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

Com. 70.

and precise concoction the process by which the body matures or "cooks" the morbid matter, as he writes. The question therefore is whether the height of the symptoms and the height of the concoction occur simultaneously in diseases. For to know this is of the greatest importance for the recognition of the state the acme or peak of the disease and for the entire plan of treatment, which is established by an inspection of the future state. Therefore, some physicians say that both the symptoms and the concoction coincide; others deny it. That they do coincide is the authority of Galen, who, when he asserts in 1. aph. 1st Aphorism that the state of a disease exists when the symptoms are at their height, describes the state of the same disease by the mark of its concoction. Hence, the same author, when Hippocrates prescribes a very thin diet while the disease is consistent in 1. aph., says that this must be done for a twofold reason: because the symptoms are at their height, and because nature is primarily engaged in the concoction. Indeed, he seems to confirm this same opinion in many places, and in the book On the Total Time of Disease original: "de tot. morbi temp." and elsewhere. But since, on the other hand, the same Galen writes in 3. de rat. uict. in ac. 3rd book on the regimen of acute diseases that the vigor of the disease sometimes occurs with the concoction itself, and at other times seems to testify that it does not occur. And, when in the same place he says that the affection from which the sick suffer is often milder, but the symptoms are increased, he teaches that the height of the disease, the height of the concoction, and the height of the symptoms are not always joined in vigor. This seems to be confirmed by both experience and the authority of Hippocrates. By experience, for in pleurisy, when the disease is still raw, the pain of the side, the difficulty of breathing, the cough, and the fevers afflict the patient most severely, and all these things are much weaker when the sputum is rendered white, smooth, and uniform. By authority, for while pus is being made, the pains and fevers become greater than when the pus is already finished; now, the finished pus is already the concoction, but it is finished before the state. Truly, this is a most difficult question, and one in which almost all the learned have labored to solve. Nevertheless, we will also venture to write what we think. That the height of both concoction and symptoms does not always coincide is clearly shown by the example of pleurisy, which is why there is room for controversy. On the other hand, it is possible to see in fevers that the height of both the concoction and the accidents symptoms often occur together. Therefore, the matter seems to us to be as follows: if we are dealing with particular diseases, it is not necessary that the vigor of both the concoction and the disease be simultaneous. But in fevers, which are diseases of the whole body, we see these things perpetually concur, unless perhaps the fever follows an inflammation of some part. In this way, it seems to us not difficult to settle the arguments raised on both sides. However, we will willingly await the opinion of others on this matter.

a B. its matter was thick and cold.

b † B. And sometimes from the form or figure, for if it becomes thinned or quickly turns, and the face and hypochondria waste away, then the sickness will be acute.

The knowledge of the universal hours of sickness is sometimes from the species of sickness: for dry spasm, epilepsy, apoplexy, and quinsy are of the very acute ones; and pure tertian, and causon a burning fever, are of the not very acute ones; and quartan, and paralysis are of the long-lasting ones original: "macronoxijs", and sometimes from the motion of the sickness: for if the paroxysms are short, they signify that the state is near: as in a pure tertian; for the time of its paroxysms is from three hours up to fourteen hours; and if they are long, they signify that the matter is thick and the state is far off: as in an impure tertian. And if there were no paroxysms there, but rather its matter was acute, as in synochi continuous fever: then the sickness will be acute. And if [it had the signs of thick cold matter] or inclined toward thickness, then the sickness will not be acute. b † [ ] And if it remained

with its disposition, then the sickness will not be of that acuteness, and sometimes it is from the strength of the sick person, to whom weakness comes quickly, wherefore it is an acute sickness, or that does not appear, and it is a non-acute sickness. And sometimes it is from age and season, for in warm weather and warm age, the state of sicknesses hastens, and in cold seasons and cold ages, the state of sicknesses is delayed, and the disposition of regions is similar. And from the pulse, for if it is quick, frequent, and large, then the sickness is inclined toward acuteness, and if not, then it is not acute. And from the rigor shivering or chill, for if it is of long duration, then the sickness is inclined toward length, and if it is of short duration, then the sickness tends toward acuteness. And when there is no rigor at all, then c [its extension is shortened.] And the hours of sickness are sometimes known from the part of the paroxysm hours, for if they are proceeding according to an excessive anticipation d [so that one anticipates the superfluity of the other, tending] toward addition, then the sickness will be in the increase, because there are sicknesses that run to the end of their hours according to e [increase,] and they are sometimes of the genus of tertian, and of the genus of f [quotidian.] But if the g [anticipation] has stood and the superfluities have stood, then without doubt the sickness will be in the state. And one that maintains one hour is of long duration, and if they are postponed, then the sickness is in the decline, and similarly the disposition of the hours is known from the increase of fever accidents, and their station, and their decline, and from the addition of its paroxysms in length, and their shortening, and perhaps they are diversified and not assimilated, and sometimes they are known from the disposition of the evacuations, for when sweat or diarrhea occurs in some paroxysm, and the second paroxysm, which is after it, is in the likeness of the vehemence of the first, and its strength, or above it, then its evacuation is because of the multitude, not because of strength, and the sickness is judged long. And sometimes they are known from the part of digestion, and the opposite of digestion, according to what we have said, for example when sputum appears with some digestion, or urine, in which there is some cloud, then it is the beginning of the increase, then sometimes that is multiplied and appears, or the opposite of it, then it is the state, and again when digestion appears, or the opposite of it quickly from the sputum, or cloud, then know that the state is near, and if it is delayed, then know that the state is far off. But the knowledge of the particular hours is thus taken, for the hour of the beginning of the paroxysm is the hour in which the pulse is constricted, and you have already known its intention, and the color of the extremities is leaden, and the extremities are cooled, and properly the extremity of the ear, and the nose, up to the hour in which the spreading of heat is felt, and sometimes alteration of color is associated with the beginning, and sluggishness, and anxiety, and slowness of movements, and depth of sleep, and softening of the eyelids, and heaviness of speech, and gooseflesh original: "horripilatio" between the shoulder blades, and in the back, and perhaps a strong rigor happens in it, and sometimes it happens again with salivation and jumping of the temples, and ringing of the ears, and sneezing, and h [tension] of the limbs of the body.

c B. it is of its shorter genus.

d B. tending toward that which the superfluity preceded.
e B. addition.
f B. quotidian.
g B. after the anticipation.
h B. tension.