Furthermore, since there is a class of secondary structures to be found [c] in nature, anyone who intends to understand diseases will have a second set of subjects to study. Since marrow and bone, flesh and sinew are composed of the elemental stuffs—from which blood also has been formed, though in a different way—most of the diseases are brought on in the manner just described. But the most serious and grievous diseases are contracted when the process of generation that led to the formation of these structures is reversed. When this happens, they degenerate. It is natural for flesh and sinews to be formed from blood, the sinew from the [d] fiber (which is of its own kind) and the flesh from the part of the blood that congeals when the sinew is separated from it. And the sticky and oily stuff that in its turn emerges from the sinew and the flesh both glues the flesh to the bone and feeds the marrow-encompassing bone itself, so causing it to grow. And because the bone is so dense, the part of this stuff that filters through, consisting as it does of the purest, smoothest and oiliest [e] kind of triangles, forms droplets inside the bone and waters the marrow. And when this is the way it actually happens in each case, health will generally result.
Disease, however, will result if things happen the other way around. For when flesh that is wasting away passes its waste back into the veins, the veins will contain not only air but also an excess of blood of great variety. This blood will have a multitude of colors and bitter aspects, and even acidic and salty qualities, and will contain bile and serum and phlegm of every sort. These are all back-products and agents of destruction. To [83] begin with, they corrupt the blood itself, and then also they do not supply the body any further with nourishment. They move everywhere throughout the veins, no longer keeping to the order of natural circulation. They are hostile to one another, since none receives any advantage from any other, and they wage a destructive and devastating war against the constituents of the body that have stayed intact and kept to their posts.
Now as the oldest part of the flesh wastes away, it resists assimilation. It turns black as a result of being subjected to a prolonged process of [b] burning, and because it is thoroughly eaten up it is bitter, and so it launches a severe attack against any part of the body that has not yet been destroyed. Sometimes the bitterness is largely refined away, and then the black color acquires an acidic quality that replaces the bitter. At other times, though, the bitterness is steeped in blood, and then it comes to have more of a reddish color, and when the black is mixed with this, it becomes a grass-like green. Further, when the flesh that is disintegrated by the fire of the inflammation is fairly young, the color that is mixed with the bitterness is a yellowish orange. Now the name “bile,” common to all these varieties, was given to them either by doctors, possibly, or else by someone who [c] had the ability to look at a plurality of unlike things and see in them a single kind that deserves to be called by a single name. As for everything that can be called a variety of bile, each has its own distinctive definition, depending on its color. In the case of serum, some of it, the watery part of the blood, is benign while that which is a part of the black, acid bile is malignant when heat causes it to be mixed with a salty quality. This kind of thing is called acid phlegm. Furthermore, when the stuff that comes from the disintegration of young, tender flesh is exposed to air and blown [d] up with wind and enveloped in moisture, bubbles form as a result, each one too small to be seen though collectively amounting to a visible mass. These bubbles look white, as foam begins to form. All this disintegration of tender flesh reacting with air is what we call white phlegm. Newly formed phlegm, furthermore, has a watery part which consists of perspiration and tears, as well as any other impurities that are discharged every [e] day. So whenever the blood, instead of being replenished in the natural way by nutrients from food and drink, derives its volume from opposite sources, contrary to nature’s way, all these things, it turns out, serve as instruments of disease.
Now when a certain part of the flesh is decomposed by disease, as long as the foundations of the flesh remain intact, the effect of the calamity is only half of what it would otherwise be, for there is still a chance of an easy recovery. But when the stuff that binds the flesh to the bones becomes [84] diseased and no longer nourishes the bone or binds the flesh to the bone because it is now separated from flesh and bone as well as from sinews,43 it turns from being slick and smooth and oily to being rough and briny, shriveled up in consequence of its bad regimen. When this occurs, all the stuff that this happens to crumbles away back into the flesh and the sinew, and separates from the bone. The flesh, which collapses with it away from its roots, leaves the sinews bare and full of brine. And the flesh itself [b] succumbs back into the bloodstream, where it works to aggravate the previously mentioned diseases.
Severe as these bodily processes are, those disorders that affect the more basic tissues are even more serious. When the density of the flesh prevents the bone from getting enough ventilation, the bone gets moldy, which causes it to get too hot. Gangrene sets in and the bone cannot take in its nourishment. It then crumbles and, by a reverse process, is dissolved into [c] that nourishment which, in its turn, enters the flesh, and as the flesh lands in the blood it causes all of the previously mentioned diseases to become more virulent still. But the most extreme case of all is when the marrow becomes diseased, either as a result of some deficiency or some excess. This produces the most serious, the most critically fatal diseases, in which all the bodily processes are made to flow backwards.
Further, there is a third class of diseases, which we should think of as [d] arising in three ways. (a) One way is from air, (b) another from phlegm and (c) the third from bile. (a) When the lungs, the dispensers of air to the body, are obstructed by humors, they do not permit a clear passage. At some places the air cannot get in, while at others more than the appropriate amount gets in. In the former case, there will be parts of the body that don’t get any breath and so begin to decay, while in the latter case the air forces its way through the veins and twists them together like strands. It makes its way into the central region of the body, the region that contains the midriff, where it is shut in, thereby causing the body to waste away. [e] These factors produce countless painful diseases, often accompanied by profuse perspiration. And often, when flesh disintegrates inside the body, air is produced there, but is unable to get out. This air then causes just as much excruciating pain as the air that comes in from outside. The pain is most severe when the air settles around the sinews and the veins there and causes them to swell, thereby stretching backwards the “back stays” (the great sinews of the shoulder and arm) and the sinews attached to them. It is from this phenomenon of stretching, of course, that the diseases called tetanus (“tension”) and opisthotonus (“backward stretching”) have received their names. These diseases are difficult to cure. In fact, the onset [85] of a fever affords the best prospects for relief from such ailments.
(b) Now as for the white phlegm, as long as it is trapped in the body, it is troublesome because of the air in its bubbles. But if it finds a vent to the outside of the body, it is gentler, even though it does deck the body with white, leprous spots and engenders the corresponding diseases. If it is mixed with black bile and the mixture is sprayed against the divine circuits in the head, thereby throwing them into confusion, the effect is [b] fairly mild if it comes during sleep, but should it come upon someone while awake, it is much harder to shake off. Seeing that it is a disease of the sacred part of our constitution, it is entirely just that it should be called the “sacred” disease (i.e., epilepsy).
Acid and salty phlegm is the source of all those diseases that come about by passage of fluids. These disorders have been given all sorts of different names, in view of the fact that the bodily regions into which the fluids flow are quite diverse.
(c) All inflammations in the body (so called from their being burned or [c] “set aflame”) are caused by bile. When bile finds a vent to the outside, it boils over and sends up all sorts of tumors, but when it i
s shut up inside, it creates many inflammatory diseases. The worst occurs when the bile gets mixed with clean blood and disrupts the disposition of the blood’s fibers, which are interspersed throughout the blood. These fibers act to preserve a balance of thinness and thickness, i.e., to prevent both the blood from getting so liquid, due to the body’s heat, that it oozes out from the body’s pores, and, on the other hand, its getting so dense that it is sluggish and hardly able to circulate within the veins. The fibers, then, by virtue [d] of their natural composition, preserve the appropriate state between these conditions. And even after death, when the blood cools down, if the fibers are [extracted from the blood and] collected, the residue will still be completely runny, while if they are left in the blood, they, along with the surrounding cold, congeal it in no time. Given, then, that the fibers have this effect upon the blood, though the bile—which originated as primitive blood and then from flesh was dissolved into blood again—is hot and liquid at first as a little of it invades the blood, it congeals under the effect [e] of the fibers, and as it congeals and is forced to extinguish its heat it causes internal cold and shivering. But as more of it flows in, it overpowers the fibers with its own heat. It boils over and shakes them up into utter confusion. And if it proves capable of sustaining its power to the end, it penetrates to the marrow and burns it up, thereby loosening the cables that hold the soul there, like a ship, and setting the soul free. But when there is rather little of it and the body resists its dissolution, the bile is itself overpowered and is expelled either by way of the body as a whole or else it is compressed through the veins into the lower or upper belly, and is expelled from the body like an exile from a city in civil strife, so [86] bringing on diarrhea, dysentery and every disease of that kind. Bodies afflicted mostly by an excess of fire will generate continuous states of heat and fevers; those suffering from an excess of air produce fevers that recur every day; while those that have an excess of water have fevers that recur only every other day, given that water is more sluggish than air or fire. Bodies afflicted by an excess of earth, the most sluggish of the four, are purged within a fourfold cycle of time and produce fevers that occur every fourth day, fevers that are hard to get over.
The foregoing described how diseases of the body happen to come about. [b] The diseases of the soul that result from a bodily condition come about in the following way. It must be granted, surely, that mindlessness is the disease of the soul, and of mindlessness there are two kinds. One is madness, and the other is ignorance. And so if a man suffers from a condition that brings on either one or the other, that condition must be declared a disease.
We must lay it down that the diseases that pose the gravest dangers for the soul are excessive pleasures and pains. When a man enjoys himself too much or, in the opposite case, when he suffers great pain, and he [c] exerts himself to seize the one and avoid the other in inopportune ways, he lacks the ability to see or hear anything right. He goes raving mad and is at that moment least capable of rational thought. And if the seed of a man’s marrow grows to overflowing abundance like a tree that bears an inordinately plentiful quantity of fruit, he is in for a long series of bursts of pain, or of pleasures, in the area of his desires and their fruition. These severe pleasures and pains drive him mad for the greater part of his life, [d] and though his body has made his soul diseased and witless, people will think of him not as sick, but as willfully evil. But the truth about sexual overindulgence is that it is a disease of the soul caused primarily by the condition of a single stuff which, due to the porousness of the bones, flows within the body and renders it moist. And indeed, just about every type of succumbing to pleasure is talked about as something reproachable, as though the evils are willfully done. But it is not right to reproach people [e] for them, for no one is willfully evil. A man becomes evil, rather, as a result of one or another corrupt condition of his body and an uneducated upbringing. No one who incurs these pernicious conditions would will to have them.
And as for pains, once again it is the body that causes the soul so much trouble, and in the same ways. When any of a man’s acid and briny phlegms or any bitter and bilious humors wander up and down his body [87] without finding a vent to the outside and remain pent up inside, they mix the vapor that they give off with the motion of the soul and so are confounded with it. So they produce all sorts of diseases of the soul, some more intense and some more frequent than others. And as they move to the three regions of the soul, each of them produces a multitude of varieties of bad temper and melancholy in the region it attacks, as well as of recklessness and cowardice, not to mention forgetfulness and stupidity. Furthermore, [b] when men whose constitutions are bad in this way have bad forms of government where bad civic speeches are given, both in public and in private and where, besides, no studies that could remedy this situation are at all pursued by people from their youth on up, that is how all of us who are bad come to be that way—the products of two causes both entirely beyond our control. It is the begetters far more than the begotten, and the nurturers far more than the nurtured, that bear the blame for all this. Even so, one should make every possible effort to flee from badness, whether with the help of one’s upbringing, or the pursuits or studies one undertakes, and to seize its opposite. But that is the subject for another speech.
[c] The counterpart to the subject just dealt with, i.e., how to treat our bodies and states of mind and preserve them whole, is one that it is now fitting and right to give its turn. After all, good things have more of a claim to be the subject of our speech than bad things. Now all that is good is beautiful, and what is beautiful is not ill-proportioned. Hence we must take it that if a living thing is to be in good condition, it will be well-proportioned. We can perceive the less important proportions and do some figuring about them, but the more important proportions, which are of [d] the greatest consequence, we are unable to figure out. In determining health and disease or virtue and vice no proportion or lack of it is more important than that between soul and body—yet we do not think about any of them nor do we realize that when a vigorous and excellent soul is carried about by a too frail and puny frame, or when the two are combined in the opposite way, the living thing as a whole lacks beauty, because it is lacking in the most important of proportions. That living thing, however, which finds itself in the opposite condition is, for those who are able to observe it, the most beautiful, the most desirable of all things to behold. Imagine a body which lacks proportion because its legs are too long or [e] something else is too big. It is not only ugly but also causes itself no end of troubles. As its parts try to cooperate to get its tasks done it frequently tires itself out or gets convulsive, or, because it lurches this way and that, it keeps falling down. That’s how we ought to think of that combination of soul and body which we call the living thing. When within it there is a soul more powerful than the body and this soul gets excited, it churns [88] the whole being and fills it from inside with diseases, and when it concentrates on one or another course of study or inquiry, it wears the body out. And again, when the soul engages in public or private teaching sessions or verbal battles, the disputes and contentions that then occur cause the soul to fire the body up and rock it back and forth, so inducing discharges which trick most so-called doctors into making misguided diagnoses. But when, on the other hand, a large body, too much for its soul, is joined with a puny and feeble mind, then, given that human beings have two [b] sets of natural desires—desires of the body for food and desires of the most divine part of us for wisdom—the motions of the stronger part will predominate, and amplify their own interest. They render the functions of the soul dull, stupid and forgetful, thereby bringing on the gravest disease of all: ignorance.
From both of these conditions there is in fact one way to preserve oneself, and that is not to exercise the soul without exercising the body, nor the body without the soul, so that each may be balanced by the other and so be sound. The mathematician, then, or the ardent devotee of any other [c] intellec
tual discipline should also provide exercise for his body by taking part in gymnastics, while one who takes care to develop his body should in his turn practice the exercises of the soul by applying himself to the arts and to every pursuit of wisdom, if he is to truly deserve the joint epithets of “fine and good.” And the various bodily parts should also be looked after in this same way, in imitation of the structure of the universe. [d] For since the body is heated and cooled inside by things that enter it and is dried and moistened by things outside of it and made to undergo the consequent changes by both of these motions, it will happen that when a man subjects his body to these motions when it has been in a state of rest, the body is overcome and brought to ruin. But if he models himself after what we have called the foster-mother and nurse of the universe and persistently refuses to allow his body any degree of rest but exercises and continually agitates it through its whole extent, he will keep in a state of [e] natural equilibrium the internal and the external motions. And if the agitation is a measured one, he will succeed in bringing order and regularity to those disturbances and those elemental parts that wander all over the body according to their affinities in the way described in the account we gave earlier about the universe. He will not allow one hostile element to position itself next to another and so breed wars and diseases in the body. [89] Instead, he will have one friendly element placed by another, and so bring about health.
Complete Works Page 195
