Galen's Commentaries on the Aphorisms of Hippocrates

brought forth. What of the fact that this very word "again," added in the whole sentence, seems to manifest the meaning we have stated, when he speaks thus: And again, refections, when they have stood at the extreme, are dangerous. For as one who makes a discourse about another matter, so he appended the word "again."

Ornamental drop cap C with floral/scrollwork backgroundSince in the previous aphorism he spoke generally about any immoderate repletion and evacuation, in this one he holds a discourse on the diet of the sick, instructing us: in long diseases always to beware of a slender diet, but in acute ones not always. For most of these seem to require a slender diet, and some of them even that which reaches the extreme of slenderness. Now, a slender diet at the extreme is that which proceeds through fasting alone, such as with melicrate, until the crisis or judgment of the disease. But a slender diet is that which proceeds through few or little-nourishing foods, such as the juice of ptisana; its limit is the dissolution of the strengths, for the sake of which we provide nourishment. In healthy bodies, it is always necessary to preserve the strength of nature, or to increase it with foods, not to demolish it. And a potent nourishment is that which increases it, which is called "full"; that which is moderate preserves it; but that which is slender diminishes it. This, therefore, must always be avoided, while the others should be used as present circumstances require. In the sick, however, it rarely happens that we strive to make the strength of the body greater than what we received. For for the most part, we hope in long diseases to cherish the powers, but in acute ones to preserve them as little weakened as possible. For if we hasten to preserve them such as we received them in these diseases, or even to increase them, we will always add to the disease. But which are the acute diseases that require a very slender diet at the extreme, and which require a very slender one but not at the extreme—that is, a slender one—Hippocrates taught more fully in the book On the Diet of Acute Diseases (which is titled by some On Ptisana). And we, in our expositions on the same book, have completed the whole discourse. Now indeed let it suffice to have said this: that in all diseases in which the greatest vigor and the judgment will occur in the first four days, provided nature is stronger, we ought to observe a complete fast, which is a diet most slender at the extreme. In those, however, which are not protracted beyond the first week, nature being strong, melicrate alone should be used; and this diet would itself be very slender, yet not at the extreme. But if we do not sufficiently trust the strength of nature, we shall use the juice of ptisana. Reasonably, however, a diet of this kind would be called slender, just as that which is by barley ptisana is not exquisitely slender unless very few things were taken; yet it is not therefore full, such as that which consists of eggs, and spelt-grits, and fish, and other things of this sort. What, therefore, has been added to the discourse concerning acute diseases in which it is not suitable, is by no means said because of peracute diseases; for concerning these he himself will speak. Where, therefore, a disease is peracute, it immediately also possesses extreme labors; a diet most slender at the extreme must also be used.

.iiii.

Ornamental drop cap V with floral backgroundA slender and exquisite diet is always difficult in long diseases, but in acute ones where it is not suitable. And again, that which reaches the extreme of slenderness is grievous. For repletions which reach the extreme are also grievous.

.v.

Ornamental drop cap I with floral backgroundIn a slender diet the sick err, whereby it happens that they are more harmed. For whatever great error is committed, it becomes greater in this than in a slightly fuller diet, for that reason.

Ornamental drop cap H with floral backgroundThe beginning of this aphorism is also found written otherwise, namely in this way: In a slender diet, for the most part, two [groups] err who are sick, whereby it happens that they are more [harmed]