EPISTOLA

Timing of the disease

...sense, and whether it is in the process of becoming (as they say), or already established original: "in fieri... uel iam facti", and also whether these stages are universal or particular. Furthermore, the knowledge of the stages of the disease is extremely necessary if anyone wishes to administer a correct cure: about which Galen has written most learnedly in three books On Crises, and Avicenna in the second book of the Canon, and in other places; it is necessary to observe this same process in all types of disease, so that nothing necessary for the cure is omitted.

Causes of the disease

And so that you may know everything perfectly, the causes must be investigated in the second place. Since to know is to understand through the cause, you will therefore study the knowledge of causes second in order. To confirm this, there is the opinion of Galen in the seventh book of On the Causes of Symptoms, where he says that it is not enough for the Physician to know only the impaired functions, but also all the efficient causes; and in the third book of the Art of Medicine original: "Artis paruae," referring to the "Microtegni," a foundational textbook of the era, he states that the cause must first be removed, then the disease that proceeded from that cause must be cured. He followed this same opinion in the third book of the Method of Healing, when he warns that one must focus on the removal of the cause, since no disease can be healed if the cause is unknown. Similarly, there are opinions of Avicenna in the first book of the Canon: when he says it is worthwhile in medicine to know the causes of sickness and of health; and similarly in the third book concerning the cure of cold colic.

Three grades of causes

Indeed, the causes which Physicians are accustomed to recognize beforehand for the understanding of a disease are of three types: namely, primitive or evident causes, which the Greeks call procatarctic External triggering factors, such as heat, cold, or diet, that set a disease in motion, and these are external; next are the antecedent causes, and third the conjunct immediate or internal causes, which must be investigated most excellently and diligently. However, I do not want you to believe that this three-fold positioning of causes opposes the sayings of Galen in the second book of On the Causes of Diseases, and the first of the Method of Healing, and in many other places, where he identifies only two types of causes—namely one external and the other internal. If you divide that internal cause into two parts, as the most learned Avicenna, a faithful interpreter, divided it along with many other most eminent physicians, you will not contradict the doctrine of Galen, despite what the modern Galenists believed, persuaded by their own crude wit original: "crassa minerva," a Latin idiom referring to a lack of refinement or simple-mindedness. For those things which are consistent with reason do not conflict with Galen's truth, if one correctly weighs what Avicenna intended through the two internal causes, and if one wishes to observe the process of nature in causation from every side. And so that you may understand the truth in this matter, let there be for the sake of example someone who, from movement and the eating and drinking of hot things, falls into an abundance of humors and thin...