On Ancient Medicine
By Hippocrates
Written 400 B.C.E
Translated by Francis Adams
Table of Contents
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
ignorant of, but which all know from usage and necessity. But still the
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.
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. Such persons, 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.
Part 11
But let us inquire what are the causes of these things which
happened to them. To him, then, who was accustomed to take only
one meal in the day, they happened because he did not wait the
proper time, until his bowels had completely derived benefit from
and had digested the articles taken at the preceding meal, and
until his belly had become soft, and got into a state of rest,
but he gave it a new supply while in a state of heat and
fermentation, for such bellies digest much more slowly, and require
more rest and ease. And as to him who had been accustomed to
dinner, since, as soon as the body required food, and when the
former meal was consumed, and he wanted refreshment, no new
supply was furnished to it, he wastes and is consumed from want
of food. For all the symptoms which I describe as befalling to
this man I refer to want of food. And I also say that all men
who, when in a state of health, remain for two or three days
without food, experience the same unpleasant symptoms as those
which I described in the case of him who had omitted to take
dinner.
Part 12
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. But on that account,
I say, we ought not to reject the ancient Art, as if it were not,
and had not been properly founded, because it did not attain
accuracy in all things, but rather, since it is capable of
reaching to the greatest exactitude by reasoning, to receive it
and admire its discoveries, made from a state of great ignorance,
and as having been well and properly made, and not from
chance.
Part 13
But I wish the discourse to revert to the new method of those who
prosecute their inquiries in the Art by hypothesis. For if hot,
or cold, or moist, or dry, be that which proves injurious to man,
and if the person who would treat him properly must apply cold to
the hot, hot to the cold, moist to the dry, and dry to the moist-
let me be presented with a man, not indeed one of a strong
constitution, but one of the weaker, and let him eat wheat, such
as it is supplied from the thrashing-floor, raw and unprepared,
with raw meat, and let him drink water. By using such a diet I
know that he will suffer much and severely, for he will
experience pains, his body will become weak, and his bowels
deranged, and he will not subsist long. What remedy, then, is to
be provided for one so situated? Hot? or cold? or moist? or dry?
For it is clear that it must be one or other of these. For,
according to this principle, if it is one of the which is
injuring the patient, it is to be removed by its contrary. But
the surest and most obvious remedy is to change the diet which
the person used, and instead of wheat to give bread, and instead
of raw flesh, boiled, and to drink wine in addition to these; for
by making these changes it is impossible but that he must get
better, unless completely disorganized by time and diet. What,
then, shall we say? whether that, as he suffered from cold, these
hot things being applied were of use to him, or the contrary? I
should think this question must prove a puzzler to whomsoever it
is put. For whether did he who prepared bread out of wheat remove
the hot, the cold, the moist, or the dry principle in it?- for
the bread is consigned both to fire and to water, and is wrought
with many things, each of which has its peculiar property and
nature, some of which it loses, and with others it is diluted and
mixed.
Part 14
And this I know, moreover, that to the human body it makes a
great difference whether the bread be fine or coarse; of wheat
with or without the hull, whether mixed with much or little
water, strongly wrought or scarcely at all, baked or raw- and a
multitude of similar differences; and so, in like manner, with
the cake (maza); the powers of each, too, are great, and the one
nowise like the other. Whoever pays no attention to these things,
or, paying attention, does not comprehend them, how can he
understand the diseases which befall a man? For, by every one of
these things, a man is affected and changed this way or that, and
the whole of his life is subjected to them, whether in health,
convalescence, or disease. Nothing else, then, can be more
important or more necessary to know than these things. 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. Now, of the sweet, the strongest is that
which is intensely sweet; of the bitter, that which is intensely
bitter; of the acid, that which is intensely acid; and of all
things that which is extreme, for these things they saw both
existing in man, and proving injurious to him. For there is in
man the bitter and the salt, the sweet and the acid, the sour and
the insipid, and a multitude of other things having all sorts of
powers both as regards quantity and strength. These, when all mixed and
mingled up with one another, are not apparent, neither do they
hurt a man; but when any of them is separate, and stands by
itself, then it becomes perceptible, and hurts a man. And thus,
of articles of food, those which are unsuitable and hurtful to
man when administered, every one is either bitter, or intensely
so, or saltish or acid, or something else intense and strong, and
therefore we are disordered by them in like manner as we are by
the secretions in the body. But all those things which a man eats
and drinks are devoid of any such intense and well-marked
quality, such as bread, cake, and many other things of a similar
nature which man is accustomed to use for food, with the
exception of condiments and confectioneries, which are made to
gratify the palate and for luxury. And from those things, when
received into the body abundantly, there is no disorder nor
dissolution of the powers belonging to the body; but strength,
growth, and nourishment result from them, and this for no other
reason than because they are well mixed, have nothing in them of
an immoderate character, nor anything strong, but the whole forms
one simple and not strong substance.
Part 15
I cannot think in what manner they who advance this doctrine, and
transfer Art from the cause I have described to hypothesis, will
cure men according to the principle which they have laid down.
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? so that
he must either play the fool, or have recourse to some one of the
well known substances; and if this hot thing happen to be sour,
and that hot thing insipid, and this hot thing has the power of
raising a disturbance in the body (and there are many other kinds
of heat, possessing many opposite powers), he will be obliged to
administer some one of them, either the hot and the sour, or the
hot and the insipid, or that which, at the same time, is cold and
sour (for there is such a substance), or the cold and the
insipid. For, as I think, the very opposite effects will result
from either of these, not only in man, but also in a bladder, a
vessel of wood, and in many other things possessed of far less
sensibility than man; for it is not the heat which is possessed
of great efficacy, but the sour and the insipid, and other
qualities as described by me, both in man and out of man, and
that whether eaten or drunk, rubbed in externally, and otherwise
applied.
Part 16
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. And these things operate thus both
upon men in health and in disease. For example, if a person in
health wishes to cool his body during winter, and bathes either
in cold water or in any other way, the more he does this, unless
his body be fairly congealed, when he resumes his clothes and
comes into a place of shelter, his body becomes more heated than
before. And thus, too, if a person wish to be warmed thoroughly
either by means of a hot bath or strong fire, and straightway
having the same clothing on, takes up his abode again in the place he
was in when he became congealed, he will appear much colder, and
more disposed to chills than before. And if a person fan himself
on account of a suffocating heat, and having procured
refrigeration for himself in this manner, cease doing so, the
heat and suffocation will be ten times greater in his case than
in that of a person who does nothing of the kind. And, to give a
more striking example, persons travelling in the snow, or
otherwise in rigorous weather, and contracting great cold in
their feet, their hands, or their head, what do they not suffer
from inflammation and tingling when they put on warm clothing and
get into a hot place? In some instances, blisters arise as if
from burning with fire, and they do not suffer from any of those
unpleasant symptoms until they become heated. So readily does
either of these pass into the other; and I could mention many
other examples. And with regard to the sick, is it not in those who
experience a rigor that the most acute fever is apt to break out?
And yet not so strongly neither, but that it ceases in a short time,
and, for the most part, without having occasioned much mischief;
and while it remains, it is hot, and passing over the whole body,
ends for the most part in the feet, where the chills and cold
were most intense and lasted longest; and, when sweat supervenes,
and the fever passes off, the patient is much colder than if he had
not taken the fever at all. Why then should that which so quickly
passes into the opposite extreme, and loses its own powers
spontaneously, be reckoned a mighty and serious affair? And what
necessity is there for any great remedy for it?
Part 17
One might here say- but persons in ardent fevers, pneumonia, and
other formidable diseases, do not quickly get rid of the heat,
nor experience these rapid alterations of heat and cold. And I reckon
this very circumstance the strongest proof that it is not from
heat simply that men get into the febrile state, neither is it
the sole cause of the mischief, but that this species of heat is
bitter, and that acid, and the other saltish, and many other
varieties; and again there is cold combined with other qualities.
These are what proves injurious; heat, it is true, is present also,
possessed of strength as being that which conducts, is
exacerbated and increased along with the other, but has no power
greater than what is peculiar to itself.