Galen's Commentaries on the Aphorisms of Hippocrates

[they] are harmed: and most approve this reading more than the other, thinking that Hippocrates wished to say this: that the sick, erring in a twofold manner upon a slender diet, are more harmed; for, without the physicians' knowledge, they are forced to take food for this very reason, because they are governed by them on a slender diet, and from this they receive greater detriment than if they were not governed on a slender diet. Furthermore, they err because nature is already in a state of weakness, as it had previously labored under a lack of nourishment. To me, however, the former reading seems better, as it also encompasses this one and makes the discourse more general, since it teaches concerning every error, whether it happens to the sick willingly or unwillingly; so that the discourse is such: whatever error happens to the sick who are governed on a slender diet, this brings the greatest danger, both because nature is weakened by such a diet, and because the transition to it is unaccustomed. Moreover, those things said concerning the healthy confirm the previously mentioned reading: in whom he says a slender diet is dangerous because they bear errors more severely, not because they are forced to err on account of the slenderness of the diet. The things which follow concerning the aphorism are manifest. VI.

Ornamental drop cap letter E Hippocrates called "extreme diseases" those that are the highest, beyond which there are no others. Wherefore he commands that in these the most exquisite treatment be used, and likewise a very slender diet be applied. Now, such diseases would be entirely peracute. But in peracute diseases, which are in their highest vigor up to the third day, a very slender diet is best. Whence, subjoining the following aphorism, he says: VII.

Ornamental drop cap letter S Just as he called extreme diseases the highest, so also he now calls "extreme labors" the highest; and by "labors" he means either the paroxysms, or simply all the occurrences of the disease. For a peracute disease possesses paroxysms and all occurrences simply as the greatest, immediately in the first days of the disease; for the vigor of the disease falls upon them immediately, which is nothing other than the highest point of the disease in its occurrences. And indeed, that disease is peracute which immediately consists in its highest vigor. Now "immediately" is to be understood as being around the first four days, or a little further. Therefore, it is appropriate to apply an extremely slender diet, since a very slender diet is necessary for diseases already established, just as he taught in the book On the Diet of Acute Diseases and in this very aphorism. Now, a peracute disease is established immediately in the first days. Furthermore, that it is consistent with reason to use the slenderest diet in the vigor of the disease has been more fully shown by us elsewhere. Now it will be enough to have said this: that if anyone fears to provide nourishment worthy of mention because of inflammations, or the fevers which are inseparable from acute diseases, he will fear to do this very thing even more while the disease persists in its vigor. For then the inflammations [phlegmasiae] especially exist, as he himself says in the book On the Diet of Acute Diseases, whether one wishes to understand by "phlegmasiae" those which are properly called inflammations, or whether it pleases—

even for the healthy, a diet established as very slender and exquisite is dangerous, because they bear errors more severely. On this account, therefore, a slender and most exquisite diet, because it becomes a little fuller, is for the most part more dangerous. VI.

Ornamental drop cap letter E For extreme diseases, extreme, exquisite remedies are best. VII.

Ornamental drop cap letter V Where the disease is peracute, it immediately has extreme labors, and an extremely slender diet must be used. But where it is not so, it happens that one can apply a fuller diet; as much food should be allowed as the disease is milder than the extreme.