Front Page Titles (by Subject) THE ART OF MEDICINE IN FORMER TIMES. - The Writings of Hippocrates and Galen
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THE ART OF MEDICINE IN FORMER TIMES. - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
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THE ART OF MEDICINE IN FORMER TIMES.
SECTION I.—TREATISE IV.
This treatise, says Haller, is correctly considered as spurious, by Mercurialis. It is manifestly posterior to the time of Aristotle, whose principles it altogether repudiates. It is entirely devoted to reasoning, but learnedly and acutely written. The origin ascribed to medicine is very probable, in a due attention to what proved hurtful or useful in diet, and in conforming its employment to the state of disease. It was undoubtedly imperfect at first, but is not undeserving of praise. It confutes the hypothesis of four primary qualities, viz., hot, moist, cold, and dry. Asserts diseases to arise independently of these, and attributes them to an acid, saline, acerb or bitter humour, secreted, and acting alone, or conjointly, by which changes occur in them; or to a change of form in various ways, productive of fluxions, wind, &c.
The treatise is stated as pointing out the antiquity, invention, certainty, and importance of medicine. Of food, generally and particularly, as of broths, drinks, bread, wine—by the first of which, seems to be chiefly meant barley water of varied strength, and constituting a chief part of dietetic practice; it then proceeds to consider primary and secondary qualities, and is followed by that of fluxions, humours, and flatus.—Ed.
Those who have undertaken to treat of medicine, have manifestly been deceived in most particulars, by attempting to found this doctrine on the hypothetical notions of cold and hot, of dry and moist, thus reducing to one or two principles the causes of death and of disease. Of this our art may reasonably complain, since its reality is acknowledged by its daily employment, and its cultivation in the hands of the most able practitioners. Doubtless there are among physicians both good and bad; and this is another proof of its existence, since, if it did not exist, this could not be the case, for all would be alike ignorant, and chance alone would decide as to the mode of treatment. We see, however, in medicine, as in other arts, workmen of infinite difference, as it respects the practice, both manual and mental.
Recourse to hypothesis should therefore be avoided in medicine, and left to subjects obscure and doubtful, which afford nothing better to their advocates. Thus in astronomy, &c., however persuaded we may be of the truth of our opinions, yet we cannot establish them fully, so as to destroy completely the doubts of others, since there is no established rule of truth, to which we can at all times refer. Such a rule, however, exists in medicine; it is an art of long existence, of sure principles, and certain regulations, through which, for a long period, numerous discoveries have been made, and which are confirmed by experience, unmixed with hypothesis. Much is, however, still required to render it perfect, by the researches of the learned; and by the aid of what is already known, endeavour to obtain the knowledge of that we know not. All those who depart from well-established rules, to riot in the path of novelty, and boast of having discovered something in our art, deceive themselves as well as others. I shall endeavour to prove this, by pointing out what medicine really is; from which it will appear, that all deviation from its present route is to be avoided.
And first it seems to me, that in treating of this art, we ought chiefly to notice such things as all mankind will agree in, for the researches of the physician should be confined to diseases to which every one is liable. It is true, that as the majority are uninformed, they cannot of themselves know how their disorders commence, nor how they will end; what increases, nor what moderates their force. This is, however, readily acquired through the information derived from those acquainted with the subject, and this more easily, since nothing is remembered with more facility than that which is the result of self-experience. A physician who is unable to make himself understood by the most ignorant, or convince them as to the nature of their complaints, would be ignorant himself, and would not mend the matter by mere speculation. Medicine would never have been discovered, had not speculation come to its assistance. No one, indeed, would have troubled himself respecting it. What need could the sick have had of medicine, who lived exactly as those in health, had they never drawn a comparison between their own state, and of those who pursued a different regimen, and observed the superiority of the one to the other? It was by noticing an apparent injury or benefit, which led them to a discovery of our art. This arose from the sick discovering that they were injured by the use of food that was beneficial in health, just as we now find to be the case. We may even go further, and say, that the diet and food in health that is now employed, would not have been found out, if men had been content with that of animals, such as grass, hay, and the fruits and productions of the earth. All animals well fed, are healthy, without any other kind of nourishment. At first, mankind lived like the beasts; and food, as at present prepared, has only been introduced, because that which was first employed was too simple and indigestible, and was, as at present, the source of indisposition, violent pains, severe disease, and even of death. It is true, habit, then, rendered it less dangerous and more supportable, yet still it proved injurious. They whose stomach was enfeebled, soon perished, whilst such as were of a stronger constitution, resisted for a longer time. Just so we find it at present; some readily digest the strongest food, which to others is difficult in the extreme. Hence arose the necessity for seeking a diet adapted to their nature, and by degrees they were led to that we now employ. After having thrashed out and washed the grain, ground and sifted it, it was kneaded and made into bread and cakes, or boiled and roasted with other things. A mixture was formed by food of different strength, in order to accommodate it to the constitution, from the belief, that eating any thing too strong and indigestible would induce pain, disease, and even death, whilst that which was appropriate and readily digested, became the source of health and strength.
Now, what more fitting name could be given to this discovery than that of medicine, which means the method of remedying evil, since this invention was intended to produce a healthy nourishment, and to preserve health, by securing them from an irregular diet, productive of pain and disease? It may indeed be said, that this primary invention is not an art, since, in what is now well known, and uniformly employed, it would perhaps be unusual, to qualify the practice by the name of an art. It at least is the fact, that such practice and invention is highly important, and is the fruit of great art and much consideration. We see in the present day, individuals appointed in our gymnasia to superintend the Athletæ, continually making discoveries in the same way, as to the most appropriate diet for those persons.
Let us examine now, how medicine, properly so called, and invented for the benefit of the sick, deserves the name; how it gave rise to artists, and why there is so much difference between them. I believe firmly, as I said before, that no one would have been led to seek for it, had the same food and regimen been equally proper both in health and sickness. We still observe among nations where medicine is unknown, that both in health and sickness, the same diet is employed. Every thing gives way to the wish of the moment, nor do they abstain from any thing that gratifies them. But, where the art is known and its dictates pursued, it is reasonable to presume that similar impressions led to the same results, as in the case above mentioned. They began by lessening the amount of food in case of sickness. This proving beneficial in some instances, but insufficient in others of greater intensity, a still weaker diet was deemed requisite. Thus they were led to employ diluted food or broths, by mixing small quantities of stronger food with water, and thereby weakening them, as well as by their mode of preparation. If even this nourishment proved too powerful in some diseases, it was discontinued, and liquids of a simple nature, regulated both as to quantity and quality, came into use. Even such slops (Sorbitiones) are occasionally injurious, increasing the complaint without strengthening the patient—all which proves, that food over-proportioned to the state of the patient, is equally injurious as in health. What difference then is there between the discovery of an appropriate regimen in disease, by a physician, and that originally contrived, in the change of the primary savage diet, to that which is now universally adopted? I think it is the result, in both instances, of one and the same invention. There is only this difference, that the last is more varied and extensive, requiring greater reflection and experience, although it is plainly deducible from the former.
If we compare the regimen of health and that required in disease, it will be perceived that ordinary food would be much more injurious in sickness than the first rude and savage nourishment would be in health. Thus, a person attacked with a disease, not of extraordinary violence, and yet somewhat dangerous, unacquainted with the risk he runs, eats bread, flesh, or other food appropriate to health, whilst another, in health, employs that which is used for animals, such as peas, barley, &c. It is certain that the latter will not be equally incommoded as the former, and this is an additional proof of the art of medicine having been discovered in the manner I have stated.
If it was the fact, as some imagine, that too strong food alone is hurtful, and that a weaker kind was equally useful in health and in disease, nothing would be easier than to fix upon a good regimen; for all that would be required, would be the mere reduction of all to a proper medium. Unhappily this is not the case. The fault is not lessened, yet the evil is as great, from the excess or defect of nourishment.—Hunger has an amazing power over man, either to cure, to weaken, or even to destroy life. Repletion causes many different disorders; inanition is productive of others not less hazardous. Hence this last, as a remedial means, is more extensive than the former, and demands more care and attention. A happy medium is a desideratum; but for this we have neither weight nor measure to assist us. The personal feeling of the individual seems the best resource; but how we are to avoid all error in the case, is the difficulty; and I will cheerfully praise the physician, who, in such circumstances, is guilty of but trifling mistakes; to avoid them entirely is almost impossible.
Most physicians resemble unskilful pilots, whose faults are unperceived in calm weather, but should a storm arise their ignorance is manifest, and destruction follows. So with the ignorant physician, in his treatment of trifling diseases, wherein he may make the grossest mistakes with impunity and escape detection; but if by misfortune they meet with a violent and dangerous disease, they are at fault; their ignorance and presumption are apparent to all, and their punishment promptly follows.
That improper fasting is as dangerous as over-eating may be proved by the example of those in health. Some have made it a rule to eat but once a day. Others, to preserve their health, make two meals daily. I do not refer to those who occasionally, or from revelry, do the same, for there are constitutions which are enabled to bear such changes with impunity, and make one or two repasts, although not accustomed thereto. There are many, however, who cannot deviate from their customary habits, without immediately feeling its influence. If, used to one meal only, they take another, they feel tired and stupid; they yawn, are drowsy, and very thirsty. Flatulence and colics assail them, and not unfrequently some severe disease attacks them; and all this arises from deviation from their single meal. On the other hand, when the first accustomed repast is neglected, the usual period for it has scarcely past, when they feel weak and tremulous; their eyes are languid, their urine becomes hot and turbid, and a bitter taste is felt in the mouth. Bellyache succeeds, with vertigo, irritability, moroseness, and dulness. At the arrival of the period for their second meal, they are incapable of digesting it. It is attended with flatulence and colic, and costiveness ensues. Their sleep is disturbed, uneasy, and troubled by dreams. And in like manner, these symptoms are the precursors of severe sickness.
From whence do these symptoms originate? In my opinion, he who is accustomed to one meal alone, is incommoded only from not allowing his digestive organ full time for disposing of his previous meal of the preceding day—but he fills it afresh, before the former food is properly concocted. Such stomachs digest much more slowly than others; they require more relaxation and repose. He, on the other hand, who has been accustomed to two meals, and omits the first, suffers from not affording his system the nourishment it required at a fixed period; that which had been previously taken having been completely exhausted. It is hunger that undermines and consumes him, and his situation I ascribe altogether to it; and any one who should pass two or three days without food would experience similar symptoms. Those constitutions that feel violently and speedily the slightest errors, may be considered as being weaker than others. Disease is the near neighbour of such debility of constitution. The difference is, that the debility in this case being greater, the slightest error in diet must be felt in a greater degree. Medicine requires, therefore, in such cases, very great strictness. It is undoubtedly difficult to attain a certainty; but art has discovered various modes of approximation, which ought to be well known, and will be duly treated of. There is no justice in opposing the ancient medicine as being founded on bad principles, from the pretext that it is not yet perfect. On the contrary, it is deserving of admiration from its advancing so far towards it, and from its having, in a period so unenlightened, discovered the route pointed out by reason, as the sure way to reach perfection.
As to those who have endeavoured to attain the art by a plan altogether new, and strive to establish its foundation on hypothesis, I would ask them which it is that is prejudicial, hot or cold, dry or moist; and if a skilful physician ought to correct each of these qualities by their opposites? Give me an individual of a weak constitution, and let him feed on wheat just thrashed, or raw flesh, and drink only water; they must admit that such fare will produce much evil, such as violent pains, deranged stomach, debility; he would not long survive. What assistance does he require? Cold, hot, dry, or moist? Which shall we select? If it is one of these four that has caused the disorder, we must choose its opposite, according to them. But the most direct and certain remedy is a change of food, giving bread instead of grain, cooked meat in place of raw, and add wine to his water. Such a change would speedily restore him to health, unless the injurious regimen had been too long persisted in. Will they persist in saying that his disease had been caused by cold, and that they had dissipated it by heat, or reversely? It would be difficult to prove the truth of such responses.
In making bread, the above four qualities are removed from the wheat. Besides this, water, fire, and many other things, each possessing its own peculiar powers and qualities, are employed. It loses part of what it had, and what remains is a compound mixture. I am convinced, that the action of bread on man is very different, according as it is made from well-washed grain or from that which has not been washed; or from white or brown bread; between that which has been kneaded with much or little water, and between ill and well-baked bread. Many other circumstances produce great difference. The same may be said of barley cakes, where we find numerous and different qualities. How can one, who has never examined this, nor thought about it, become acquainted with diseases, when each of the particulars above mentioned is productive of different sensible effects, on which depend the lives of healthy persons, of convalescents, and of the sick? Nothing is more important than a full acquaintance with all these different qualities. They who have rightly pursued the art of medicine, have therein found the variation in the nature of man: a subject so extraordinary, as to have ascribed it to a Deity. They have not considered whether it was the cold, hot, dry, or moist, that benefited or injured man; but believed that injury was the result of an excess of power, which human nature could not overcome, and which they therefore strove to weaken, by opposing mild things to stronger of the same nature, weak bitters to the more powerful, &c., and thus of every thing carried to its highest grade. They observed that all these qualities were found in man, and all at times became prejudicial. In fact, there is in him, both bitter, saline, mild, acid, acrid, insipid, and many other qualities, possessed of different powers, in proportion to their quantity and degree of strength. All of these, when well united, and tempered by each other, are insensible to us, and do no injury; but if one should separate, and exist alone, it then becomes sensible, and ravages the system. It is the same with aliment. That which is improper for us, is either bitter, saline, acid, or too strong. Hence it is productive of the same inconvenience as the humours I have mentioned, whilst that which is appropriate possesses none of those injurious qualities, nor is it too powerful. Such is the case with bread, barley cakes, and other similar articles, employed in profusion by mankind. I do not speak of dishes and preparations, intended solely to gratify the taste or irritate the appetite. Such are highly pernicious. I refer to common nourishment, which causes no uneasiness, or any separation of the particles of the humours of the body, and serving only to strengthen, nourish, and promote its growth. All these benefits arise from its well-attempered state, in which nothing predominates, nothing is irritating, nothing too strong. Every thing is reduced to a point, so as to be esteemed simple, homogeneous, and at the same time, of adequate strength.
I cannot imagine how the partisans of this doctrine, which is so distant from the true route of medical science, and so beset with conjectures, could contrive to practise on their system, for I do not think they have ever discovered any thing, that is, per se, hot, cold, dry, or moist, and unparticipating in any other quality; nor that they have other varieties of food and drinks than those familiar to us; but it has pleased them to call such a thing hot, that one cold, this dry, and another moist! Now they must be embarrassed should they order something hot, and the patient should ask them which; they must therefore either trifle with him, or change their notions; for if the hot is always conjoined with the bitter in one thing, with the insipid in another, and with the nauseous in a third, and if many other qualities are also united with the hot, even such as are of a contrary nature, which of all these hot things will he direct? the hot and bitter, or hot and insipid, or perhaps, something that is cold and bitter, for such there are as well as cold and tasteless. But we well know that each of these four varieties produces contrary effects, not on man alone, but likewise on leather, wood, and many other bodies, far less sensible than that of man.
It is not the hot that exercises such power, but the bitter, the tasteless, and the other qualities I have mentioned, that produce a powerful effect both externally and internally on man, whether in eating or drinking, or in employment of external applications. In a word, heat and cold, of all qualities, I conceive to be those that have the least power over our bodies, and for the following reasons. Whilst the hot and cold are well united together, they do no harm, since they mutually neutralize each other; but if disunited, or either predominates, then they prove injurious. Even here, however, if it is cold that affects us, the injury is not of long duration; for our internal heat immediately opposes it with all its power, without the need of other assistance, and this both in health and disease; hence we see that if in health we are made extremely cold, by winter or cold bathing, or other cause, the greater the degree of cold, not amounting to an actual freezing of the body, in the same proportion will he be warmed by clothing himself, or getting under cover. So likewise, if much heated by the warm bath, or a large fire, he continues with the same clothing, in a place but little cooler, it will appear much colder to him; and should he expose himself to a draft of air, or fan himself, the sense of cold will be greatly augmented. This is still more evident from walking upon ice or snow. The feet, the hands and face, suffer much from the cold, and when covered up in bed, they suffer from heat and irritation, and sometimes small vesicles appear on the skin, as if it had been burnt by fire. So long as the cold continued, this was not felt, so true it is, that these two opposing powers succeed each other quickly. Many other instances might be adduced, but we will now examine what ensues in case of sickness. In the instance of fevers, in proportion to the violence of the chill, will be that of the subsequent hot stage. If the chill was not of long continuance, the fever is commonly of short duration, and rarely dangerous. In terminating, the heat retires last from the feet, as being the part of the body in which the cold had been most severe, or of longer continuance. At length, when the sweating stage has carried off the fever, the patient’s sensations are much more cool and refreshed, than if he had not had the preceding febrile state. Since, then, these two opposites so quickly succeed each other, and thereby temper their respective excess, what great harm can result, or what need of much foreign assistance?
It is asserted that those who have ardent fevers, or inflammation of the lungs or other parts, are not so speedily liberated from the heat, nor do they feel this beneficial influence of the cold. I reply to this, that I consider it a certain proof, that fever does not arise from heat alone, but requires the co-operation of other causes. We have a hot bitter, a hot acid, a hot salt, and many more of different character; and the same may be said of cold. Now these are the causes of the disease. Heat is present undoubtedly, but it exerts no injurious effects, unless conjoined with some other quality, which irritates, and augments its influence, without which it possesses alone its own appropriate power of warming.
We have one fact, among many others, of the most conclusive character, that is, when attacked with a cold in the head, and a discharge from the nose takes place, the humour is more acrid at the beginning than that which is natural to the parts. The nose is swelled and inflamed, and the increased heat is manifest to the touch. If long continued, the humour produces excoriation; at length the symptoms become moderated, but not until the humours become thicker, less acrimonious, more concocted and commingled, than at first. It is true we have such fluxions, manifestly induced by cold alone; such are cured by warmth, just as affections resulting from heat alone are removed by cold, and in both cases, promptly and without coction. All other fluxions arising from acrimony and an ill state of the humours, are only cured by the concoction and bland state that is brought about in them. So also we see fluxions on the eyes, owing to various acrimonies that ulcerate the lids, excoriate the cheeks, and even destroy the cornea. These violent effects are only terminated by the concoction of the humours, becoming thereby more consistent, and of a purulent nature. Now this concoction is accomplished through the mixture and modified temperature of the humours. We observe in like manner fluxions on the fauces, throat, &c., inducing hoarseness, quinsy, erysipelas, peripneumony;—all such humours are at first salt and irritating, and thus produce and maintain these complaints; but when they become thicker, and by concoction lose their acrimony, then the fever declines, and the evil passes away. Now if hot or cold, without the addition of any other quality, should induce disease, and such is sometimes the case, then it ought to terminate so soon as they are respectively changed for each other; in all other cases, the evil ensuing arises from the agency of other powers. Thus, when a humour, called yellow bile, is diffused through the system, what anxiety, heat, and debility immediately ensue! A spontaneous discharge from the bowels, or produced by medicine duly and appropriately, almost as rapidly put them to flight. But if this humour is allowed to remain, crude and unconcocted, the fever and pains will continue unabated. But if the humour be that called green bile (æruginosi humores), how raging are the symptoms, and the pains in the intestines and chest! Nor do they cease, until this bile, mixed and weakened by other humours, is discharged. There are several ways of concocting, weakening, and inducing the natural consistence of such humours; and to these we are wonderfully assisted, by a knowledge of crises, and of critical days. It is neither on the hot nor the cold that we are to operate, for they can neither concoct, nor render consistent. What then is accomplished? We reply, that they are capable of admixture, and that by this they destroy each other’s influence. Mixed with any thing else, they still are hot and cold, and cease not to act, unless commingled together. The other qualities in man, the more they are mixed together, so much the milder and better they become; and man is never in better health, than when these humours are thoroughly concocted and at rest, without any one predominating; and this, I trust, is sufficient, so far as respects the hypothesis of these four qualities!
I will now say a few words relative to sundry philosophers and physicians, who affirm, that it is impossible to become acquainted with medicine without previously knowing the nature of man, and how he was first formed and created. I think myself, that all that they have written or said about nature, is infinitely less useful to the physician than to the book-maker; and that, whatever can be best attained respecting the nature of man, is through the means of medicine itself; nor can it be attained, without a full acquaintance with this art in all its vast extent. I have known many persons thoroughly acquainted with all that has been said by those writers respecting the nature of man, &c. But all that is requisite for the physician, on this head, in order to practise successfully, is that which is connected with his food and drink, and the changes which different articles are capable of producing in him. It is not sufficient to say that cheese is injurious, because it induces pain from eating it in excess. We must know also, what kind of pain, and which, and why, such or such parts of the body suffer from it. Amidst our food and drinks, there are many that are bad, which do not affect the system in the same way. Pure wine, taken in excess, weakens—as those acquainted with its powers well know, as well as the parts of the body on which it acts. Now I wish the same information, as to other things. Cheese, since we have mentioned this, is not injurious to every one. Many employ it largely, without any bad effect. Nay, it is beneficial to thin persons; although, it is true, that some are much incommoded by its employment. This depends on a difference of constitution, and this is owing to something in the system that is inimical to cheese, and by its presence it becomes excited; and the more abundant the humour and powerful, the greater will be the opposition it occasions. If, however, cheese was contrary to the nature of man, all should equally suffer from it, and those who are fully sensible of all this, will not be led into mistake. In convalescence, as well as in chronic diseases, many troublesome symptoms ensue, some arising spontaneously, others from the rash or imprudent use of different things. I have known many physicians, as well as common people, attribute such symptoms to something out of the way done by the patient, as bathing, walking, or eating what they were not accustomed to; and limiting their views to this alone, although, in many instances, it might be the most appropriate step they could have taken. Ignorant of the cause, they blame at hazard, and prohibit that which is most proper. This is an evil of no trifling import. In order to avoid it, the physician should be acquainted with the different effects of bathing at a fit or improper time, and so of other things, for all act diversely according to circumstances. Now, a physician unacquainted with the comparison of action of different things, on man, under different circumstances, can neither know their effects nor employ them properly.
He ought, moreover, to know how to distinguish between those affections that arise from the functions, and those of his organization. I mean by the functions or faculties, the highest grade and power of the humours; by organization, the conformation of the parts that compose the body. Some of these are hollow and contractile, some expanded, others solid and round, or broad and pendent; some are broad, long, dense, thin, florid, spongy, and soft. Of all these, which are best adapted to attract moisture from the rest? The hollow and equally expanded, or the solid and round, or the hollow, gradually diminishing? Doubtless, the last, as exemplified externally. A man, for instance, cannot drink with his mouth open; but he closes his lips, so as to leave only a small opening, or by employing a tube, when the liquid is readily attracted. Cups, have been made on this principle, with a large belly and small orifice, to attract the humours from the flesh. There are in nature many things analogous. In the human body, the head and bladder, and uterus, for they all manifestly attract, and hence are always full of moisture. Those that are hollow, but expanded, although retaining fluids that are poured into them, yet they cannot attract them. Such parts as are solid and round, neither attract nor contain, for the liquids finding no place, will run over them. The spongy and soft parts, as the spleen, the lungs, the breasts, suck up the moisture presented to them, by which they swell and become hard. It is so likewise, with the cavities containing humours, as the stomach, or any into which a daily flow is made, with no power to distribute from its structure. These imbibe the humour, and by its incorporation, although small and empty, they become dense, firm, and hard, if concoction does not ensue, and the humour is not discharged. All this promotes flatus and pain, causing the sound that is heard in the large and hollow cavities of the chest and belly; for as this wind is not confined to one spot, its motion is accordingly accompanied by noise and uneasiness. Should it press upon the soft and fleshy parts, these will feel a sense of fulness and of numbness. Or should it be opposed by some large part, which is not strong enough to resist it without suffering, nor yet so weak as to yield, and give way to it; if, like the liver, the part is tender, florid, sanguineous, &c., its size and firmness prevents it giving way; the wind, from this resistance becomes more powerful, and greatly augments the evil. Hence so frequently arise such severe pain in the liver, terminating often in tumours and abscess. So also with the diaphragm, though in a less degree. It is a firm and resisting part, but being more tendinous and stronger, it is less sensible to pain; yet this occurs at times, and even abscesses are formed.
Many other varieties of form exist, both in and externally, very different from each other, and modifying the occurrences both of health and of disease. A large or small head,—a large, long, or short neck, a round or flaccid abdomen, narrow or broad chest and ribs, and many more, whose variations all require to be known, in order to be enabled to discover correctly, the true cause of the symptoms we perceive.
As to the powers of the humours, or what they effect on the system, we should be acquainted with their respective affinities. For instance, we should know, if a mild humour is changed into another kind, not by any mixture, but by degenerating from its pristine state, what is the first alteration it undergoes; whether it becomes bitter, saline, austere, or acid. The last of these is certainly the most injurious of all these changes which it could pass through; and whoever can, by his research on external circumstances, extend it to those of internal character, will be the best qualified to estimate their proper treatment, which consists in the removal, as far as possible, of every thing hurtful to the body.