Hippocrates

“ But to go still further back, I hold that the diet and food which people in health now use would not have been discovered, provided it had suited with man to eat and drink in like manner as the ox, the horse, and all other animals, except man, do of the productions of the earth, such as fruits, weeds, and grass; for from such things these animals grow, live free of disease, and require no other kind of food. And, at first, I am of opinion that man used the same sort of food, and that the present articles of diet had been discovered and invented only after a long lapse of time. ”

“ But with regard to the most obscure and difficult diseases, a judgment is to be formed rather from opinion than art; and it is in such cases that experience differs much from inexperience. And it is a most important consideration to determine what is the cause of diseases, and what the beginning and fountain-head, as it were, of the evils in the body; for if one be acquainted with the cause of the disease, he may be able to apply the suitable remedies to the affections of the body, judging of diseases from their contraries: for this mode of cure is that which is most in accordance with nature. ”

“ Whoever would wish to discover the cause why this universe was framed, would not be far from the truth, in my opinion, if he said with one of the ancients, that the Father and Maker of it is good, and for that reason he spared not to impart of his most excellent nature to a substance having nothing beautiful in itself, but possessing the capacity of becoming all things. ”

“ Whoever having undertaken to speak or write on Medicine, have first laid down for themselves some hypothesis to their argument, such as hot, or cold, or moist, or dry, or whatever else they choose (thus reducing their subject within a narrow compass, and supposing only one or two original causes of diseases or of death among mankind) , are all clearly mistaken in much that they say; and this is the more reprehensible as relating to an art which all men avail themselves of on the most important occasions, and the good operators and practitioners in which they hold in especial honor. ”

“ Who does not lament to think of a generous mind placed under circumstances where cowardice is honored and courage debased? And what more melancholy picture of human misery can be imagined than that which is here exhibited of the bodily and mental powers in a state of arrested development from the effects of confinement? ”

“ So that the first inventors, pursuing their investigations properly, and by a suitable train of reasoning, according to the nature of man, made their discoveries, and thought the Art worthy of being ascribed to a god, as is the established belief. For they did not suppose that the dry or the moist, the hot or the cold, or any of these, are either injurious to man, or that man stands in need of them; but whatever in each was strong, and more than a match for a man’s constitution, whatever he could not manage, that they held to be hurtful, and sought to remove. ”

“ But I think that of all the qualities heat and cold exercise the least operation in the body, for these reasons: as long time as hot and cold are mixed up with one another they do not give trouble, for the cold is attempered and rendered more moderate by the hot, and the hot by the cold; but when the one is wholly separate from the other, then it gives pain; and at that season when cold is applied it creates some pain to a man, but quickly, for that very reason, heat spontaneously arises in him without requiring any aid or preparation. ”

“ Of all the diseases the acute are the most painful and the most fatal, and they require the greatest care and the most accurate treatment. No additional mischief should, at all events, be inflicted by the physician, but he must do the patient as much good as lies in his power; and if the physician treats the case properly, and the patient sinks under the weight of the disease, it will not be the physician’s fault; but if, while the physician does not treat nor understand the disease properly, the patient fall a victim to the disease, the physician will then be to blame. ”

“ But when the body is at rest, the soul, being in a state of movement, steals over the organs of the body, manages its own abode, and itself performs all the actions of the body; for the body, being asleep, does not perceive, but the soul, being awake, beholds what is visible, hears what is audible, walks, touches, is grieved, reflects, and, in a word, whatever the offices of the soul or body are, all these the soul performs in sleep. ”

“ For the art of Medicine would not have been invented at first, nor would it have been made a subject of investigation (for there would have been no need of it) , if when men are indisposed, the same food and other articles of regimen which they eat and drink when in good health were proper for them, and if no others were preferable to these. But now necessity itself made medicine to be sought out and discovered by men, since the same things when administered to the sick, which agreed with them when in good health, neither did nor do agree with them. ”

“ Then such waters as flow to the rising sun, must necessarily be clear, fragrant, soft, and delightful to drink, in such a city. For the sun in rising and shining upon them purifies them, by dispelling the vapors which generally prevail in the morning. ”

“ Thus, for example, hunger is a disease; for whatever afflicts man is called a disease. What, then, is the cure of hunger? Whatever will allay hunger, that is to say, food, and by it the other is to be cured. Again, drink cures thirst; and, moreover, evacuation cures repletion, and repletion evacuation, and rest labor, and labor rest; and, in a word, the contraries are the cure of contraries. For medicine consists of addition and subtraction—the subtraction of what is redundant, and the addition of what is deficient. And he that does these things best, is the best physician ”

“ It was the necessity, he says, [39] which men in the first stages of society must have felt of ascertaining the properties of vegetable productions as articles of food that gave rise to the science of Dietetics; and the discovery having been made that the same system of regimen does not apply in a disordered as in a healthy condition of the body, men felt themselves compelled to study what changes of the aliment are proper in disease; and it was the accumulation of facts bearing on this subject which gave rise to the art of Medicine. ”

“ To say that the soul is fire, is as if one were to call a saw or a wimble the artisan or his art, because his work is accomplished in co-operation with these instruments. From this it appears why animals stand in need of heat. ”

“ 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. ”

“ When the country is bare, not fenced, and rugged, blasted by the winter and scorched by the sun, there you may see the men hardy, slender, with well-shaped joints, [454] well-braced, and shaggy; sharp industry and vigilance accompany such a constitution; in morals and passions they are haughty and opinionative, inclining rather to the fierce than to the mild; and you will find them acute and ingenious as regards the arts, and excelling in military affairs; and likewise all the other productions of the earth corresponding to the earth itself. ”

“ In that part of the universe where Nature and Generation exert their powers, it is necessary that there should be these three things: In the first place, that thing which being tangible furnishes a body to everything which comes into existence. ”

“ Nowadays we have abandoned all general rules of practice, and profess to be guided solely by experience; but how variable and uncertain are its results in the present case! I myself—albeit but verging towards the decline of life—can well remember the time when a physician would have run the risk of being indicted for culpable homicide if he had ventured to bleed a patient in common fever; about twenty-five years ago venesection in fever, and in almost every disease, was the established order of the day ”

“ For when suffocating heat sets in all of a sudden, while the earth is moistened by the vernal showers, and by the south wind, the heat is necessarily doubled from the earth, which is thus soaked by rain and heated by a burning sun, while, at the same time, men’s bellies are not in an orderly state, nor the brain properly dried; for it is impossible, after such a spring, but that the body and its flesh must be loaded with humors, so that very acute fevers will attack all, but especially those of a phlegmatic constitution. ”

“ The changes of the seasons, too, are not great nor violent, for, in fact, they change gradually; and therefore their figures resemble one another, as they all equally use the same food, and the same clothing summer and winter, respiring a humid and dense atmosphere, and drinking water from snow and ice; neither do they make any laborious exertions, for neither body nor mind is capable of enduring fatigue when the changes of the seasons are not great. ”

“ But I would more especially commend the physician who, in acute diseases, by which the bulk of mankind are cut off, conducts the treatment better than others. Acute diseases are those which the ancients named pleurisy, pneumonia, phrenitis, lethargy, causus, and the other diseases allied to these, including the continual fevers. For, unless when some general form of pestilential disease is epidemic, and diseases are sporadic and [not] of a similar character, there are more deaths from these diseases than from all the others taken together. ”

“ In pneumonia, pleurisy, and in all the affections about the lungs and trachea, the disease is held to be of a dry nature when there is no expectoration from the parts affected; and in any complaints about the liver, the mesentery, the stomach, the small or great intestines, or spleen, when the belly is either entirely constipated, or when the discharges brought away by artificial means are dry and scybalous; and diseases of the arteries and veins are known to be dry by the dryness of the tongue, and the parched appearance of the whole body. ”

“ When loss of speech seizes a person, on the fourteenth day of a fever, there is not usually a speedy resolution, nor any removal of the disease, for this symptom indicates a protracted disease; and when it appears on that day, it will be still more prolonged. When, on the fourth day of a fever, the tongue articulates confusedly, and when there are watery and bilious discharges from the bowels, such a patient is apt to fall into a state of delirium; the physician ought, therefore, to watch him, and attend to whatever symptoms may turn up. ”

“ For, as far as I know, neither the hot nor the cold, nor the dry, nor the moist, has ever been found unmixed with any other quality; but I suppose they use the same articles of meat and drink as all we other men do. But to this substance they give the attribute of being hot, to that cold, to that dry, and to that moist. Since it would be absurd to advise the patient to take something hot, for he would straightway ask what it is? ”

“ For it is wonderful that physicians practising an art, in which the remedies applied may be determined by experience whether they are beneficial or hurtful, should yet make the most conflicting statements respecting those things which are beneficial and those which are prejudicial. For, in philosophy, it is not to be wondered at that there should be no end to most disputes, since these things cannot be clearly determined by experience ”

“ But when the fever ceases, the feet, on the contrary, become hotter than the rest of the body; for when the heat leaves the feet, it is kindled up in the breast, and sends its flame up to the head. And when all the heat rushes upwards, and is exhaled at the head, it is not to be wondered at that the feet become cold, being devoid of flesh, and tendinous ”

“ 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. ”

“ In cases of false conception, in which women are deceived by the non-appearance of the menses, and by the increase of the belly and movement in it, they will be found to have had headache and pains about the neck and hypochondria, and there is no milk in the breasts except a little of a watery character. But when the swelling of the womb passes away they will conceive, unless there be any other impediment. For this affection is beneficial in so far as it produces a change in the uterus, so that afterwards the woman may prove with child. ”

“ It cannot have escaped the most careless observation what changes the great pabulum, water, undergoes in the process of vegetation—how it is converted into various woods, and barks, and leaves, and flowers, all of which are resolvable, by the process of decay, into air, or reducible into earth. It is also well known that, although a more unfrequent occurrence, all the solid parts of a tree may undergo a mutation into rock, that is to say, may become petrified. But it is in the higher classes of animals that these changes of simple matter admit of the greatest variety. ”

“ The author sets out with stating “that there are certain arts which are of laborious acquisition, but are profitable to those who practise them; of general utility to the common people, but painful to those who exercise them. Of such a nature is the art of medicine. The physician contemplates dreadful things (δεινὰ) , comes in contact with what are unpleasant, and reaps sorrow to himself from the afflictions of others; but the sick are freed from the greatest evils by the art, namely, from diseases, pains, sorrow, and death; for medicine has been found decidedly to be a cure for all these. ”

“ In the season of summer and autumn an epistaxis, suddenly occurring in acute diseases, indicates vehemence of the attack, and inflammation in the course of the veins, and on the day following, the discharge of thin urine; and if the patient be in the prime of life, and if his body be strong from exercise, and brawny, or of a melancholic temperament, or if from drinking he has trembling hands, it may be well to announce beforehand either delirium or convulsion; [578] and if these symptoms occur on even days, so much the better; but on critical days, they are of a deadly character. ”

“ For the whole space between the earth and heaven is full of air, and it is the cause of winter and of summer; in winter becoming condensed and cold, and in summer mild and tranquil. The path also of the sun, moon, and stars is through air—for air is the pabulum of fire, and fire deprived of air could not live.... And with regard to the sea, that it contains a portion of air is obvious to everybody. For water-animals could not exist if they did not participate in the air ”

“ In conclusion, I would beg leave to remark that, if the work of Hippocrates, in its present form, appear defective when compared with what a modern work on the same subject would be expected to be, it has also peculiar traits which would hardly be matched in a modern composition. In a modern work we might have a greater abundance of particular facts, and a more copious detail of individual observations, but would there be such an exuberance of general truths, of grand results, and of original reflections? ”

“ This is the universal recipient and substance of impression for things generated, bearing the same relation to things which are generated from them that water does to juice, and silence to sound, and darkness to light, and materials to the things fabricated from them. For water is void of taste and quality, bearing the same relation to sweet and bitter, and to sharp and salt. The air is unformed as to sound, or speech, or melody. And darkness is devoid of color and shape, and bears the same relation towards bright, and yellow, and white. ”

“ The same persons creep out, and they creep in not the same persons; to one man they say one thing, and do another; the same person not always the same—sometimes he has one mind, and sometimes another. In this manner all the arts have communion with human nature.” All this is too fanciful and recondite for the physician of whom Celsus says “primus ex omnibus memoria dignis ab studio sapientiæ disciplinam hanc separavit.” ”

“ One may judge from the urine what is to take place, for if the urine be thicker, and more yellowish, so much the better; but if it be thinner, and blacker, so much the worse; [575] but if it undergo changes, it indicates a prolongation of the disease, and the patient, in like manner, must experience a change to the worse and the better. Irregular fevers should be let alone until they become settled, and, when they do settle, they are to be treated by a suitable diet and medicine, attending to the constitution of the patient. ”

“ Wherefore, I say, that such constitutions as suffer quickly and strongly from errors in diet, are weaker than others that do not; and that a weak person is in a state very nearly approaching to one in disease; but a person in disease is the weaker, and it is, therefore, more likely that he should suffer if he encounters anything that is unseasonable. It is difficult, seeing that there is no such accuracy in the Art, to hit always upon what is most expedient, and yet many cases occur in medicine which would require this accuracy, as we shall explain. ”

“ And in diseases and injuries, when there is a necessary succession of bad symptoms, the physician gets the blame, as men do not perceive that the aggravation of the symptoms is a necessary consequence of the nature of the disease. And if a physician visits a patient in fever, or who has met with an injury, and if the patient gets worse after the first medicine that is administered, the physician is blamed ”

“ Suidas says, regarding the first principles: “The first principles of all things are two, the efficient and the passive. The passive, then, is a being devoid of qualities—earth, matter. The efficient is the reason residing in it, namely, God. The principles and elements are different, inasmuch as the former are increate and indestructible, while the elements are destructible by burning. Besides, the first principles are without body and form, but the elements have form.” ”

“ It is unquestionably the work of a man possessed of a highly cultivated mind, free from the popular superstition of his age, and familiarly acquainted with comparative anatomy, and having no contemptible knowledge of human physiology. There is, in fact, no name, whether in ancient or modern times, to which it might not do honor. That it is not unworthy, then, of the great Hippocrates, all must allow, but whether or not he be the actual author of it, there is much difficulty in determining satisfactorily. ”

“ Things not animals are animated; animals are animated, the parts of animals are animated. It (the embryo) is and is not.” Now, I must say, that all this appears to me to savour more of the taste of Democritus than of Hippocrates himself. It may be said, indeed, that the very circumstance of Galen’s having admitted the work as genuine, and having composed an elaborate commentary on it, is a most presumptive proof of its authenticity; for where shall we find so excellent a judge of the doctrines of Hippocrates as his great commentator? ”

“ The ancient physicians commonly used the term Epidemic in the same sense as it is understood now, that is to say, as applying to any disease which attacks a multitude of persons in a locality at any particular period. This, as will be seen in our annotations below, is nearly the definition which Galen gives of it; and it is generally used by Hippocrates, in the first and third books of the “Epidemics,” in pretty much the same sense as it is used by our great modern authority on epidemics, Sydenham. ”