On Airs, Waters, and Places

By Hippocrates

Written 400 B.C.E

Translated by Francis Adams


  
Table of Contents

Part 1
   

 Whoever wishes to investigate medicine properly, should proceed thus: in  the first place to consider the seasons of the year, and what effects each  of them produces for they are not at all alike, but differ much from themselves  in regard to their changes. Then the winds, the hot and the cold, especially  such as are common to all countries, and then such as are peculiar to each  locality. We must also consider the qualities of the waters, for as they  differ from one another in taste and weight, so also do they differ much  in their qualities. In the same manner, when one comes into a city to which  he is a stranger, he ought to consider its situation, how it lies as to  the winds and the rising of the sun; for its influence is not the same  whether it lies to the north or the south, to the rising or to the setting  sun. These things one ought to consider most attentively, and concerning  the waters which the inhabitants use, whether they be marshy and soft,  or hard, and running from elevated and rocky situations, and then if saltish  and unfit for cooking; and the ground, whether it be naked and deficient  in water, or wooded and well watered, and whether it lies in a hollow,  confined situation, or is elevated and cold; and the mode in which the  inhabitants live, and what are their pursuits, whether they are fond of  drinking and eating to excess, and given to indolence, or are fond of exercise  and labor, and not given to excess in eating and drinking.  


Part 2
   

 From these things he must proceed to investigate everything else. For if  one knows all these things well, or at least the greater part of them,  he cannot miss knowing, when he comes into a strange city, either the diseases  peculiar to the place, or the particular nature of common diseases, so  that he will not be in doubt as to the treatment of the diseases, or commit  mistakes, as is likely to be the case provided one had not previously considered  these matters. And in particular, as the season and the year advances,  he can tell what epidemic diseases will attack the city, either in summer  or in winter, and what each individual will be in danger of experiencing  from the change of regimen. For knowing the changes of the seasons, the  risings and settings of the stars, how each of them takes place, he will  be able to know beforehand what sort of a year is going to ensue. Having  made these investigations, and knowing beforehand the seasons, such a one  must be acquainted with each particular, and must succeed in the preservation  of health, and be by no means unsuccessful in the practice of his art.  And if it shall be thought that these things belong rather to meteorology,  it will be admitted, on second thoughts, that astronomy contributes not  a little, but a very great deal, indeed, to medicine. For with the seasons  the digestive organs of men undergo a change.

Part 3
   

 But how of the aforementioned things should be investigated and explained,  I will now declare in a clear manner. A city that is exposed to hot winds  (these are between the wintry rising, and the wintry setting of the sun),  and to which these are peculiar, but which is sheltered from the north  winds; in such a city the waters will be plenteous and saltish, and as  they run from an elevated source, they are necessarily hot in summer, and  cold in winter; the heads of the inhabitants are of a humid and pituitous  constitution, and their bellies subject to frequent disorders, owing to  the phlegm running down from the head; the forms of their bodies, for the  most part, are rather flabby; they do not eat nor drink much; drinking  wine in particular, and more especially if carried to intoxication, is  oppressive to them; and the following diseases are peculiar to the district:  in the first place, the women are sickly and subject to excessive menstruation;  then many are unfruitful from disease, and not from nature, and they have  frequent miscarriages; infants are subject to attacks of convulsions and  asthma, which they consider to be connected with infancy, and hold to be  a sacred disease (epilepsy). The men are subject to attacks of dysentery,  diarrhea, hepialus, chronic fevers in winter, of epinyctis, frequently,  and of hemorrhoids about the anus. Pleurisies, peripneumonies, ardent fevers,  and whatever diseases are reckoned acute, do not often occur, for such  diseases are not apt to prevail where the bowels are loose. Ophthalmies  occur of a humid character, but not of a serious nature, and of short duration,  unless they attack epidemically from the change of the seasons. And when  they pass their fiftieth year, defluxions supervening from the brain, render  them paralytic when exposed suddently to strokes of the sun, or to cold. These diseases are endemic to them, and, moreover, if any epidemic disease  connected with the change of the seasons, prevail, they are also liable  to it. 

Part 4
   

 But the following is the condition of cities which have the opposite exposure,  namely, to cold winds, between the summer settings and the summer risings  of the sun, and to which these winds are peculiar, and which are sheltered  from the south and the hot breezes. In the first place the waters are,  for the most part, hard cold. The men must necessarily be well braced and  slender, and they must have the discharges downwards of the alimentary  canal hard, and of difficult evacuation, while those upwards are more fluid,  and rather bilious than pituitous. Their heads are sound and hard, and  they are liable to burstings (of vessels?) for the most part. The diseases  which prevail epidemically with them, are pleurisies, and those which are  called acute diseases. This must be the case when the bowels are bound;  and from any causes, many become affected with suppurations in the lungs,  the cause of which is the tension of the body, and hardness of the bowels;  for their dryness and the coldness of the water dispose them to ruptures  (of vessels?). Such constitutions must be given to excess of eating, but  not of drinking; for it is not possible to be gourmands and drunkards at  the same time. Ophthalmies, too, at length supervene; these being of a  hard and violent nature, and soon ending in rupture of the eyes; persons  under thirty years of age are liable to severe bleedings at the nose in  summer; attacks of epilepsy are rare but severe. Such people are likely  to be rather long-lived; their ulcers are not attended with serious discharges,  nor of a malignant character; in disposition they are rather ferocious  than gentle. The diseases I have mentioned are peculiar to the men, and  besides they are liable to any common complaint which may be prevailing  from the changes of the seasons. But the women, in the first place, are  of a hard constitution, from the waters being hard, indigestible, and cold;  and their menstrual discharges are not regular, but in small quantity,  and painful. Then they have difficult parturition, but are not very subject  to abortions. And when they do bring forth children, they are unable to nurse them; for the hardness and indigestable nature of the water puts  away their milk. Phthisis frequently supervenes after childbirth, for the efforts of it frequently bring on ruptures and strains. Children while  still little are subject to dropsies in the testicle, which disappear as  they grow older; in such a town they are late in attaining manhood. It  is, as I have now stated, with regard to hot and cold winds and cities  thus exposed. 

Part 5
   

 Cities that are exposed to winds between the summer and the winter risings  of the sun, and those the opposite to them, have the following characters:-  Those which lie to the rising of the sun are all likely to be more healthy  than such as are turned to the North, or those exposed to the hot winds,  even if there should not be a furlong between them. In the first place,  both the heat and cold are more moderate. 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.  The persons of the inhabitants are, for the most part, well colored and  blooming, unless some disease counteract. The inhabitants have clear voices,  and in temper and intellect are superior to those which are exposed to  the north, and all the productions of the country in like manner are better.  A city so situated resembles the spring as to moderation between heat and  cold, and the diseases are few in number, and of a feeble kind, and bear  a resemblance to the diseases which prevail in regions exposed to hot winds.  The women there are very prolific, and have easy deliveries. Thus it is  with regard to them. 

Part 6
   

 But such cities as lie to the west, and which are sheltered from winds  blowing from the east, and which the hot winds and the cold winds of the  north scarcely touch, must necessarily be in a very unhealthy situation:  in the first place the waters are not clear, the cause of which is, because  the mist prevails commonly in the morning, and it is mixed up with the  water and destroys its clearness, for the sun does not shine upon the water  until he be considerably raised above the horizon. And in summer, cold  breezes from the east blow and dews fall; and in the latter part of the  day the setting sun particularly scorches the inhabitants, and therefore  they are pale and enfeebled, and are partly subject to all the aforesaid  diseases, but no one is peculiar to them. Their voices are rough and hoarse  owing to the state of the air, which in such a situation is generally impure  and unwholesome, for they have not the northern winds to purify it; and  these winds they have are of a very humid character, such being the nature  of the evening breezes. Such a situation of a city bears a great resemblance  to autumn as regards the changes of the day, inasmuch as the difference  between morning and evening is great. So it is with regard to the winds  that are conducive to health, or the contrary. 

Part 7
   

 And I wish to give an account of the other kinds of waters, namely, of  such as are wholesome and such as are unwholesome, and what bad and what  good effects may be derived from water; for water contributes much towards  health. Such waters then as are marshy, stagnant, and belong to lakes,  are necessarily hot in summer, thick, and have a strong smell, since they  have no current; but being constantly supplied by rain-water, and the sun  heating them, they necessarily want their proper color, are unwholesome  and form bile; in winter, they become congealed, cold, and muddy with the  snow and ice, so that they are most apt to engender phlegm, and bring on  hoarseness; those who drink them have large and obstructed spleens, their  bellies are hard, emaciated, and hot; and their shoulders, collar-bones,  and faces are emaciated; for their flesh is melted down and taken up by  the spleen, and hence they are slender; such persons then are voracious  and thirsty; their bellies are very dry both above and below, so that they  require the strongest medicines. This disease is habitual to them both  in summer and in winter, and in addition they are very subject to dropsies  of a most fatal character; and in summer dysenteries, diarrheas, and protracted  quartan fevers frequently seize them, and these diseases when prolonged  dispose such constitutions to dropsies, and thus prove fatal. These are  the diseases which attack them in summer; but in winter younger persons  are liable to pneumonia, and maniacal affections; and older persons to ardent fevers, from hardness of the belly. Women are subject to oedema  and leucophlegmasiae; when pregnant they have difficult deliveries; their  infants are large and swelled, and then during nursing they become wasted  and sickly, and the lochial discharge after parturition does not proceed  properly with the women. The children are particularly subject to hernia,  and adults to varices and ulcers on their legs, so that persons with such  constitutions cannot be long-lived, but before the usual period they fall  into a state of premature old age. And further, the women appear to be  with child, and when the time of parturition arrives, the fulness of the  belly disappears, and this happens from dropsy of the uterus. Such waters  then I reckon bad for every purpose. The next to them in badness are those  which have their fountains in rocks, so that they must necessarily be hard,  or come from a soil which produces thermal waters, such as those having  iron, copper, silver, gold, sulphur, alum, bitumen, or nitre (soda) in  them; for all these are formed by the force of heat. Good waters cannot  proceed from such a soil, but those that are hard and of a heating nature,  difficult to pass by urine, and of difficult evacuation by the bowels.  The best are those which flow from elevated grounds, and hills of earth;  these are sweet, clear, and can bear a little wine; they are hot in summer  and cold in winter, for such necessarily must be the waters from deep wells.  But those are most to be commended which run to the rising of the sun,  and especially to the summer sun; for such are necessarily more clear,  fragrant, and light. But all such as are salty, crude, and harsh, are not  good for drink. But there are certain constitutions and diseases with which  such waters agree when drunk, as I will explain presently. Their characters  are as follows: the best are such as have their fountains to the east;  the next, those between the summer risings and settings of the sun, and  especially those to the risings; and third, those between the summer and  winter settings; but the worst are those to the south, and the parts between  the winter rising and setting, and those to the south are very bad, but  those to the north are better. They are to be used as follows: whoever  is in good health and strength need not mind, but may always drink whatever  is at hand. But whoever wishes to drink the most suitable for any disease,  may accomplish his purpose by attending to the following directions: To  persons whose bellies are hard and easily burnt up, the sweetest, the lightest,  and the most limpid waters will be proper; but those persons whose bellies  are soft, loose, and pituitous, should choose the hardest, those kinds  that are most crude, and the saltiest, for thus will they be most readily  dried up; for such waters as are adapted for boiling, and are of a very  solvent nature, naturally loosen readily and melt down the bowels; but  such as are intractable, hard, and by no means proper for boiling, these  rather bind and dry up the bowels. People have deceived themselves with  regard to salt waters, from inexperience, for they think these waters purgative,  whereas they are the very reverse; for such waters are crude, and ill adapted  for boiling, so that the belly is more likely to be bound up than loosened  by them. And thus it is with regard to the waters of  springs. 


Part 8
   

 I will now tell how it is with respect to rain-water, and water from snow.  Rain waters, then, are the lightest, the sweetest, the thinnest, and the clearest; for originally the sun raises and attracts the thinnest and lightest  part of the water, as is obvious from the nature of salts; for the saltish part is left behind owing to its thickness and weight, and forms salts;  but the sun attracts the thinnest part, owing to its lightness, and he abstracts this not only from the lakes, but also from the sea, and from  all things which contain humidity, and there is humidity in everything; and from man himself the sun draws off the thinnest and lightest part of  the juices. As a strong proof of this, when a man walks in the sun, or sits down having a garment on, whatever parts of the body the sun shines  upon do not sweat, for the sun carries off whatever sweat makes its appearance;  but those parts which are covered by the garment, or anything else, sweat,  for the particles of sweat are drawn and forced out by the sun, and are  preserved by the cover so as not to be dissipated by the sun; but when  the person comes into the shade the whole body equally perspires, because  the sun no longer shines upon it. Wherefore, of all kinds of water, these  spoil the soonest; and rain water has a bad spot smell, because its particles  are collected and mixed together from most objects, so as to spoil the  soonest. And in addition to this, when attracted and raised up, being carried  about and mixed with the air, whatever part of it is turbid and darkish  is separated and removed from the other, and becomes cloud and mist, but  the most attenuated and lightest part is left, and becomes sweet, being  heated and concocted by the sun, for all other things when concocted become  sweet. While dissipated then and not in a state of consistence it is carried  aloft. But when collected and condensed by contrary winds, it falls down  wherever it happens to be most condensed. For this is likely to happen  when the clouds being carried along and moving with a wind which does not  allow them to rest, suddenly encounters another wind and other clouds from  the opposite direction: there it is first condensed, and what is behind  is carried up to the spot, and thus it thickens, blackens, and is conglomerated,  and by its weight it falls down and becomes rain. Such, to all appearance,  are the best of waters, but they require to be boiled and strained; for  otherwise they have a bad smell, and occasion hoarseness and thickness  of the voice to those who drink them. Those from snow and ice are all bad,  for when once congealed, they never again recover their former nature;  for whatever is clear, light, and sweet in them, is separated and disappears;  but the most turbid and weightiest part is left behind. You may ascertain  this in the following manner: If in winter you will pour water by measure  into a vessel and expose it to the open air until it is all frozen, and  then on the following day bring it into a warm situation where the ice  will thaw, if you will measure the water again when dissolved you will  find it much less in quantity. This is a proof that the lightest and thinnest  part is dissipated and dried up by the congelation, and not the heaviest  and thickest, for that is impossible: wherefore I hold that waters from  snow and ice, and those allied to them, are the worst of any for all purposes  whatever. Such are the characters of rain-water, and those from ice and  snow.