Edited by Dr. Shahid Athar
Historical Notes
The JIMA believes not only in the revivalism and fine establishment of the tenets of the Islamic faith within the individual and within Muslim society but also in restoration, review, research and compilation of the knowledge of the brilliant past of Islamic Medicine. We have proposed to several Islamic countries to open a department of Islamic Medicine in their medical schools as well as to establish an Institute of Islamic Medicine for gathering extent works of great Hakims of the past, to translate them, to do clinical and laboratory research on their empirical findings and their vast Pharmacopoeia.To this end, we have obtained permission first to publish in parts the translation by Martin Levey of Adab al-Tabib of Al-Ruhawi's "Practical ethics of the physicians" which was printed by the American Philosophical Society as the Transactions of APS, vol. 57, part 3, 1967, Philadelphia.
Who was Ruhawi?
Ishaq Ibn Ali Al-Ruhawi must have written his deontological treatise, Adab al-Tabib in the 9th century. After al-Rubawi, to complete the picture, one should mention two of the greatest physician-philosophers of the Islamic World, al-Farabi (d. 950 A.D.) AND IBN SINA (B. 980 A.D.). Al- Ruhawi was probably from Ruha, a city of northwest Iraq. Earlier, it had been called Edessa, a well known center of Nestorian learning at one time. He was a Christian who embraced Islam and had written two works on Galen.Al-Ruhawi's Adab al-Tabib is found as a unique copy in the Suleymaniye Kitabhane #1658. It comprises 112 folios, seventeen lines per page and is written in a good Nashki hand. The dedication is to the Sultan Bayezid.
In previous publications the first chapter and part of chapter 11 of Ruhawi's Adab Al-Tabib were presented. JIMA will continue to publish pertinent sections and chapters of this great work of the second IsIamic Century . (9th century A.D.).
Statement on Edible Matter
(Ruhawi's Adab al-Tabib translated by Martin Levey)
Since what we have mentioned in regard to the five senses is useful for systematic improvement, a word is in order on the natural matters as an example and for guidance,. We mentioned the natural matters of air, exercise, and rest. It is necessary to follow up with a statement on edible matter, by the way, with brevity and with mention of useful factors which will encourage and urge one to study science in its occurrences and its books.
I say that edible matter may be called food as a synonym since food is sometimes made of it. Real foods are substances which are distinguished from edible matter by the first, second, and third cooking, and their superfluities, which are not eaten, are thrown away. Those substances remain which are suited to become a part of the one who eats [them], and takes the place of what was lost by him since they make a quantitative excess. In this way, he is not dissolved away and does not perish.
The situation is such that you will find that edible things have different tastes and qualities, and accordingly affect the body in various ways. Thus, it is necessary to know their composition and functions. I mean also that one should also understand the body and its natural complexion; together with this it is indispensable for you to know the natural or acquired complexion of its stomach.
Our excellent teacher Galen encourages and leads us to this in his book On Nutrition. He said, "It is necessary that one be careful to know these matters. You find that foods sometimes are slow to swell up and sometimes quick. This depends on the reaction of the stomach at the beginning or by the substances in that which was eaten and drunk. Because some of them are moist, some dry, some viscous, some quickly separating and falling apart, some pungent and acrid, some sour or bitter or sweet or salty, and sometimes these properties are found in drugs, therefore properties of foods are considered as easy remedies."' It is essential that the physician take Galen completely at his word to the full extent of this science for the preservation of life is of great importance.
Galen said that the science of the properties of foods is close to being one of the most useful of medical sciences. While there is not always need to employ the other [sciences] for bodily health, the need for food is always present, both in times of health and illness, for life does not go on without it.
It is not necessary, 0 physician, that you imitate any writer in regard to the properties of foods, their states, and their functions in the body. Some have written volumes on the basis of experience but this experience is insufficient when applied to an actual case. You may, however, find some similar factors which are common but it is not sound to judge by these merely. An example of this is that you find several things which cause diuresis or facilitate an abundant flow, and so on. You find that some are cold and some hot. In teaching this, Galen quoted the scholar and physician before him called Theophilus. It is this, Galen said that Theophilus stated that men are not wise who believe that a single property like taste or heat or smell when found in two things will make them all alike. Aside from this common factor, there may be many different properties. One must not, therefore, treat all substances which empty the belly, or cause diuresis, or have any other common property, as being alike in all their properties. This is so because that (substance] may be hot or cold or salty and not every sweet or salty thing has the same strength in taste. But one may consider that the resultant action of a substance comes from its total make-up. Whoever grasps this principle will make no mistake and will not lose the truth.
It is not convenient for you to hold back anything of a food or drug because of its effect on one sense, and so believing that it possesses only this effect. Sometimes you find that what seems very apparent is one thing but its actual effect is another. Examples are the lentil and cabbage which act oppositely [to their effect on the sense of smell]. They empty some bellies and fill others; they do this since in their creation they are made up of two different substances having two different properties in composition and complexion.
Galen said, "As to the reason why the lentil' empties and softens the belly of some people, and does not restrict and block it, I add that I explained this in the book On Simple Drugs. It is that many kinds [of drugs] which are considered to be simple and single are compounded, at the beginning of their creation, of different substances with opposite properties instead of what we compound with our skill. In them, there are different activities. You find these in many foods like the lentil, cabbage, and all sea animals which have a skin with a sharp taste; each one of them is composed [of substances] with opposite properties. Thus, their body is hard and slow to swell, the belly is under control and may be emptied. The explanation for this is what when they are cooked, their soup empties the belly but its hard body keeps the belly under control. People, however, disagree about this.
When considering foods, the conditions in the stomach [should be recognized]. You may find that a flame heat dominates it. This may be so because of the complexion brought about in creation or yellow bile which pours into it because it has been deviated from its source on its way to the intestines. In this case the stomach digests some foods which are thick like beef, etc., and the thin ones like the meat of chicken and partridge spoil in it. It is not necessary to examine and experiment with the foods to prohibit some since some are quickly land some are slowly digested, according to the conditions in the stomach. Since this stomach condition is far from normal, it is not correct to make a judgment on the foods in it.
It is necessary to examine once more the question of foods. Some edibles which are in abundance resemble body matter. These are wheat, barley, rice, and similar grains; also there are palatable foods as animal meats which may be quickly cooked and digested. All of these and what is similar to them feed man when they are well prepared; they are good nutritionally.
As to the edibles which do not resemble the body of the eater, when they are together with non-nutritional matter [they] may make one ill if he does not know how to use them. These edibles have excessive sourness, are excessively salty, excessively sweet, and an excessively styptic acridity may predominate. These are more like drugs. Between the extremes of these edibles and their opposites, there are many which, when well prepared, will nourish the eater and not injure him.
There are also those which, because of moderation in taste, are often employed to improve bodies. It improves the health of old people, especially those whose complexion is cold, in whom phlegm predominates, in periods of cold and in cold countries. Understand this, and compare with it the rest of the edibles which have obvious and different tastes. When you recognize good food, then beware of an excess or deficiency but favor moderation. This is better.
Hippocrates had a saying that every excess is an enemy of nature, and a deficiency is lacking in trustworthiness. When one exceeds the natural amount, Hippocrates stated that there is no bearing or appetite or any other favourable thing. Hippocrates also said that when excessive food is ingested, it is superfluous and causes illness with its coldness.' He stated that it is important that one predetermine the amount of food for the body with regard to the state of the season in which one is. There are two seasons, summer and autumn, when the body cannot endure excessive food. In regard to the seasons of winter and spring, it may take much food. Hippocrates pointed this out in a statement when he declared that the most difficult period for the body to take care of food is in summer and autumn; the easiest time is in winter and spring. Galen explained and commented upon this by saying that bodies begin to be cold in the autumn, to come together to be thick, and then in winter to loosen and to be light. Galen said also that in winter and spring, the belly is hottest and sleep is longer, Because of these two reasons, more food is necessary since more natural bodily heat is required then. Thus, more food is essential. Evidence of this comes from the aged.
It is also indispensable to know the time of the meal and the small snacks. I mean that it is necessary to eat during the day and night, and [it is necessary] to know the time between meals. The eater must know this and also the speed of his digestion, and also how long it takes his stomach to be emptied of the last meal and of spoiled mixtures and excesses. Hippocrates summed this up when he stated in On Epidemics, in the sixth discourse, when he arranged for the food after exercise and before sleep. He said, "Weariness, food, sleep, and coition must be aU organized by a natural arrangement." He meant that one must predetermine intentionally the quantity of exertion of each one by the eater. Hippocrates said that the body which is not clean, whenever it ingests food, makes its advances in evil
In some edibles like vegetables, there is very little nutriment; in some there is much as in animal meats and hard grains. Some are in between these like the meat of lamb, chicken, partridge, the yolk of eggs, etc. For this reason, it is necessary to know the science of this to use what is valuable according to the need. [Another reason] is that the spoilation of some edibles is rapid since they change so quickly; some are slow to spoil since they are resistant.
Thus, it is incumbent upon the physician to know the arrangements of food according to this and according to the condition of the stomach. It is often convenient to present the quickly changing foods first before those which ripen slowly in order to facilitate the penetration of a hard one so that it not be spoiled were it to precede the quick one. To eat melon, apricot, and others first before bread and other edibles is better. For this reason, one must be careful what he cats after the meal so as not to spoil the food, mixtures, and the stomach. Do not neglect, in view of what i have presented, to take account of age, heat, the countries, habits, occupations, and conditions since the science of an these is necessarily indispensable for everyone who wishes to nourish his body properly. Carry on by these and compare them.
Statement on Beverages
As to the water which is contrary to that here mentioned, its matter has mixed with other matter possessing other attributes like sulphur and borax waters, etc. Waters like these have different tastes and properties. Owing to the fact that they vary in taste, smell and weight, for this reason, they affect the body in different ways. The physician must know the properties of waters and their differences. Otherwise, if the question of water is neglected, great harm will come to the body; this is because it is essential for life and its need is continuous.
So far as internal harm to the body is concerned, then, there are the matter [of water], the matter of the air, the factor of the seasons when they change, and the effect of the winds generally in [some] countries. Therefore, Hippocrates said that he, who wants to study medicine the straightforward way, must do this that I describe. It is, first, that you must consider the times of the year and what can be done since they are not alike. They are very different not only in themselves but compared also to others. Then, attention must be paid to the hot and cold winds, especially those common to all people and those peculiar to each country. It is also necessary to consider the properties of waters since they may not only differ in taste and weight but also be different in [other] properties.
When we reflect on the results of Hippocrates' advice, we understand that water is important, when suitable, for the preservation of health; it is harmful if not suitable. No one can be more discriminating in acquiring this [knowledge] than were the ancients. The most efficient in this was Hippocrates so listen to his teaching and hold on to it in order to attain your wish in the art of medicine.
Hippocrates said, "I want to inform you of the other waters and which of them are more effective in bringing good health. I shall describe what it is necessary to derive from evil and salty waters since the kind of waters is very important in aiding health.
There are waters which are stagnant, tainted and are at the bottom. These are warm, odorous, and thick in summer for they do not flow. They are used since rainwater does reach them. They tend toward a dirty colour and are bitter. In winter, they are covered with ice, and are turbid with the water coming from snow and hail. These waters are the most apt to cause phlegm, hoarseness, and a large, hard spleen in the one who always drinks them.
He said that these waters are bad for all things. Further, those waters which issue forth from rocky places are harsh like those which come from earth where there are hot waters, or where copper, silver, gold, sulphur, alum, or borax are produced. It is because these are produced form a hot shaft and it is impossible that good waters come from this earth. They are harsh, cause difficulty in urination, and prevent excretion.
He said that the best waters flow from lofty and high places, from mountains which have soil. These waters, whose sources are deeper, are palatable, pure, have little redness, are hot in winter and cold in summer. Superior waters, he said, are those whose sources are opposite to the rising locations of the sun; those after them (in superiority] have their sources between where the summer sun rises and sets. The third best are the waters [whose source is] between where the winter sun sets and where the summer sun sets. The worst waters arise opposite to the north. The waters are very bad in the times of the southern winds but; better in the times of the northern winds. He said that it is necessary to use these waters knowing this. As to the healthy and strong person, it is not essential that the discriminate among the waters; he drinks what is available. He praised rainwater as the lightest purest, most palatable, and finest of waters. This is because when the sun raises the water, it carries off the thinnest and lightest. Consider the use of the saltpan where the salty part of the water remains because of its thickness and heaviness, becoming saltier. The sun carries off the finer water; since it is light it raises it. It is raised from palatable waters, from sea water, from all bodies, and from the bodies of men continuously [especially] that which is the thinnest and lightest of the moisture.
Thus, when a man walks or sits in the sun and puts on his clothes then that part of his body exposed to the sun does not seem to perspire since the sun always carries away the perspiration by evaporating it. That part of his body which is covered with clothes or anything else perspires because the sun causes the sweat to come out. The covering keeps and preserve it. When this man moves into the shade, all his body is so since the rays of the sun do not fall upon him. For this reason, rainwater may be putrid and have a bad odor since it comes from many different kinds of moisture and is mixed with them. As a result, it is the first of waters to stink.
Then, after Hippocrates demonstrated how rainwater comes about, he said, "This water may be the best of waters but it needs to be cleansed by boiling." Then he said, "If this is not done, then it develops a bad odour and it causes the drinker to be hoarse, to cough, and to have trouble with the voice." Then said Hippocrates, "As to the water from snow and ice, it is all bad since when water is once frozen, it will not get back to its original properties but that which is pure, light, and palatable is expressed. The sediment and what is close to being a solid remains."
I have mentioned these quotations from Hippocrates to show the pressing need of water and to encourage you to study this science in the books of Hippocrates and Galen.
I shall now return to the value of taking hot water baths. The value of this bathing is different for the sick and for those who are well. For healthy people, it is good to bathe in potable, cold water, or for some in water with salt or borax, and for some with other tastes, hot and non-hot water. These waters may be good for some sick people but not for all, for people of certain ages but not for all, in some but not all countries, and depending on certain habits.
In this, there may be much error; it is necessary to be aware of it and to study it. Strive to know the good from the bad waters by the method described by Hippocrates. These methods are these. Make your decision according to the lightness of the water. its ability to become quickly cold or hot. Hippocrates said about this, "The water which warms quickly and becomes cold quickly is the lightest of waters." In the fifth section of his book, he said, "The lightness of its weight is so in comparison with any other, and is seen in the rapidity of its drying with what was kneaded with it, and in the quickness of cooking what is cooked [in it]."
Statement on Sleeping and Being Awake
The physician takes care of the matter of sleeping and waking and knows the function of each in healthy and sick bodies. Thus, he should be able, according to bodies of animals, to predetermine the state of a sufficient and suitable amount [of sleep] for the preservation of health and treatment of the ill. This is because sleep is a natural thing without which man cannot retain his health; there must be a definite time for it in the natural order.The excellent Hippocrates explains it in the sixth discourse of the book On Epidemics. He said, "Weariness, eating, sleeping, and coition all must be done plainfully. " Galen interpreted "plainfully" as meaning the limitation of their quantities for every man, as [the amount of] sleep is found naturally for different ages of man. We say that it is the kindness of the exalted God who created sleep and rest for the animal's body in order to return to it a replacement for that which was lost from it during waking. This is because during waking the natural heat expands to the outside of the body and to other regions, and spreads with it the blood which helped it form. It is spread in the body so that the animal moves by the power of [this] heat to its activities and to obtain food for survival.
Whenever it moves, moisture is lost little by little to cause dryness. If it keeps on moving and the waking is not interrupted, then the dryness becomes excessive to its body so that it will die. For this reason, the exalted God made the times of sleeping between the times of waking. This is so that the heat is gathered during sleep inside the body and cold is outside; the organism of the animal relax, its senses abate, its actions stop, and heat begins in the digestion of food, in improvement of fluids to aid the organs. The latter exert an attractive power and are moistened in this way. This is the opposite of losing [moisture]. With sleep, also strengthening are the retentive faculty, the altering power, and the evacuating strength. Due to the soundness of these four powers and the efficiency of their activities, the body is healthy and its functions are proper. in addition to strengthening nature, sleep weakens the physical powers; the senses and faculty of reason are weak during it due to their abdication of these functions.
If this is so, then the physician must know the amount of sleep and work for each man for everyone has a natural quantity which he requires according to his complexion, his habits, his activities, his food, his age, season, and the state of the air. If one of them [i.e. sleeping and wakefulness] is not in its properly natural quantitative state and time, then it indicates divergence from bodily health. For this reason, Hippocrates said, "If sleep and sleeplessness are excessive, then the necessary amount is a bad sing." When the physician sees this, then he knows that this immoderate condition indicates disease in the brain. This is because sleep is a special state of the brain and occurs when it is cold and moderately moise. If these are excessive then they cause cold brain disease. For this reason, Galen said that sleeplessness comes from coldness of the most important sentient, the brain. When this coldness is strong and mixed with moisture, then the disease called lasir'as" occurs which is cold vertigo. When dryness is also with it, the disease is called catalepsy which is called jumud. Sleeplessness is also because of the heat of the most important sentient but this heat may be either from a particular, bad complexion or from black bile.
Hippocrates said that when sleep causes pain in any disease, it is a sign of death. When sleep is useful, it is not a sign of death. Hippocrates said also that when sleep quiets the confusion of the mind, it is a good sign. Make your decision on sleep and wakefulness according to what we have considered of their conditions and according to what the ancients said about them.
Know that when sleep follows constipation of what should be evacuated or when waking follows evacuation of what was confined, then both are dependent on the difference in the states of the mixtures in the body. When one sleeps and he has unripe food and nutriment which is unabsorbed, it ripens it, improves absorption, heats, and moistens. If it finds the body clean and nutriment is needed, it strengthens the heat and drives moisture off. For this reason, it substitutes for the small amount of substance, the coldness of the body. When [one sleeps] and [has eaten] moderate food, the normal heat is strengthened and is very useful. When during sleep there is much material, it is difficult to ripen it; then sleep is harmful. This is also so in the be-inning of abscesses in intermittent-nittent fevers. For this reason, physicians order no sleep at the beginning of an abscess.
Make use of sleep and waking according to these laws. Some ancients said that in sleep there is a similarity to death. This is because perception by the senses and discrimination by them stop; it is not possible to notice anything perceptible with them. For this reason, it is necessary for students of science and for those who seek the virtues that they not show zeal for sleep but zeal for seeking the realities of science and the virtues during their lives. Otherwise, their waking is sleeping and their life is death.
Statement on Psychic Events
It is necessary fox the physician also to know what psychic events are, how many there are, and from where each kind stems. If he does not know these, then he cannot preserve them in their natural condition and drive away the non-natural. It is said that you should know that man has a power by which he distinguishes and thinks, a power by which he is angry and enraged, and thirdly, a power by which he desires and lusts for pleasures. Man completes his actions and work by these three powers. The ancients called them the deteriorating powers; they recognized that characters and physical events are different for each of these three kinds of power of the soul.
Also he must know what the ancients mean with their word "event". Galen explained it; I shall relate what he said. Galen wrote that as long as the soul of man remains in its state, this is its state - as rest and quiet. If its state changes, then we can imagine that change as a movement which belongs to it. Some movement is very translational and some is otherwise. We call the movement which is very translational an action, and the movement which is [done] by something other than itself an event. An example of this is that if a man takes a thing and conveys it from its place to another place, then the movement of the hand is an action of that man and his hand, but the movement of the thing is an event of the thing. This is the relation of the action and event for movement in space.
As to the movement in change, as when the body of a man is heated by a fire or the warmth of the sun, this heat is an event to the body, and the heat [of the fire or sun] is the action of the things which heat. When the exalted God created the matter of man's body from these powers and their actions in whatever amount, it was then necessary that these quantities be natural for that particular man. If any of it is lacking or is excessive, then it is not natural. The natural one indicates possession of a healthy power for a certain body; the unnatural indicates disease [of the power and body].
Because both of the animal souls [the second and third of the three powers] which are in man, especially the carnal one of the two, often harms the rational soul to attain pleasure in a persistent fashion, it is essential that the pleasure be of limited duration and of a moderate amount. When it exceeds this amount, it is harmful and causes illness. For this reason, the intelligent soul will stop this corruption by determining and limiting their periods to act and their amounts. The situation being so, he must know the action of each one of these souls, first separately without being, affected by the other two, and then how it acts with their help. The action of the rational soul is [to determine] the existence of the correlation of things and their difference. An example of this is that when you hear two statements you notice their difference from another, you know the real one and the untrue one. As to its action with the help of another, it is that when the physical desires, it may some movements which are strengthened by the soul of anger. This is the [soul of the] animal since this soul has strength and courage. If these were not, it would be impossible to make a stand and attain any aim. Galen said that the essence of this soul, by which is meant the soul of anger, is the natural beat. Galen said, "The essence of this power by which man is strengthened in endurance and patience in work, in my opinion, is the natural heat since whenever the movement of the natural heat is stronger, the man is more hot; also coldness causes laziness and quietness, and thus heat causes willingness, movement, and power for action. Thus, youth and wine arouse movement and courage in man, and age and cold remedies cause laziness and weakness. The latter corrupt action and movement."
Moderation of the rational soul indicates that it is sagacious, has much understanding and a good memory, and has a longing for beautiful deeds.
When it is not in moderation, the opposite is true.
Galen said, "It is true that if the rational soul is silly, of little understanding and memory, and not desirous of meritorious actions, and both the animal souls are strong but not very obedient, then it [i.e. the rational soul] is not moderate. The rational soul needs to be prepared for perspicacity and for what is correct, and to be expert in attuning, to things and their differences. If the power of the soul of an-er, an animal one, is of easy obedience, the carnal soul, a vegetable one, is weak. It is because the latter is not dependent on the rational soul." Plato described it and likened it to the predatory beast, saying, "Whoever needs to be straightened up has a weak vegetable soul for this should not hinder the rational soul from its actions. Since the powers of these souls from its actions. Since the powers of these souls are dependent on the complexity of the body, whatever happens to their actions and characters in the events which change them and remove them from moderation and a satisfactory state, occurs only because of bodily change. This may be seen in what happens to one who is anxious, excited, or steals, drinks wine and other drinks." He, whose complexion is changed by any of these causes, the examples alone, changes in his character as a result and in the states of his souls which were previously healthy - when his soul was quiet without movement and without that event. Therefore, the physician must be trained to recognize the types of these complexions so as to know in certain people's complexions, if they wish preservation, what is good in one's character and the powers of his souls, and also the rectification of that which is out of line. It is also necessary to investigate further what has happened to the souls if it may be determined for the bodies. In some people who are sensitive to shame there may be a natural inclination which is not the state of the soul nor the complexion. One exception to the word "naturally" is that nature may be somewhat changed by education.
If you wish to examine what is in the [irrational] nature of man and the events of the souls and their characters, examine those who are the uneducated - the unimproved with virtues and sciences - as, for example, children. You will find these events and characters separately especially in those who do not have good habits and have no one to educate them. These do only what is in their nature.
Galen has described some of these characters in children. We must relate it in his words. The observation was made by one of intelligence and a good mind. Galen said, "There are children who do not lie at all and children who do not speak the truth at all. Some feel ashamed and others do not. Some are timid and some bold; some are voracious and some are not. Some are generous and help one another and some are avaricious and do not help one another. Some of them like cruelty and anger, some like justice. Some have mercy on any sympathy for children who are beaten and some advise to beat them and laugh about it. They differ from one another; the differences are in their characters.
"If this is so, then the physician must know the [irrational] natural character and the difference between it and the educated character so as to examine the condition of the souls and the events [associated with them]; the character is improved with good education and good habits do not cause him to err."
"Just as association with good and virtuous ones causes the soul to acquire the virtues and goodness of the [good] souls, so associating with evil ones and those with bad habits spoils the character of many people. They lose their good temperament for the other [evil one]. For this reason, the physician must first take care of the soul by improving the soul of the patient and the events [associated with it]. He must care for the soul more than anything else since the completion of man is in his soul; completion is dearer than that which is completed."
From these conclusions mentioned, one must know that purpose of the book, to encourage it, and to read what Galen and others have stated. Galen explained it in his book On Natural Powers and in his book On the Opinions of hippocrates. Plato described [it] in his book On the Characteristics of the Soul and in his writing where he explained that the powers of the soul are dependent -on the complexion of the body, the actions of the soul and its characteristics, and other events relating to it. He also explained that each of the three powers which many ancients called the souls, i.e. that rational, animal, and vegetable souls, has a dwelling and a place special to its actions. The place of the rational soul is the brain; the place of the animal soul is the heart, and the place of the vegetable soul, which is carnal, is the liver. Undoubtedly, upon the health of these organs will depend the health of the souls in action. If they are sick, then [the souls will be] ill. Thus, it is necessary as previously mentioned, that the physician understand the states of these organs if he wants to recognize "physical events." The latter are mentioned as part of the natural matter previously numbered; they are the attributes of the air, motion, quietness, food, drink, discharge [of excesses] and congestion, sleeping, waking, physical events, the countries, occupations, and other matters mentioned earlier.
We mentioned the importance of these natural matters to maintain completely the health of the body and to maintain the health of organs and their parts. We began, by example, teaching the friends of the medical arts to show how the physician uses them for the maintenance of health. Our example for this was the brain since it is the most important of bodily organs. We set down in each chapter, what we mentioned of the statements on these natural matters, the summations and principles which encourage students. We recall for the learned ones what was said regarding, every meaning. We did not finish them all but discussed some of them, For this reason, we returned to the rest, as we did previously, for a statement on treatment of the brain which is the example here for all organs. Then we went on to mention treatment of one organ as distinguished from another by brief descriptions. God is the helper with His generosity.
Statement on Habits
Habit is very important in the preservation of health and in the treatment of the ill. This is because in mankind people are accustomed to things in [certain] measures and times. [Accordingly], their complexions develop to endure them and their bodies are healthy with them. When they [i.e. the habits] stop, then their health is affected, they become ill and their bodies are troubled. Also inhabitants of countries located in different situations are accustomed and grow used to different activities, different foods and drinks, different dwellings, and so on. For them, these are natural and necessary for maintenance of the body rather than being unnatural. Through these habits, the body retains its health. Though some may become accustomed to the morals of others and some consent to the actions of others, there are some people for whom these actions and morals are not praiseworthy and satisfactory. An example of this is that some people are accustomed to the eating of barley bread and to eating curd and cheese. Also you find that some people are accustomed to drinking much pure wine for their complexion is hot, their bodies accept it, and it suits their health. We also observe that some whose complexions are hot cannot drink that amount of wine and drugs. This is so because of habit. Also we find that some people since childhood have been in heavy occupations of a difficult type so that their bodies are weak and thin from going through that toil and weariness continually. You will also find that some who are stouter and stronger than these cannot endure these occupations since they are not accustomed to them. When one who is accustomed to food in a certain amount increases this quantity, then it is harmful. Thus, he who is accustomed to eating once [at a certain time], eats twice, then he is harmed to the point of illness.Hippocrates said much concerning this. I shall give two of them [i.e. his statements]. One concerns the change of habits of people. The second is general, and example of which is the case of different people who are accustomed to certain things which are very natural for them. It is not good to give these up.
As to the statement of Hippocrates in regard to the habits of people, he said, "It is obvious that unwise management in eating and drinking is harmful for the preservation of health. This is easily seen in the change from one kind of regimen to another. The change in one who was accustomed to eating once [a day] to a contrary [system] causes harm and weakness. If one eats at an unaccustomed time, it weakens him immediately, overburdens his body, and makes it lazy and atonic.
"Some may be exposed to the softness of nature. The cause of this is that one's stomach is exposed to the contrary of what is the natural state. This may be because his habit was to have an empty stomach and not be filled twice, and not to digest food twice. It may become accustomed to being filled twice, i.e. in the transition period from one habit of eating to another, if the bowels had been exhausted in the [double) eating period. For this, it is required that one sleep the entire night after the evening meal, if it is winter avoiding the cold, and if it is summer avoiding the heat. If it is not possible for one to sleep then he walks gently a great deal without stopping. After that he does not eat or eats only a little. A little does not harm one; having the same effect is also a drink not mixed with water."
This statement of Hippocrates is sufficient to explain and serve as an example for what we mentioned of the change in the body with the change in habits for anyone. If you wish to listen to all that Hippocrates has related on the subject of habits and also what Galen has said in his commentary on it, then delve into Hippocrates' book and Galen's commentary on it.
As to a general example, Hippocrates said, "I shall give you a demonstration from the best of proofs as to the softness of one's body. This is that you find many Scythians, all of whom are in agriculture, who are heavy in their shoulder blades, in their upper arms, wrists, haunches, and in their chests. This is due only to the softness of their nature. They cannot string a bow or shoot javelins with their shoulders because of their softness and weakness. If they are steamed, the moistness in their joints dries and they become stronger than previously...
"They are not bound in clothes in childhood as is practiced in Egypt. This is not their usual custom since they ride the horse constantly. Those males who cannot ride the horse but sit on the cart rarely hasten in walking because of their heaviness; their females are stronger than they in breadth and thickness."
He also said, "I declare that because they ride the horse, they are affected by an illness called qadmata in Greek . This is because their feet are always suspended on the horse. When the illness is strongly evident, they become lame. They treat themselves in this manner. When their illness begins, they cut open two veins behind the ears bilaterally. When the blood is shed, sleep overpowers them because of weakness. So they complete the treatment; some of them recover and some do not."
I believe that the seminal fluid is corrupted by this treatment since whoever is bled in these two veins behind the ears becomes sterile. Most are bled only in those two veins.
Thus, I have related to you these statements once again and improved the way for you to recognize the changes due to habit in healthy and ill people. If you wish to listen to the words of Hippocrates on habits, and how the inhabitants of [various] countries acquire them depending on the change of air, water, and countries, read what he wrote in his book on countries, water, and air. By means of it, you will be in a position to judge many factors related to habits. I finish [here) what I mentioned to you [hoping to] awaken and encourage [you].
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