winter time, bathe the face freely with cold water; when the days are long the siesta should be taken before the midday meal, when short, after it. In winter, it is best to rest in bed the whole night long; if there must be study by lamp-light, it should not be immediately after taking food, but after digestion. He who has been engaged in the day, whether in domestic or on public affairs, ought to keep some portion of the day for the care of the body. The primary care in this respect is exercise, which should always precede the taking of food; the exercise should be ampler in the case of one who has laboured less and digested less well.
Useful exercises are: reading aloud, drill, handball, running, walking; but this is not by any means most useful on the level, since walking up and down hill varies the movement of the body, unless indeed the body is thoroughly weak; but it is better to walk in the open air than under cover; better, when the head allows of it, in the sun than in the shade; better under the shade of a wall or of trees than under a roof; better a straight than a winding walk. But the exercise ought to come to an end with sweating, or at any rate lassitude, which should be
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well this side of fatigue; and sometimes less, sometimes more, is to be done. But in these matters, as before, the example of athletes should not be followed, with their fixed rules and immoderate labour. The proper sequel to exercise is: at times an anointing, whether in the sun or before a brazier; at times a bath, which should be in a chamber as lofty, well lighted and spacious as possible. However, neither should be made use of invariably, but one of the two the oftener, in accordance with the constitution. There is need of a short rest afterwards.
Coming to food, a surfeit is never of service, excessive abstinence is often unserviceable; if any intemperance is committed, it is safer in drinking than in eating. It is better to begin a meal with savouries, salads and such-like; and after that meat is to be eaten, best either when roasted or boiled. All preserved fruits are unserviceable for two reasons, because more is taken owing to their sweetness, and even what is moderate is still digested with some difficulty. Dessert does no harm to a good stomach, in a weak one it turns sour. Whoever then in this respect has too little strength, had better eat dates, apples and such-like at the beginning of the meal. After many drinkings which have somewhat exceeded the demands of thirst, nothing should be eaten; after a surfeit of food there should be no exertion. Anyone who has had his fill digests the more readily if he concludes the meal with a drink of cold water, then after keeping awake for a time has a sound sleep. When a full meal is taken at
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midday, after it there should be no exposure to cold, heat or fatigue, which do not harm the body so easily when it is empty as when it is full. When from whatever causes there is prospective want of food, everything laborious should be avoided.
3 Now the foregoing precepts indeed almost always hold good; but some particular notice requires to be taken of changes of surroundings and varieties of constitution and sex and age and seasons. For it is not safe to remove either from a salubrious to an oppressive locality, or from an oppressive to a salubrious one. It is better to make the move from a salubrious into an oppressive place at the beginning of winter, from an oppressive into a salubrious one in early summer. It is not good indeed to overeat after a long fast, nor to fast after overeating. And he runs a risk who goes contrary to his habit and eats immoderately whether once or twice in the day. Again, neither sudden idleness after excessive labour, nor sudden labour after excessive idleness, is without serious harm. Therefore when a man wishes to make a change, he ought to habituate himself little by little; indeed any work is easier even for a boy or an old man than for an unaccustomed adult. Hence also too idle a life is inexpedient, because there may come up some necessity for labour. But if at any time a man has had to undergo unaccustomed labour, or at any rate much more than he is used to, he should go to bed on an empty stomach, more especially if he has a bitter taste in his mouth, or his eyes are dimmed, or his bowels disturbed; for then he must not only sleep with his stomach empty, but even remain at rest over the next day, unless rest has quickly removed the trouble; in this case
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he should get up and take slowly a short walk. But even when there has been no necessity for a sleep, because a man has only done more moderate work, still he ought, all the same, to take a little walk. This then should be the rule for everyone after incurring fatigue before taking food: first to walk about a little, then, if no bath is at hand, to undergo anointing and sweating in a warm place whether in the sun or before a fire; when there is a bath, he should first sit in the warm room, then, after resting there a while, go down into the tubs; next, after being anointed freely with oil and gently rubbed down, again descend into the tub; finally he should foment the face, first with warm, then with cold water. A very hot bath does not suit such cases. Therefore if one's excessive fatigue almost amounts to a fever, it is quite sufficient for him to sit in warm water, to which a little oil may be added, up to the groins, in a tepid room; next his whole body, and especially the parts which have been under water, should be rubbed gently with oil to which a little wine and pounded salt have been added. This done, anybody who has undergone fatigue is ready for food, in particular food of a fluid consistency; he should be content with water to drink, or if wine, certainly diluted, of the sort to promote diuresis. Further it should be recognized that after labour accompanied by sweating a cold drink is most pernicious, and even although sweating after a fatiguing journey has passed off, it is unserviceable. After coming out of the bath, too, Asclepiades held it unserviceable; and this is true in the case of those whose bowels are loose at uncertain moments, and who readily shiver; but it is not the universal rule
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in all cases, since it is more natural that a heated stomach should be cooled, and a cold one warmed by a drink. I grant so much, but I hesitate to give this as a rule, for as a matter of fact a cold drink is bad while sweating. It also happens that after a dinner of many courses and many drinks of diluted wine a vomit is even advantageous; the next day there should be a prolonged rest followed by exercise in moderation. If there is oppression due to a persistence of fatigue, water and wine should be drunk alternately, but the bath seldom used. A change of work, too, relieves lassitude; and when a novel form of customary work has tired a man, that form to which he is accustomed restores him. To one who is fatigued that couch is best which he uses every day; for whether soft or hard, one to which he is unaccustomed wearies him. Certain things are specially applicable to one who is fatigued whilst travelling on foot. To be rubbed often while actually on the way restores him; after the journey he should sit awhile, then undergo anointing; next at the bath foment with hot water his upper rather than his lower parts. But anyone who has become overheated in the sun should go at once to the bath, and there have oil poured over the head and body; next go down to a thoroughly hot tub; then have water poured over his head freely, first hot, next cold. On the other hand, he who has become much chilled should first sit in the calidarium, well wrapped up, until he sweats; next be anointed, afterwards laved, then take food in moderation and after that drinks of undiluted wine. He too who on a voyage is troubled by seasickness, if he has vomited out a quantity of bile, should fast or take very little food. If he has spewed
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out sour phlegm, he may take food notwithstanding, but lighter than usual; if he has nausea without vomiting, he should either fast, or after food excite a vomit. But he who has spent all day sitting in a carriage or at the games should not after that hurry but walk slowly; also it is of service to linger somewhat in the bath, and then take a small dinner afterwards. When overheated in the bath, taking vinegar and holding it in the mouth restores him; if that is not at hand, cold water may be taken in the same way.
But above all things everyone should be acquainted with the nature of his own body, for some are spare, others obese; some hot, others more frigid; some moist, others dry; some are costive, in others the bowels are loose. It is seldom but that a man has some part of his body weak. So then a thin man ought to fatten himself up, a stout one to thin himself down; a hot man to cool himself, a cold man to make himself warmer; the moist to dry himself up, the dry to moisten himself; he should render firmer his motions if loose, relax them if costive; treatment is to be always directed to the part which is mostly in trouble.
Now the body is fattened: by moderate exercise, by oftener resting, by anointing, and by the bath if after a meal at midday; by the bowels being confined, by winter cold in moderation, by sleep adequate but not over long, by a soft couch, by a tranquil spirit, by food whether solid or fluid which is sweet and fatty; by meals rather frequent and as large as it is possible to digest. The body is thinned: by hot water if one bathes in it and especially if salt; by the bath on an empty stomach, by a scorching sun, by heat of all kinds, by worry, by late nights; by sleep unduly short or overlong, by a hard bed throughout the summer; by running or much walking or any violent exercise; by a vomit, by purgation, by sour and harsh things consumed; by a single meal a day; by the custom of drinking wine not too cold upon an empty stomach.
But as I have mentioned a vomit and a purge among thinning measures, there are some things to be said in particular concerning them. I note that a vomit was rejected by Asclepiades in the book written by him, entitled De tuenda sanitate; I do not blame him for being disquieted with the custom of those, who by ejecting every day achieve a capacity for gormandizing. He has even gone somewhat further; for from the same volume he has expelled likewise purgings; which indeed are pernicious when procured by too powerful medicaments. Such measures, however, are not to be dispensed with entirely, because regard for different constitutions and times can make them necessary, provided that they are employed in moderation and only when needed. Hence Asclepiades has himself allowed that what is already corrupted ought to be expelled: so this kind of treatment is not wholly to be condemned. But there may be more than one reason for this too; and so a somewhat closer consideration may be given to the matter.
A vomit is more advantageous in winter than in summer, for then more phlegm and severer stuffiness in the head occur. It is unsuitable for the thin and for those with a weak stomach, but suitable for the plethoric, and all who have become bilious, whether after overeating or imperfect digestion. For if the meal has been larger than can be digested, it is not
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well to risk its corruption; and if it has already become corrupted, nothing is more to the purpose than to eject it by whatever way its expulsion is first possible. When, therefore, there are bitter eructations, with pain and weight over the heart, recourse should be had at once to a vomit, which is likewise of service to anyone who has heartburn and copious salivation or nausea, or ringing in the ears, or watering of the eyes, or a bitter taste in the mouth; similarly in the case of one who is making a change of climate or locality; as well as in the case of those who become troubled by pain over the heart when they have not vomited for several days. Nor am I unaware that in such cases there is prescribed rest, but that is not always within the reach of those who are obliged to be busy; nor does rest act in the same way with everybody. Accordingly I allow that vomiting should not be practised for the sake of luxury; on account of health I believe from experiment that it is sometimes rightly practised, nevertheless with this reservation, that no one who wants to keep well, and live to old age, should make it a daily habit. He who after a meal wants to vomit, if he does so easily should first take tepid water by itself; when there is more difficulty, a little salt or honey should be added. To cause a vomit on getting up in the morning, he should first drink some honey or hyssop in wine, or eat a radish, and after that drink tepid water as described above. The other emetics prescribed by the ancient practitioners all disturb the stomach. After a vomit, when the stomach is weak, a little suitable food should be taken, and for drink, unless the vomiting has made the throat raw, three cupfuls of cold water. He who has provoked
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a vomit, if it be early in the day, should after that take a walk, next undergo anointing, then dine; if after dining, he should the next day bathe, or sweat in the baths. After that the following meal had better be a light one, consisting of bread a day old, harsh undiluted wine, roasted meat, all food being of the dryest. Whoever aims to provoke a vomit twice a month, had better arrange to do so on two consecutive days, rather than once a fortnight, unless this longer interval causes heaviness in the chest.
Now defaecation is to be procured also by a medicament, when, the bowels being costive, too little is passed, with the result that there is increase of flatulence, dizziness of vision, headaches, and other disturbances in the upper parts. For what can rest and fasting help in such circumstances which come about so much through them? He who wants to defaecate should in the first place make use of such food and wine as will promote it; then if these have little effect, he should take aloes. But purgatives also, whilst necessary at times, when frequently used entail danger; for the body becomes subject to malnutrition, since a weakened state leaves it exposed to maladies of all sorts.
The body is heated: by anointing, by salt-water affusion and the more so when hot; by all food which is salt, bitter and fleshy; and after meals by the bath and harsh wine. On the contrary it is cooled: by the bath and sleep on an empty stomach, if not too prolonged; by all sour food; by the coldest water to drink, by oil affusion when mixed with water.
The body is rendered humid: by more than customary exertion, by a frequent bath, by food in
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increased amount, by copious drinking, followed by walking and late hours; much walking, early and forced, has by itself the same effect, food being taken not immediately after exercise; so also those classes of edibles which come from cold and rainy and irrigated localities. On the contrary the body is dried: by moderate exercise, hunger, anointing without the addition of water, summer heat with moderate exposure to the sun, cold water to drink, food immediately after exercise, and all edibles coming from hot and dry districts.
The bowels are confined by exertion, by sitting still, by besmearing the body with potter's clay, by a scanty diet, and that taken once a day in the case of one accustomed to two meals, by drinking little and that only after the consumption of whatever food is to be taken, also by rest after food. On the contrary they are rendered loose: by increasing the length of the walk, more food and drink; by moving about after the meal; by frequently drinking during the meal. This too should be recognized, that a vomit confines the bowels when relaxed, and relaxes them when costive: again, a vomit immediately after the meal confines the bowels, later it relaxes them.
As to what pertains to age: the middle-aged sustain hunger more easily, less so young people, and least of all children and old people. The less readily one supports it, the more often should food be taken; one who is growing needs it most. Children and the old should bathe in warm water. Wine should be diluted for children; for the old men it should be rather undilute: but at neither age be of a kind to cause flatulence. It matters less for the young what they take and the way they are treated. Those who
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when young are relaxed, when old are generally costive; those constipated in youth are often relaxed when old. It is better to be rather relaxed when young, rather costive when old.
The season of the year also merits consideration. In winter it is fitting to eat more, and to drink less but of a stronger wine, to use much bread, meat preferably boiled, vegetables sparingly; to take a single meal unless the bowels are too costive. If a meal is taken at midday, it is better that it should be somewhat scanty, and that dry, without meat, and without drinking. At that season everything taken should be hot or heat-promoting. Venery then is not so pernicious. But in spring food should be reduced a little, the drink added to, but, however, of wine more diluted; more meat along with vegetables should be taken, passing gradually from boiled to roast. Venery is safest at this season of the year. But in summer the body requires both food and drink oftener, and so it is proper in addition to take a meal at midday. At that season both meat and vegetables are most appropriate; wine that is much diluted in order that thirst may be relieved without heating the body; laving with cold water, roasted meat, cold food or food which is cooling. But just as food is taken more frequently, so there should be less of it. In autumn owing to changes in the weather there is most danger. Hence it is not good to go out of doors unless well covered, and with thick shoes, especially on the colder days; nor at night to sleep in the open air, or at any rate to be well covered. A little more food may now be taken, the wine less in quantity but stronger. Some think orchard fruit injurious, which is generally the
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case when eaten immoderately all day, without reducing more substantial food. Hence it is not the fruit but the heaping of all things together which does harm, but in none of them all is there less harm than in the fruit. But it is not fitting to eat of it oftener than other kinds of food, and when eaten, it is necessary to subtract some of the more substantial food. But venery is useful neither in summer nor in autumn; it is more tolerable nevertheless in autumn, in summer it is to be abstained from entirely, if that possibly be done.
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
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beneficial to the head as cold water, and so he who has a weak head every day throughout the summer hold it for a while under the stream from a large conduit. But even if he undergoes anointing without going into the bath, and cannot bear cooling of the whole body, he should always nevertheless douche his head with cold water; but since he does not want the rest of his body wetted, he bends forward for the water not to run down his neck, and with his hands directs the flow to his face, that his eyes or other parts may not be irritated. He must take food in moderation and such as he can easily digest; and if fasting affects his head, he should take a meal at midday; if it does not so suffer, the single meal is preferable. It is more expedient for him to drink a light wine, well diluted, rather than water, in order that he may have something in reserve when his head begins to become heavier; and to him, on the whole, neither wine nor water is proper always; each constitutes a remedy when taken in its turn. To write, to read, to argue, is not beneficial to him, particularly after dinner; after which, indeed, even cogitation is not sufficiently safe; worst of all, however, is a vomit.
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
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after dinner either wrangling or mental worry is injurious to everybody, it is especially so to those who are disposed to pains in the head or windpipe, or to other forms of oral affections. Choked nostrils and running from the nose can be also avoided, or minimized, if one who is liable to these makes as little change as possible in respect to residence and water; if he protects the head, that it may not be scorched by the sun, or be chilled by a passing cloud; if the head be shaved after digestion and the stomach empty; if there be no reading or writing after a meal.
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,
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there must be no tension of mind, no moving about in a walk however short.
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
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drink wine cold, a large drink after dinner, but as I have said through a tube, ending all by drinking cold water. He whose food tends to turn sour should beforehand take a draught of tepid water and vomit; but if as a consequence he has frequent motions, he should, whenever possible after each stool, take a draught of cold water.
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
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those ulcerations which are due to cold. It gives the surface of the body a good colour; it promotes diuresis. If excessive it weakens the body, mollifies sinews, relaxes the stomach. Yet cold and heat are both least safe when applied suddenly to persons unaccustomed to them; for cold gives rise to pain in the side and other diseases, cold water excites swelling in the neck. Heat hinders concoction, prevents sleep, exhausts by sweating, renders liable the body to pestilential illnesses.
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
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to be done in pestilence of all sorts, and particularly in one brought by south winds. And the same precautions are needed by those who travel, when they have left home during an unhealthy season, or when entering an unhealthy district. Even when something prevents observance of other rules, yet he ought to keep up the alteration, mentioned above, from wine to water, and from water to wine.