The Canon of Medicine (Canon Medicinae), Vol. II

Tex. 5.

the patient is afflicted to the greatest degree: the increase, the decrease, the beginning, the time closer to the first onset. But these times are frequently neither felt, nor if they are felt, do they signify anything that the physician must act upon: therefore, they would be of no help to the art. This happens in the most acute diseases, which, when they come to the state the peak or acme of the disease, must have certainly begun and increased before they reach their vigor. However, the transition through such times is so precipitous that they are neither apparent to the senses, nor can they receive any work from the physician. For this reason, if you say that those people are free from disease during these times, you will not be mistaken. Concerning unhealthy or "unfavorable" times, however, the account is different. The sick sometimes perish at the beginning of the disease, sometimes in the increase, often in the state, so that it is necessary for the following times to be absent. They never perish, however, when the disease is inclining—truly inclining, not falsely—as Auer. 3. Coll. notes. A false inclination is understood as that in which, while the symptoms are diminished and the struggle of nature against the matter seems to be resolved, this happens not through the victory of nature, but of the disease. Nature indeed withdraws from the fight, pulling itself back from the violence of the disease, as happened to Hermocrates, of whom Hippocrates writes in 3. Vulg. Morb. Sect. 1. 3rd book of Epidemics, section 1. There, although he seemed to be freed from the disease by the twentieth day, he nonetheless died on the twenty-seventh. Therefore, we believe it is established up to this point how, through universal times, diseases sometimes proceed with everything present, and sometimes not. But the account does not seem to be different regarding particular ones, for even if the patient dies at a time of rest, that is, at the time of a sharper struggle, at which you might have said the disease has inclined, it was not, however, a true inclination. It was not unlike that which has already been mentioned, and for this reason everything seems to be remitted, because nature, struck down by the violence of the disease, withdraws itself from the struggle. Thus, it must be determined no differently for a particular inclination than for a universal one. Truly, that which they further add about the time of inequality, which they place as the part of the disease between the beginning and the increase as the middle, does not seem to be of much moment. For in our judgment, this inequality is a difference of time, not a time. Sometimes the beginning is unequal, and sometimes the increase is unequal, which we believe is called by Galen, in 1. De diff. feb. On the Differences of Fevers, book 1, a compressed ascent, or a compressed annotation. Likewise, the interval which is between the already finished and the future paroxysm in intermittent diseases is not a time of the disease, nor is it to be called a part of the disease, since at that time the patient is almost in a natural state, in the same state in which convalescents are, whom you would not call sick. But whether, as was said in the last place, there are some diseases which are mutilated in all particular times, this is not ambiguous; indeed, neither Galen nor Avicenna nor others deny it.

Cap. 7.

Cap. 6. 7. 8.

And the beginning, indeed, etc.] Since the beginning of diseases is spoken of in three ways, as Galen notes in De Crisib. On Crises and often elsewhere: concerning the first onset of the disease; concerning the first three days; and concerning that whole time during which the disease is crude. The first two meanings are manifest even to the common people; the third is for physicians alone, for which reason the beginning of the disease is defined by Avicenna through the concoction or crudity of the disease. This is indeed artificial, although I do not deny that various indications for acting are suggested to physicians from other beginnings as well. Indeed, since the number of the critical days is counted from the day of the onset, which sometimes happens at the very first attack, sometimes in the first three days, and sometimes even later, hence the day of the onset is placed by Galen among the beginnings of diseases, not indeed because the onset is the beginning or a part of the disease, but because it is a testimony of a body not faring well, and a sign of an incipient disease. It happens here indiscriminately in the beginning, taken in whatever way. Thus, those must err who think the onset is a fourth mode of beginning, distinct from the other three. But one might doubt, what is the reason that Avicenna defines the beginning through crudity or con-

coction, even though crudity is not a perpetual indicator of a beginning? For it appears, as this author admits, that sometimes there is concoction in the beginning of fevers, even when concoction is not expected in all diseases, such as in ephemeral fevers and bare intemperies imbalances of the primary qualities. Truly, this question is more difficult than one would have believed. Some think that the beginning is described in this place only for material diseases; in this kind of disease, there is certainly no doubt that the indicators of diseases are to be sought from the signs of crudity or concoction. Although Cap. 5. Galen, in his book De tot. morb. temp. On the Total Time of Disease, establishes that this is common to all healthy diseases in general, among which number there are many bare intemperies and immaterial diseases, and that they possess all times and are recognized through signs of concoction and crudity: those who understand the definition handed down in this place only concerning material diseases seem certainly to oppose Galen. Add to this that if this reasoning of the beginning were not common to all diseases, another common definition should have been brought forward by our author. And Avicenna would have to be wrong, who immediately pronounces that this beginning is found in every disease; by Galen, however, this beginning was not to be reckoned among those significations which are common to all diseases. Others have thought that, although the note of crudity and concoction can exist in all diseases, this reasoning of the beginning is understood only by the physician who relies first on the senses, in those diseases in which concoction and crudity can appear, which is something that does not happen in all diseases. But since, as we have said, Galen thinks it is generally appropriate for all dissoluble diseases that they are recognized through the signs of crudity and concoction, and yet among dissoluble diseases there are many in which signs of crudity can neither be looked for nor exist, neither does Galen seem to be saved from calumny by these, nor does this signification of the beginning seem to be common. Therefore, it does not seem to us that we should depart from the first solution: that this reasoning of the beginning is common to diseases, not all, but only material ones; immaterial diseases, however, are distinguished by other marks, such as the occurrences of symptoms. Although Galen makes it common to all dissoluble, that is, as it should be understood, all healthy diseases, to recognize their times by signs of concoction and crudity, he himself teaches that not all healthy diseases are recognized by concoction or crudity. He asserts, however, that this reasoning of the beginning, with other significations of the same word which are common to all diseases, offers no objection. Nor does it make Galen worthy of accusation, who, even if he brought forward this third one with other significations of the beginning, did not say that this is the most common beginning for all diseases. Our author, indeed, even if he defines the beginning which is in fevers, does not understand it as anything other than the beginning of material fevers. Therefore, when he immediately adds that this beginning is found in every disease, it is to be understood concerning material disease. Hence, also in defining, he says that the beginning is the hour set forth at which the innate heat is suffocated by the matter. Nevertheless, one must still doubt regarding Avicenna, who, when defining the beginning of fevers in general, seems to include ephemeral ones as well; in which, however, as we were saying, concoction is not expected. But perhaps more carefully on this matter at another time.

And the state is the hour, etc.] He emulates Galen in 1. De crisibus On Crises, book 1 and Aphor. 30. 1. Aph. Aphorism 1. Yet there is a great quarrel here among the learned. The symptoms are certainly the signs of the struggle between nature and disease, which, while nature and disease wrestle, must follow, and in a greater struggle, greater ones. Whence also in 2. Aphor. Aphorism 2, Hippocrates asserts that all things are weaker in the beginnings, but stronger in the state. And Galen explains this concerning symptoms in Aphor. 30.. Again, our author defines the state here as that at which the trace of concoction is completed, a thing which Galen also mentions everywhere: the beginning by crudity, the increase by obscure concoction, the state by manifest concoction, but not yet perfect; the decline, however, by manifest.