Galen's Commentaries on the Aphorisms of Hippocrates

is subject to no such danger, because it never reaches extreme repletion, for which reason it is not necessary to dissolve it, as is necessary for the other habit of athletes when it reaches the extreme. For this one must be dissolved, not delaying at all, but anticipating the danger by its dissolution. But the reason why it must be dissolved, he himself set forth, saying: "For they are able neither to remain in the same state, nor to be at rest." For since nature is always working at concoction, the distribution of nourishment, the generation of blood, addition, agglutination, and assimilation; when nothing can be added

to the solid parts of the body, and the veins no longer have a receptacle in which the distributed nourishment may be received, then the danger is imminent, either of rupture or of sudden death. Therefore, so that the body may again have a place by which it may be nourished, the good habit must be dissolved without delay. Its dissolution is evacuation, as is clear. And this also must not be done beyond measure, since immoderate evacuation is no less dangerous than immoderate repletion. Now the determination of the quantity of evacuation regards not only the superabundant humor, but also the strength of the person who must be evacuated. For different people bear evacuations differently. These things indeed were said by him concerning the good habit of athletes, which can of themselves guide those who have chosen such a mode of life, and they are for physicians like an example of the discourse to be added afterwards. For he says thus: "And evacuations which lead to the extreme are dangerous. And again, refections, when they have been extreme, are dangerous." In which whole discourse the sum of the meaning is this: that one should neither evacuate nor replenish beyond measure; of which thing the evidence can be the good habit of athletes, which, though otherwise being faulty (as that which both abounds in good humors and has robust strength), bears this one greatest evil: that it comes to extreme repletion. Wherefore it must be dissolved immediately; and just as, conversely, those who are endowed with such a nature are not to be led to extreme evacuation, so also those who need any other evacuation are not to be evacuated beyond measure. For to speak generally, in every evacuation one must attend to the strength of the sick person; and as long as he bears it and is not yet in distress, one must attempt to draw out the exceeding humor; but when they fail, even if superfluities remain, one must beware of their evacuation. Moreover, as to what he says: "And again, refections, if they consist in the extreme, are dangerous": if one ought to refer this discourse back to the example, lest it be truncated, it will seem to have been said regarding the ultimate repletion, which he orders to be avoided; and that bodies should not be restored to such an extent that they come to extreme repletion. But if you consider the figure of the speech, as some commentators have done, you will think that he speaks of the same thing twice, but in different ways. When, therefore, he has said thus: "So also evacuations which lead to the extreme are dangerous," you will think this only: that he enjoins that immoderate evacuations are to be fled, because they are very dangerous. But when, subjoining, he has said: "And again, refections, when they consist in the extreme, are dangerous," he forbids immoderate evacuations on account of this: because even the refections after them are by no means safe, since nature has already been made weak and can no longer sufficiently concoct, nor distribute nourishment, nor assimilate it. But if anyone accepts the discourse in this way, the other part of the doctrine concerning superfluous repletion will clearly be left out, and the example concerning the good habit of those in training will have been brought forward in vain.