Morbi autem unde nascantur, quis dubitet?
Nam cum quatuor illa (43) sint ex quibus compactum est corpus, Terra, Ignis, Aqua, Aer,
horum non naturalis ex(44)cessus defectusque et ex loco proprio in alienum translatio,
per quam quod sibi conve(45)niens est, non tenent, intestinam quandam seditionem et morbos inferunt.
Quando e(46)nim praeter naturam unumquodque fit aut transfertur, calescunt utique quae ante frigebant,
(47) arida madent, gravescunt levia, et cetera omnia similiter permutantur.
Solummodo ve(48)ro idem aliquid sibimet secundum idem atque similiter et debita proportione servata ac(49)cedens vel decedens permittet se idem sibi ipsi sospes integrumque manere.
Quod autem (50) aberrat, sive accedendo seu decidendo, mutationes varias, morbos, corruptiones infinit(51)as inducit.
Ex secundis quoque compositionibus secundum naturam constitutis secun(52)da bonae vel malae valetudinis coniectura id quaerenti cuique dabitur.
Cum enim medul(53)la ex illis et os et caro et nervi constiterint, sanguis praeterea ex iisdem quamvis alio modo concreverit, ceteri quidem eventus plurimi quemadmodum superiora contingunt (733, 1) maximi vero morbi atque gravissimi hoc pacto nascuntur.
Quando videlicet ordine con(2)verso ista ex se invicem fiunt, procul dubio corrumpuntur.
Nempe secundum naturam (3) carnes et nervi ex sanguine generantur, nervi quidem a villis et ligamentis propter cogna(4)tionem, carnes autem a coagulatione quadam eius quod secretum a villis et ligamentis (5) concrevit.
Quod rursus a nervis et carnibus emanat glutinosum et pingue, simul quidem (6) carnem ut plurimum ad ossium naturam, ac etiam os ipsum medullam circundans nutrien(7)do exauget.
Quod rursus per ossium crassitudinem stillat purissimum genus triangulorum (8) lenissimumque et pinguedine abundantissimum, dum defluit ex ossibus atque delabitur, me(9)dullam irrigat.
Quatenus igitur singula hunc in modum fiunt, bona valetudo servatur. (10) Mala vero sequitur valetudo, quando fit contra.
Nam quoties eliquata caro tabem rur(11)sus transmittit in venas, sanguis una cum spiritu multus ac varius in venis, coloribus di(12)versis amaritudineque et acidis salsisque infectus saporibus, bilem, cruorem, pituitam gignit (13) quam plurimam.
Quae quidem omnia rursus sic genita et corrupta sanguinem ipsum in (14) primis inficiunt,
et ipsa nullum nutrimentum adhibentia corpori, feruntur passim per ve(15)nas
nullo prorsus naturalis circuitus ordine observato. Inimica sane inter sese ista sunt, (16) propterea quod nullum sui sibi invicem praebent usum.
Naturali praeterea corporis habi(17)tudini suoque in statu perseveranti dissolvendo et liquefaciendo plurimum adversantur.
(18) Portio nanque carnis vetustissima cum liquescit, ad digestionem concoctionemque ineptissi(19)ma, propter veterem exustionem nigrescit,
quia vero contabuit penitusque exesa est, ama(20)ritudinem contrahit, ceteris omnibus corporis partibus nondum contaminatis adver(21)sam.
Et tum quidem pro amaritudine niger ipse color acerbitatem et acrimoniam habet, (22) eo iam quod amarum fuerat magis attenuato,
tum vero amaritudo rursus sanguine tin(23)cta colorem habet rubeum, sed nigro huic admixta felleum.
Praeterea flavus color cum ama(24)ritudine coit, quando ob ignis flammam nova caro liquescit.
Et nomen quidem omnibus (25) his commune bilem imposuit vel medicus aliquis, vel certe eo ingenio praeditus quispiam (26) quo multa dissimilia dispicere posset, ac rursus genus in multis unum uno cognomento (27) dignum inspicere.
Quae vero bilis species appellantur, pro colorum varietate rationem sin(28)gulis propriam acceperunt.
Cruor praeterea, qui sanguis residuum et defluxus est, lenis (29) est ac mitis, qui vero bilis atrae acrisque, agrestis. Quando propter caliditatem salso sapori mi(30)scetur huiusmodi quiddam acida pituita nuncupatur.
Saepe vero tenerioris recentisque car(31)nis portio quaedam una cum aere colliquescit,
deinde vento inflatur incluso, humiditate (32) protinus circumfusa, fiuntque ex hoc ampullae, quae sigillatim propter parvitatem videri non (33) possunt, iunctae vero simul et in grandiorem tumefactae molem conspiciuntur
coloremque (34) propter spumae generationem habent album. Omnem hanc tenerioris carnis eliquatio(35)nem una cum spiritu factam, quae ex humiditate vento circumfusa tumescit, albam pitui(36)tam appellamus,
recentis item pituitae residuum defluxumque lacrimas atque sudorem, et (37) quotcunque alia in quae quotidie corpus resolvitur.
Atque haec omnia instrumenta morbo(38)rum, quando scilicet sanguis non cibis et potibus secundam naturam, sed ex contrariis (39) praeter naturae leges excrescit.
Quando igitur caro quaelibet circumciditur, eiusque radix per(40)manet, dimidia quaedam est calamitatis potentia. Facile enim restauratur.
Quando vero (41) quod carnes ossibus alligat, aegrotat, et sanguis ex illis ac nervis defluens haud amplius (42) nutrit ossa carnemve revincit,
sed ex pingui et glutinoso asper, salsus, siccus et squalidus (43) iniquitate victus est factus,
tunc certe quod omnia ista perpetitur, abscissum ab ossibus (44) sub carne nervisque riget.
Caro etiam a radicibus decidens nudos relinquit nervos, et fal(45)so obductos humore
et in fluenta sanguinis permanans, morbis quos supra diximus nu(46)mero etiam plures reddit.
Graves quidem hae corporibus passiones, quae vero has praece(47)dunt, admodum graviores.
Quando videlicet os ob carnis crassitudinem respirationem (48) non habet sufficientem, ideoque putredinis calore vexatum atque restrictum, alimenta non (49) suspicit
rursusque ipsum in illam contra decidit frigefactum. Illa vero in carnem, caro in san(50)guinem rursus delabitur, unde acriores superioribus morbi nascuntur.
Extremum vero (51) omnium est, quando medullae natura propter defectum aliquem aut excessum aegrotat.
(52) Hinc enim omnium vehementissimi et ad mortem periculosissimi morbi proveniunt, tunc (53) enim omnis compago corporis necessario dissipatur.
Tertiam post haec morborum speciem (54) tripartito dividimus.
Alius enim spiritu, alius pituita, alius bile creatur.
Nam cum spiritus (734, 1) ipsius custos et quasi penuarius pulmo distillatione occlusus libera et expedita spiracu(2)la nobis non exhibet, et hinc quidem nullus mittitur spiritus, illinc vero plusquam opor(3)tet accipitur, tunc quae respiratione et refrigerio carent, marcescunt.
Quod vero accipi(4)tur nimium, per venas traductum eas contorquet liquefacitque corpus, eius in medio Dia(5)phragma, medium scilicet interpositum occupans.
Hinc morbi admodum molesti multo (6) cum sudore innumerabiles oriuntur.
Saepe etiam intra corpus discreta et rarefacta carne (7) innascitur spiritus, qui cum foras egredi nequeat, iisdem quibus et ingressi aliunde spiri(8)tus, doloribus afficit.
Sed ingentibus tunc affligit doloribus, quando nervis proximisque (9) venulis circumfusus haec inflat et ligamenta continuosque nervos a tergo intendit atque de(10)torquet.
Qui sane morbi ab ipsa intendente et instante passione tensiones et a tergo con(11)tortiones cognominantur,
quorum difficile remedium est. Subortae enim febres hos ma(12)xime solvunt.
Alba vero pituita propter ampullarum spiritum intus inclusa difficilis,
ad (13) exteriorem cutem delapsa, mitior, sed corpus variis sordibus aspergit, albisque inficit ma(14)culis, atque morbos alios eiusmodi generat.
Atrae vero bili permixta cum divinissimos ca(15)pitis meatus illabitur, dissipare eos solet atque turbare. Si dormientibus in contingat, mi(16)tior,
sin vigilantibus, expulsu difficilior. Cum vero sacrae naturae languor hic sit, haud abs (17) re sacer morbus est appellatus.
Proinde pituita acida atque item salsa, languorum omnium (18) qui distillatione fiunt origo est,
quoniam vero plurima loca illabitur, malas gignit valetu(19)dines plurimas.
Quae autem partes corporis tumescere dicuntur, a bilis incendio, (20) et combustione vexantur,
quae cum expirat extrinsecus varios aestu suo tumores produ(21)cit,
intrinsecus vero cohibita urentes edacesque morbos plurimos procreat.
Tunc autem (22) pessima est, quando pus sanguini mixta et villorum ligaminumque fila suo ex ordine di(23)movet,
quae ideo in sanguinem diductae et sparsae sunt, ut mediocrem tenuitatis et crassi(24)tudinis habitum consequatur, neque propter caliditatem cum ipse sit lubricus, raro ex cor(25)pore defluat,
neque si crassior sit, ad motum fiat ineptior atque aegre per venas fluat et refluat.
(26) Ad hunc utique naturae commoditatem huiusmodi peropportuna sunt ligamenta,
quas si(27)quis etiam mortuo et ob frigus rigente sanguine invicem conducat et contrahat, reliquus (28) sanguis omnis diffunditur. Cum vero missae fuerint, illico cum praecedente frigore restrin(29)guntur.
Quoniam vero hanc vim villi huiusmodi in sanguinem habent, cum bilis natura (30) sanguis vetus evaserit ac rursus ex carnibus in hunc fuerit resoluta,
calida et humida pau(31)latim primam incidens villorum illorum vi conpressa restringitur.
Compressa vero extinctaque (32) violenter procellam intus tremoremque ciet.
Ceterum quando uberior affluit, calore pro(33)prio ligamenta exuperans praeterque modum exaestuans, servat quidem,
ac si continue ad (34) finem usque idonea victoriae sit, penetrat in medullas adustisque radicibus inde animae vin(35)cula quasi navis funes resolvit et amputat liberamque dimittit.
Sed cum inferior adest, cor(36)pusque liquescens ei restitit, ipsa devincta aut per totum corpus excidit aut per venas in (37) ventrem inferiorem superioremve compulsa tanquam transfuga ex seditiosa civitate, sic (38) effugit e corpore,
morbosque eos inducit, quos Diarrhaeas vocant et Dysenterias, id est (39) fluxus ventris lubricos fluxusque mordaces, necnon multas generis eiusdem alias mole(40)stias infert.
Quando igitur corpus ignis potissimum excessu languet, continua febre labo(41)rat,
quando vero aeris, quotidiana discreta. Aquae tertiana, propterea quod aqua segnior (42) est quam ignis et aer.
Terrae demum excessu, quartana. Terra siquidem omnium tardissi(43)ma, quarto gradu cum sit, temporis circuitu quarto fervet defervetque. Hinc quartanas in(44)vehit febres, quae vix seroque sanantur.
Diseases of the body arise (i) when any of the four elements is out of place or there is too much or too little of them in any part: and (ii) when blood, flesh, and sinews are produced in a wrong order. The proper order is that flesh and sinew should be formed from blood, flesh from the liquid and sinew from the fibrous part of it; and that from these should exude a glutinous matter which nourishes bone and marrow. When this order is reversed, all sorts of bile and phlegm are generated. The various kinds of bile. Of phlegm there is an acid and a white sort. Stages of the disease:—(1) When the flesh is attacked, if the foundations remain sound, there is less danger. (2) There is more when the flesh falls away from the sinews and bones. (3) Worse still are the prior disorders, such as crumbling away and gangrene of the bones; and (4) worst of all is disease of the spinal marrow.] Now every one can see whence diseases arise.
There are four natures out of which the body is compacted, earth and fire and water and air,
and the unnatural excess or defect of these, or the change of any of them from its own natural place into another,
or—since there are more kinds than one of fire and of the other elements—the assumption by any of these of a wrong kind, or any similar irregularity, produces disorders and diseases;
for when any of them is produced or changed in a manner contrary to nature, the parts which were previously cool grow warm,
and those which were dry become moist, and the light become heavy, and the heavy light; all sorts of changes occur.
For, as we affirm, a thing can only remain the same with itself, whole and sound, when the same is added to it, or subtracted from it, in the same respect and in the same manner and in due proportion;
and whatever comes or goes away in violation of these laws causes all manner of changes and infinite diseases and corruptions.
Now there is a second class of structures which are also natural, and this affords a second opportunity of observing diseases to him who would understand them.
For whereas marrow and bone and flesh and sinews are composed of the four elements, and the blood, though after another manner, is likewise formed out of them, most diseases originate in the way which I have described;
but the worst of all owe their severity to the fact that the generation of these substances proceeds in a wrong order; they are then destroyed.
For the natural order is that the flesh and sinews should be made of blood, the sinews out of the fibres to which they are akin, and the flesh out of the clots which are formed when the fibres are separated.
And the glutinous and rich matter which comes away from the sinews and the flesh, not only glues the flesh to the bones, but nourishes and imparts growth to the bone which surrounds the marrow;
and by reason of the solidity of the bones, that which filters through consists of the purest and smoothest and oiliest sort of triangles, dropping like dew from the bones and watering the marrow.
Now when each process takes place in this order, health commonly results; when in the opposite order, disease.
For when the flesh becomes decomposed and sends back the wasting substance into the veins, then an oversupply of blood of diverse kinds, mingling with air in the veins, having variegated colours and bitter properties, as well as acid and saline qualities, contains all sorts of bile and serum and phlegm.
For all things go the wrong way, and having become corrupted, first they taint the blood itself,
and then ceasing to give nourishment to the body they are carried along the veins in all directions,
no longer preserving the order of their natural courses, but at war with themselves, because they receive no good from one another,
and are hostile to the abiding constitution of the body, which they corrupt and dissolve.
The oldest part of the flesh which is corrupted, being hard to decompose, from long burning grows black,
and from being everywhere corroded becomes bitter, and is injurious to every part of the body which is still uncorrupted.
Sometimes, when the bitter element is refined away, the black part assumes an acidity which takes the place of the bitterness;
at other times the bitterness being tinged with blood has a redder colour; and this, when mixed with black, takes the hue of grass;
and again, an auburn colour mingles with the bitter matter when new flesh is decomposed by the fire which surrounds the internal flame;
— to all which symptoms some physician perhaps, or rather some philosopher, who had the power of seeing in many dissimilar things one nature deserving of a name, has assigned the common name of bile.
But the other kinds of bile are variously distinguished by their colours.
As for serum, that sort which is the watery part of blood is innocent, but that which is a secretion of black and acid bile is malignant when mingled by the power of heat with any salt substance, and is then called acid phlegm.
Again, the substance which is formed by the liquefaction of new and tender flesh when air is present,
if inflated and encased in liquid so as to form bubbles, which separately are invisible owing to their small size, but when collected are of a bulk which is visible,
and have a white colour arising out of the generation of foam—all this decomposition of tender flesh when intermingled with air is termed by us white phlegm.
And the whey or sediment of newly-formed phlegm is sweat and tears, and includes the various daily discharges by which the body is purified.
Now all these become causes of disease when the blood is not replenished in a natural manner by food and drink but gains bulk from opposite sources in violation of the laws of nature.
When the several parts of the flesh are separated by disease, if the foundation remains, the power of the disorder is only half as great, and there is still a prospect of an easy recovery;
but when that which binds the flesh to the bones is diseased, and no longer being separated from the muscles and sinews1 , ceases to give nourishment to the bone and to unite flesh and bone,
and from being oily and smooth and glutinous becomes rough and salt and dry, owing to bad regimen,
then all the substance thus corrupted crumbles away under the flesh and the sinews, and separates from the bone,
and the fleshy parts fall away from their foundation and leave the sinews bare and full of brine,
and the flesh again gets into the circulation of the blood and makes the previously-mentioned disorders still greater.
And if these bodily affections be severe, still worse are the prior disorders;
as when the bone itself, by reason of the density of the flesh, does not obtain sufficient air, but becomes mouldy and hot and gangrened and receives no nutriment,
and the natural process is inverted, and the bone crumbling passes into the food, and the food into the flesh, and the flesh again falling into the blood makes all maladies that may occur more virulent than those already mentioned.
But the worst case of all is when the marrow is diseased, either from excess or defect;
and this is the cause of the very greatest and most fatal disorders, in which the whole course of the body is reversed.
[(iii) A third class of diseases is produced a. by wind—i. e. disorders of the lungs, tetanus and opisthotonus; b. by phlegm—i. e. leprosy, epilepsy, and catarrh.] There is a third class of diseases which may be conceived of as arising in three ways;
for they are produced sometimes by wind, and sometimes by phlegm, and sometimes by bile.
When the lung, which is the dispenser of the air to the body, is obstructed by rheums and its passages are not free, some of them not acting, while through others too much air enters, then the parts which are unrefreshed by air corrode,
while in other parts the excess of air forcing its way through the veins distorts them and decomposing the body is enclosed in the midst of it and occupies the midriff;
thus numberless painful diseases are produced, accompanied by copious sweats.
And oftentimes when the flesh is dissolved in the body, wind, generated within and unable to escape, is the source of quite as much pain as the air coming in from without;
but the greatest pain is felt when the wind gets about the sinews and the veins of the shoulders, and swells them up, and so twists back the great tendons and the sinews which are connected with them.
These disorders are called tetanus and opisthotonus, by reason of the tension which accompanies them.
The cure of them is difficult; relief is in most cases given by fever supervening.
The white phlegm, though dangerous when detained within by reason of the air-bubbles,
yet if it can communicate with the outside air, is less severe, and only discolours the body, generating leprous eruptions and similar diseases.
When it is mingled with black bile and dispersed about the courses of the head, which are the divinest part of us, the attack if coming on in sleep, is not so severe;
but when assailing those who are awake it is hard to be got rid of, and being an affection of a sacred part, is most justly called sacred.
An acid and salt phlegm, again, is the source of all those diseases which take the form of catarrh,
but they have many names because the places into which they flow are manifold.
[c. by bile—i. e. tumours and inflammations, chills and shuddering, disease of the marrow, diarrhoea and dysentery.] Excess of fire causes continuous fever, of air quotidian, of water tertian, of earth quartan.
Inflammations of the body come from burnings and inflamings, and all of them originate in bile.
When bile finds a means of discharge, it boils up and sends forth all sorts of tumours;
but when imprisoned within, it generates many inflammatory diseases,
above all when mingled with pure blood; since it then displaces the fibres which are scattered about in the blood
and are designed to maintain the balance of rare and dense, in order that the blood may not be so liquefied by heat as to exude from the pores of the body,
nor again become too dense and thus find a difficulty in circulating through the veins.
The fibres are so constituted as to maintain this balance;
and if any one brings them all together when the blood is dead and in process of cooling, then the blood which remains becomes fluid, but if they are left alone, they soon congeal by reason of the surrounding cold.
The fibres having this power over the blood, bile, which is only stale blood, and which from being flesh is dissolved again into blood,
at the first influx coming in little by little, hot and liquid, is congealed by the power of the fibres;
and so congealing and made to cool, it produces internal cold and shuddering.
When it enters with more of a flood and overcomes the fibres by its heat, and boiling up throws them into disorder,
if it have power enough to maintain its supremacy, it penetrates the marrow and burns up what may be termed the cables of the soul, and sets her free;
but when there is not so much of it, and the body though wasted still holds out, the bile is itself mastered, and is either utterly banished, or is thrust through the veins into the lower or upper belly, and is driven out of the body like an exile from a state in which there has been civil war;
whence arise diarrhoeas and dysenteries, and all such disorders.
When the constitution is disordered by excess of fire, continuous heat and fever are the result;
when excess of air is the cause, then the fever is quotidian; when of water, which is a more sluggish element than either fire or air, then the fever is a tertian;
when of earth, which is the most sluggish of the four, and is only purged away in a four-fold period, the result is a quartan fever, which can with difficulty be shaken off.