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Extract from "On Ancient Medicine", by Hippocrates, translated by Francis Adams, (1891), from his The Genuine Works of Hippocrates, published in New York by the medical publisher William Wood and Company.
Hippocrates, Hippocrates of Cos, Hippocrates of Kos, a man of enormous and justified fame, is considered the father of modern medicine. He lived during the age of Pericles, this great physician, (ca. 460-370 BCE), though his life per se, and perhaps even his works, are more of an accumulation of efforts of others through addition and edit than the work of the one man known as Hippocrates. Still he is the outstanding figure in antiquity in the history of medicine, and perhaps it really doesn't matter if people could ever know his absolutely original works, or not. Part of his life may be legendary, but his lasting importance to the practice of medicine is all that really matters.
Part 1
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. For there are practitioners, some bad and some far otherwise,
which, if there had been no such thing as Medicine, and if nothing had been
investigated or found out in it, would not have been the case, but all would
have been equally unskilled and ignorant of it, and everything concerning the
sick would have been directed by chance. But now it is not so; for, as in all
the other arts, those who practise them differ much from one another in
dexterity and knowledge, so is it in like manner with Medicine. Wherefore I
have not thought that it stood in need of an empty hypothesis, like those
subjects which are occult and dubious, in attempting to handle which it is
necessary to use some hypothesis; as, for example, with regard to things above
us and things below the earth; if any one should treat of these and undertake
to declare how they are constituted, the reader or hearer could not find out,
whether what is delivered be true or false; for there is nothing which can be
referred to in order to discover the truth.
Part 2
But all these requisites belong of
old to Medicine, and an origin and way have been found out, by which many and
elegant discoveries have been made, during a length of time, and others will
yet be found out, if a person possessed of the proper ability, and knowing
those discoveries which have been made, should proceed from them to prosecute
his investigations. But whoever, rejecting and despising all these, attempts to
pursue another course and form of inquiry, and says he has discovered anything,
is deceived himself and deceives others, for the thing is impossible. And for
what reason it is impossible, I will now endeavor to explain, by stating and
showing what the art really is. From this it will be manifest that discoveries
cannot possibly be made in any other way. And most especially, it appears to
me, that whoever treats of this art should treat of things which are familiar
to the common people. For of nothing else will such a one have to inquire or
treat, but of the diseases under which the common people have labored, which
diseases and the causes of their origin and departure, their increase and
decline, illiterate persons cannot easily find out themselves, but still it is
easy for them to understand these things when discovered and expounded by others.
For it is nothing more than that every one is put in mind of what had occurred
to himself. But whoever does not reach the capacity of the illiterate vulgar
and fails to make them listen to him, misses his mark. Wherefore, then, there
is no necessity for any hypothesis.
Part 3
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.
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, for when they suffered much and
severely from strong and brutish diet, swallowing things which were raw,
unmixed, and possessing great strength, they became exposed to strong pains and
diseases, and to early deaths. It is likely, indeed, that from habit they would
suffer less from these things then than we would now, but still they would
suffer severely even then; and it is likely that the greater number, and those
who had weaker constitutions, would all perish; whereas the stronger would hold
out for a longer time, as even nowadays some, in consequence of using strong
articles of food, get off with little trouble, but others with much pain and
suffering. From this necessity it appears to me that they would search out the
food befitting their nature, and thus discover that which we now use: and that
from wheat, by macerating it, stripping it of its hull, grinding it all down,
sifting, toasting, and baking it, they formed bread; and from barley they
formed cake (maza), performing many operations in regard to it; they boiled,
they roasted, they mixed, they diluted those things which are strong and of
intense qualities with weaker things, fashioning them to the nature and powers
of man, and considering that the stronger things Nature would not be able to
manage if administered, and that from such things pains, diseases, and death
would arise, but such as Nature could manage, that from them food, growth, and
health, would arise. To such a discovery and investigation what more suitable
name could one give than that of Medicine? since it was discovered for the
health of man, for his nourishment and safety, as a substitute for that kind of
diet by which pains, diseases, and deaths were occasioned.
Part 4
And if this is not held to be an
art, I do not object. For it is not suitable to call any one an artist of that
which no one is gnorant of, but which all know from usage and necessity. But
still discovery is a great one, and requiring much art and investigation.
Wherefore those who devote themselves to gymnastics and training, are always
making some new discovery, by pursuing the same line of inquiry, where, by
eating and drinking certain things, they are improved and grow stronger than
they were.
Part 5
Let us inquire then regarding what
is admitted to be Medicine; namely, that which was invented for the sake of the
sick, which possesses a name and practitioners, whether it also seeks to
accomplish the same objects, and whence it derived its origin. To me, then, it
appears, as I said at the commencement, that nobody would have sought for
medicine at all, provided the same kinds of diet had suited with men in
sickness as in good health. Wherefore, even yet, such races of men as make no
use of medicine, namely, barbarians, and even certain of the Greeks, live in
the same way when sick as when in health; that is to say, they take what suits
their appetite, and neither abstain from, nor restrict themselves in anything
for which they have a desire. But those who have cultivated and invented
medicine, having the same object in view as those of whom I formerly spoke, in
the first place, I suppose, diminished the quantity of the articles of food
which they used, and this alone would be sufficient for certain of the sick,
and be manifestly beneficial to them, although not to all, for there would be
some so affected as not to be able to manage even small quantities of their
usual food, and as such persons would seem to require something weaker, they
invented soups, by mixing a few strong things with much water, and thus
abstracting that which was strong in them by dilution and boiling. But such as
could not manage even soups, laid them aside, and had recourse to drinks, and
so regulated them as to mixture and quantity, that they were administered
neither stronger nor weaker than what was required.
Part 6
But this ought to be well known,
that soups do not agree with certain persons in their diseases, but, on the
contrary, when administered both the fevers and the pains are exacerbated, and
it becomes obvious that what was given has proved food and increase to the
disease, but a wasting and weakness to the body. But whatever persons so
affected partook of solid food, or cake, or bread, even in small quantity,
would be ten times and more decidedly injured than those who had taken soups,
for no other reason than from the strength of the food in reference to the
affection; and to whomsoever it is proper to take soups and not eat solid food,
such a one will be much more injured if he eat much than if he eat little, but
even little food will be injurious to him. But all the causes of the sufferance
refer themselves to this rule, that the strongest things most especially and
decidedly hurt man, whether in health or in disease.
Part 7
What other object, then, had he in
view who is called a physician, and is admitted to be a practitioner of the
art, who found out the regimen and diet befitting the sick, than he who
originally found out and prepared for all mankind that kind of food which we
all now use, in place of the former savage and brutish mode of living? To me it
appears that the mode is the same, and the discovery of a similar nature. The
one sought to abstract those things which the constitution of man cannot
digest, because of their wildness and intemperature, and the other those things
which are beyond the powers of the affection in which any one may happen to be
laid up. Now, how does the one differ from the other, except that the latter
admits of greater variety, and requires more application, whereas the former
was the commencement of the process?
Part 8
And if one would compare the diet
of sick persons with that of persons in health, he will find it not more
injurious than that of healthy persons in comparison with that of wild beasts
and of other animals. For, suppose a man laboring under one of those diseases
which are neither serious and unsupportable, nor yet altogether mild, but such
as that, upon making any mistake in diet, it will become apparent, as if he
should eat bread and flesh, or any other of those articles which prove
beneficial to healthy persons, and , that, too, not in great quantity, but much
less than he could have taken when in good health; and that another man in good
health, having a constitution neither very feeble, nor yet strong, eats of
those things which are wholesome and strengthening to an ox or a horse, such as
vetches, barley, and the like, and that, too, not in great quantity, but much
less than he could take; the healthy person who did so would be subjected to no
less disturbance and danger than the sick person who took bread or cake
unseasonably. All these things are proofs that Medicine is to be prosecuted and
discovered by the same method as the other.
Part 9
And if it were simply, as is laid
down, that such things as are stronger prove injurious, but such as are weaker
prove beneficial and nourishing, both to sick and healthy persons, it were an
easy matter, for then the safest rule would be to circumscribe the diet to the
lowest point. But then it is no less mistake, nor one that injuries a man less,
provided a deficient diet, or one consisting of weaker things than what mare
proper, be administered. For, in the constitution of man, abstinence may
enervate, weaken, and kill. And there are many other ills, different from those
of repletion, but no less dreadful, arising from deficiency of food; wherefore
the practice in those cases is more varied, and requires greater accuracy. For
one must aim at attaining a certain measure, and yet this measure admits
neither weight nor calculation of any kind, by which it may be accurately
determined, unless it be the sensation of the body; wherefore it is a task to
learn this accurately, so as not to commit small blunders either on the one
side or the other, and in fact I would give great praise to the physician whose
mistakes are small, for perfect accuracy is seldom to be seen, since many
physicians seem to me to be in the same plight as bad pilots, who, if they
commit mistakes while conducting the ship in a calm do not expose themselves,
but when a storm and violent hurricane overtake them, they then, from their
ignorance and mistakes, are discovered to be what they are, by all men, namely,
in losing their ship. And thus bad and commonplace physicians, when they treat
men who have no serious illness, in which case one may commit great mistakes
without producing any formidable mischief (and such complaints occur much more
frequently to men than dangerous ones): under these circumstances, when they
commit mistakes, they do not expose themselves to ordinary men; but when they
fall in with a great, a strong, and a dangerous disease, then their mistakes
and want of skill are made apparent to all. Their punishment is not far off,
but is swift in overtaking both the one and the other.
Part 10
And that no less mischief happens
to a man from unseasonable depletion than from repletion, may be clearly seen
upon reverting to the consideration of persons in health. For, to some, with
whom it agrees to take only one meal in the day, and they have arranged it so
accordingly; whilst others, for the same reason, also take dinner, and this
they do because they find it good for them, and not like those persons who, for
pleasure or from any casual circumstance, adopt the one or the other custom and
to the bulk of mankind it is of little consequence which of these rules they
observe, that is to say, whether they make it a practice to take one or two
meals. But there are certain persons who cannot readily change their diet with
impunity; and if they make any alteration in it for one day, or even for a part
of a day, are greatly injured thereby. Suchpersons, provided they take dinner
when it is not their wont, immediately become heavy and inactive, both in body
and mind, and are weighed down with yawning, slumbering, and thirst; and if
they take supper in addition, they are seized with flatulence, tormina, and
diarrhea, and to many this has been the commencement of a serious disease, when
they have merely taken twice in a day the same food which they have been in the
custom of taking once. And thus, also, if one who has been accustomed to dine,
and this rule agrees with him, should not dine at the accustomed hour, he will
straightway feel great loss of strength, trembling, and want of spirits, the
eyes of such a person will become more pallid, his urine thick and hot, his
mouth bitter; his bowels will seem, as it were, to hang loose; he will suffer
from vertigo, lowness of spirit, and inactivity,- such are the effects; and if
he should attempt to take at supper the same food which he was wont to partake
of at dinner, it will appear insipid, and he will not be able to take it off;
and these things, passing downwards with tormina and rumbling, burn up his
bowels; he experiences insomnolency or troubled and disturbed dreams; and to
many of them these symptoms are the commencement of some disease.
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