Surgery teaches us to treat or alleviate diseases through manual interventions like cutting and setting fractures. However, effective treatment requires a holistic approach that includes diet and pharmaceuticals. Those who attempt surgery without a foundational understanding of anatomy or medicine may achieve success by chance, but this is misguided and risky, as the potential for causing more harm than good is high. 

A surgeon has five primary responsibilities: removing unnecessary tissue, restoring dislocations, separating joined structures, rejoining separated parts, and creating prosthetics and orthotics. Practical experience is vital for mastering these tasks, often more effective than theoretical learning.

Examples of surgeries:

– Amputation of diseased or corrupted tissue
– Extraction of retained placentas or deceased fetuses
– Surgical excision of tumors, warts, and growths
– Removal of foreign objects, such as bullets and splinters
– Treatment of ingrown eyelashes and toenails
– Tooth extractions and addressing kidney stones
– Uvulectomy and circumcision
– Cataract removal

– Fitting an artificial limb or dental device

– Designing supportive garments for correct posture

A surgeon must maintain a steady hand and resolute mind even amidst screams of his patient’s terror and others questioning or criticizing his methods. Because while surgical procedures can cause severe pain, they are often necessary to prevent lifelong suffering or even death. Common people often don’t understand this vital relationship between pain and healing, which is evident from when the ancient Romans dragged their surgeon, Archagatus, from his home and stoned him to death. Later, his contributions to their community were ultimately recognized and they constructed a golden statue of him and placed it in Aesculapius’s temple, dedicated to his perpetual memory. 

Understanding humors is essential for physicians, as every disease involves a mixture of these substances. Hippocrates believed health depends on the balance of four humors: blood, phlegm, bile, and melancholy. Imbalances can disrupt bodily functions, leading to treatments like bloodletting and purging to restore health.

Natural humors are vital for life and categorized as alimentary (nourishing) or excrementitious (waste). Blood, generated from food in the stomach, is crucial for nourishment. It must be purified of waste humors, such as yellow bile and melancholy, to maintain health. Each humor influences health differently; for example, excess phlegm can cause edema. Blood flows most abundantly from 3 AM to 9 AM, while phlegm dominates at night. 

Sanguine individuals have a robust physique and rosy complexion, reflecting a balance of skin and blood, but may face blood-related ailments. Choleric individuals, with a pale complexion and lean physique, are bold and quick-witted but prone to fevers. Phlegmatic individuals often appear lethargic and suffer from respiratory issues, while melancholic individuals may have a dark demeanor and face various ailments, including tumors and skin conditions.

Temperaments can shift throughout life due to diet and lifestyle. A sanguine person may become choleric through hot, dry foods or strenuous activity. Conversely, thickening foods can lead to a melancholic temperament. Understanding these dynamics is crucial for assessing a person’s disposition and its causes.

Surgeons are guided by principles of nature and ancient wisdom to maintain balance in the human body. The four elements—fire, air, water, and earth—are the simplest components, which exhibit heat, cold, moisture, and dryness. They are impossible to isolate, as illustrated by burning green wood: fire creates flames, smoke embodies air, moisture represents water, and ashes denote earth. Fire and air are light, while water and earth are heavier.

Temperament also comes from temperature, which changes throughout the four stages of life: childhood (hot and moist), youth (temperate), adulthood (hot and dry), and old age (cold and dry). Each stage brings noticeable changes, ultimately leading to an increase in coldness and dryness, often associated with ailments. The four seasons parallel these life stages: spring (hot and moist), summer (hot and dry), autumn (chilly mornings and hot afternoons), and winter (cold and moist). Each season has distinct health implications, with spring being the most wholesome, as it is hot and moist just as youth is, and winter is cold and dry just as old age is.

As for the four humors, blood is temperate; choler is hot and dry, phlegm is cold and moist; and melancholy is cold and dry. Medicines are categorized by their effects on the body, classified as hot, cold, moist, or dry. 

Furthermore, there are four geographic locations that effect human behavior and their health. Southern regions, like Africa and the Middle East, often produce lean physiques and high-pitched voices, while northern populations, such as the Scythians and Germans, typically exhibit fair complexions and robust builds. Central regions blend these traits, exemplified by the Carthaginians, who balanced aggression with intellect. Historically, northern people excel in warfare, while southern people advance knowledge and science. Eastern populations are characterized by strong intellect, while western groups are delicate. Extreme climates can lead to cruelty, with northern aggression stemming from anger and southern violence being more premeditated. 

You must understand these four factors – the humors, elements, temperatures, and geographic locations – and how they interact with each other so you can make the proper diagnosis and treat the body accordingly.

A faculty is what arises from the body’s temperament and is responsible for executing actions. Three main faculties govern human function: the animal, vital, and natural. The animal faculty is linked to the brain and has three types: sensitive (the five senses), moving (muscles and voluntary motion), and principal (reasoning, memory, imagination). The vital faculty is in the heart and regulates life and pulsation. The natural faculty is in the liver and distributes nourishment, including generative, growth, and nourishing sub-faculties. Four supporting faculties—attractive, retentive, digestive, and expulsive—aid in nutrition, ensuring the body processes and utilizes nourishment effectively. Understanding these faculties is key to human physiology and nutrition.

An action is a motion arising from a faculty that performs a task. Work denotes what has been accomplished from the action. For instance, nutrition and flesh formation are natural actions, while nourished body parts are their work. Actions are categorized as natural or voluntary. Natural actions occur automatically, like the heart’s motion. Voluntary actions arise from the sensitive, moving, and principal faculties, requiring the organ, medium, and object. The sensitive soul perceives through five senses. Voluntary motions are executed by muscles and include imagination, reasoning, and memory. These actions rely on spirits to function effectively.

The spirit is an ethereal substance derived from blood, acting as a conduit for bodily functions. There are three types: animal, vital, and natural. The animal spirit is formed in the brain and enables sensation and movement but can lead to conditions like apoplexy when blocked. The vital spirit resides in the heart and nourishes the body and prevents decay. The natural spirit is in the liver, aiding digestion and transporting heat. Each body part has a unique spirit, and their depletion can harm health. Restoration through nourishing foods and movement is essential for maintaining vitality.

Sex, skin color, excretions, organ condition, lifestyle and diet all affect the body’s temperament.

Females tend to be colder, softer, and less vigorous than males. Some women exhibit masculine characteristics, and some men may appear delicate with effeminate qualities. Eunuchs often show feminine traits. Hermaphrodites possess features of both sexes, representing an ambiguous nature. Skin color reflects the dominant humor, as discussed previously. The color of excretions is also telling: healthy wounds have white discharge and bloody or discolored discharge signals weakness.

The condition of organs can be evaluated by their shape, size, placement, and connections. Most external body parts are round to reduce injury risk. Variations in size and the presence of organs are significant for health assessment.

Physically active individuals, like farmers, develop stronger bodies. Those near water may experience cold ailments. Metalworkers, particularly blacksmiths, often face heat-related issues, while sedentary jobs can lead to delicate bodies. A balanced lifestyle with moderate labor, suitable clothing, and sensible eating is vital for maintaining natural temperament, especially for practitioners like surgeons as we explore non-naturally occurring phenomena.

Non-natural elements are essential for health but are not part of the body. Proper use sustains health while misuse leads to illness. There are four types: substances taken, external applications, expelled materials, and activities.

This is further categorized into six elements:

1. Air 
2. Food and Drink 
3. Labor and Rest 
4. Sleep and Wakefulness 
5. Repletion and Inanition 
6. Perturbations of the Mind  

Air is vital for life; we cannot survive without it. Understanding air’s qualities is essential for managing health. Warm air is crucial for treating head wounds in winter, while cold air can worsen conditions. Healthy air is clear, light, and pure, unlike unhealthy air which is foul or stagnant. Winds also affect air quality: east wind is warm and dry, while the west wind is cold and moist. Guido of Caulias observed that healing varies by location. The cold, moist air in Paris slows recovery compared to the dry air in Avignon. Ultimately, air quality significantly impacts health and well-being. 

To maintain health and ward off illness, it’s essential to consume nourishing and easily digestible foods. Examples include good wine, egg yolks, quality milk, well-baked wheat bread, and various meats, such as capons, partridges, veal, mutton, and kid. Foods with harmful qualities often include those that are acrid, bitter, salty, or acidic. However, even the most beneficial foods can be detrimental if consumed in excessive quantities. 

Overeating, regardless of food quality, can lead to illness. Gluttony is a common issue, and while individuals should aim to eat enough to refresh their bodies, they shouldn’t eat so much as to overwhelm them. Avoiding overeating and engaging in regular physical activity are fundamental principles for maintaining health. It’s also crucial to understand which illnesses require light diets and which can handle more substantial nourishment. 

Both healthy individuals and those with ailments must consider the qualities of their food, which can be categorized as heating, cooling, moistening, or drying. Children benefit from hot and moist foods, while older adults may require cooler and drier options. However, older individuals may also need hot and moist foods to counteract the coldness and dryness associated with aging.

To address illnesses, it’s essential to utilize opposing qualities in food. For instance, a moist diet is suitable for those with fevers, as fever represents a dry imbalance. Thus, dietary choices should carefully consider the nature of the illness. The order is also crucial for digestion, with easier-to-digest items preceding harder-to-digest ones. For example, slippery, fatty, and liquid foods should be eaten first, followed by astringent foods, which help tighten and support the stomach. Foods promoting bowel movements should be consumed in the morning, while nourishing foods should be reserved for the evening. Additionally, drinks should follow food, not precede it.

For healthy individuals, meal timing should be consistent, with exercise preceding meals to eliminate waste and prepare the body. However, with sick individuals, meal timing may need to adapt based on their illness progression. Providing food during fever can sometimes feed the disease rather than nourish the patient.

Variety is essential; consuming the same food repeatedly can lead to diminished appetite and difficulty in digestion. A diverse selection of dishes enhances the digestive process, as the stomach responds better to variety.

Lastly, dietary needs vary by age and season. Children require hot, moist, and abundant nourishment for growth, while older adults need less food and should focus on warming and hydrating options. Middle-aged individuals benefit from a balanced diet, while seasonal adjustments are necessary, such as warming foods in winter and cooler, moist foods in summer.

Physicians define “motion” as all forms of exercise, including walking, running, riding, and playing sports. Massage is also considered exercise and encompasses three types: gentle, hard, and neutral.

Hard massage uses vigorous pressure to tighten and firm the flesh but can lead to negative effects if overused, such as thinning of tissues and fluid shifts within the body. Gentle massage, on the other hand, involves light rubbing that relaxes and smooths the skin, and helps prevent wrinkles, though its benefits require sustained application. Neutral massage promotes flesh retention, enhancing the body’s fullness by keeping blood and spirits from dissipating.

Exercise offers many benefits: it boosts heat, digestion, and aids in waste expulsion. It also strengthens respiration and increases overall physical resilience, which is why rural workers can endure labor without fatigue. Exercise should be done before meals to enhance appetite and prevent the absorption of harmful humors from the intestines. Exercising immediately after eating can circulate undigested food into the bloodstream, causing health issues. Exercise should cease when the body feels full, the face reddens, sweating begins, and fatigue sets in, as continuing beyond this point can lead to stiffness and loss of vital fluids.

Moderate exercise that engages all body parts evenly is ideal for those in good health. Individuals with specific health issues should tailor their exercise intensity accordingly; those with cold, dense humors may need more vigorous activity, while those with lighter, hot humors should engage in milder exercises.

Exercise should occur as often as appetite dictates, as it rekindles the inner heat necessary for digestion. The final phase of an exercise routine involves gentle rubbing and drying of the limbs to draw out sweat and impurities, alleviating muscle stiffness. Conversely, a sedentary lifestyle can lead to the accumulation of unhealthy substances, resulting in various health issues.

We will outline the benefits and drawbacks, optimal timing, lying positions, and the significance of dreams and post-sleep feelings.

Sleep is the body’s essential rest, characterized by a cessation of sensory perception and movement. It occurs when the brain is enveloped in soothing humidity, allowing the body to digest food and transform it into blood. Properly timed sleep aids digestion by redirecting the body’s heat and vital spirits, alleviating fatigue and worries. Nighttime is the best period for sleep due to its moisture, silence, and darkness, which promote inward retention of heat and spirits. Daytime sleep can be detrimental, often interrupted by light or noise, leading to incomplete digestion and resulting in symptoms like acidic belching and headaches. Oversleeping can also hinder the body’s elimination processes, potentially leading to disease.

The ideal sleep duration varies by individual, but digestion typically completes within seven to eight hours, indicated by settling stomach and yellow urine. In contrast, symptoms like an extended stomach and headaches suggest incomplete digestion.

Sleeping on the right side initially aids food movement to the stomach’s bottom for effective digestion. During the night, turn to the left side to help with liver function, then return to the right side in the morning to allow digestive vapors to escape. Never sleep on your back, as this creates kidney stones, convulsions, and the palsy. Sleeping on the stomach can also help with digestion, but only for those who do not have eye problems, as the fluid accumulation from this position can harm the eyes.

Dreams offer insights into emotions and bodily humors. Individuals with an abundance of choler may experience vivid, intense, and chaotic dreams characterized by brightness and fire. This reflects their heightened feelings of anger or agitation. Those dominated by phlegm might dream of water-related imagery like floods, snow, or falling. These dreams signify their sluggish and stagnant emotional state and might be indicative of feelings of being overwhelmed or heavy.

Dreams filled with darkness, pits, and despair relate to a melancholic disposition. This imagery reflects deep-seated sadness, anxiety, or depression. People with an abundance of blood are associated with vitality and joy. Their dreams are often pleasant and celebratory, filled with images of social gatherings, romance, and beauty, reflecting their positive emotional state.

Lack of sleep hurts the brain’s temperature, leads to the build-up of unprocessed bodily matter, headaches, loss of body mass, weakness, and ulcers that resist treatment.

Repletion is characterized by an abundance of nutrients and energy, while inanition signifies a lack of sustenance, leading to fatigue and weakness.

Repletion occurs when the body has received sufficient nourishment, resulting in vitality and overall well-being. This state supports bodily functions, enhances mental clarity, and promotes a sense of cheerfulness. Proper repletion is crucial for maintaining energy levels, supporting physical activity, and ensuring effective digestion.

Conversely, inanition arises from inadequate food intake or poor nutrition, leading to exhaustion and diminished health. Symptoms of inanition may include lethargy, weakness, and a sense of heaviness. This state can impair cognitive functions and hinder daily activities, ultimately affecting quality of life.

The perturbations of the mind resemble physical mishaps that arise and fade without harming the mind’s essence. Surgeons should recognize the importance of these emotional disturbances, as they can create significant turmoil in the body and lead to serious health issues. Emotions like joy, hope, and love illustrate this connection, radiating warmth and uplifting the spirit in response to current or anticipated pleasures. When we encounter something we love, the heart swells as if to embrace it, often enhancing our complexion with a rosy hue. This reaction stems from the influence of the beloved object, which stirs the heart. Before emotions manifest, our senses must accurately perceive these stimuli and relay the information to our common sense, which then distributes it to various faculties, prompting desire or aversion. Joy enhances our faculties, aids digestion, and can improve overall health, but excessive joy can be harmful, especially to those who are less robust, such as the elderly. Anger generates heat that can lead to severe health issues, while sorrow constricts the heart, weakening vitality and dimming the complexion. Fear causes a rapid withdrawal of spirits, resulting in paleness and trembling due to an overwhelming rush of heat and blood to the heart.

The face, being thin-skinned, reveals these emotional states, serving as an effective indicator of internal feelings. While some emotions can be beneficial, like joy, others, particularly anger and fear, are rarely advantageous. Therefore, surgeons should exercise caution, avoiding the incitement of such passions in patients unless absolutely necessary.

A disease is an effect that opposes nature, harming and disrupting bodily function. Diseases can be classified into three categories: distemperature, ill conformation, and solution of continuity.

Distemperature occurs when similar body parts conflict, deviating from their natural state. This can be a simple distemperature, caused by an excess of one quality (hot, cold, moist, dry), or a compound distemperature, resulting from two excess qualities. Conditions like inflammation or phlegmon can arise from these imbalances.

Ill conformation involves anatomical defects, categorized by faulty shape, abnormal size, altered number of parts, or improper positioning.

Solution of continuity affects both similar and organ parts, named according to the specific areas involved. Each category highlights different ways in which the body can become diseased.

In this context, ‘symptom’ refers specifically to changes directly caused by a disease, closely following the disease itself. There are three main types of symptoms:

The first type involves damage to bodily functions, such as blindness (complete loss of sight), impaired vision (reduced capability), and early-stage cataracts (distorted sight).

The second type is a significant alteration in the body’s usual condition due to changes in certain qualities, like skin reddening from phlegmon, livid skin from gangrene, foul nasal odor from a polypus, bitter taste from jaundice, and scaly skin in leprosy.

The third type relates to improper retention or expulsion of substances, such as bleeding without excess humors or retaining harmful substances like menstrual blood or bladder stones.

The knowledge and application of indications are vital for surgeons, guiding their practice through reason rather than chance. An indication serves as a reliable guide, directing physicians toward preserving health or curing illness. Galen defines an indication as a clear suggestion of beneficial or harmful actions, unique to the medical profession.

Indications fall into three categories: natural phenomena, “not natural” elements, and those contrary to nature. Natural elements should be preserved, reflecting the patient’s inherent characteristics like strength, age, and habits. “Not natural” factors can align with or conflict against natural elements, such as the air we breathe, which may exacerbate a disease. Conversely, indications contrary to nature require counteractive measures.

Interventions must be tailored to the unique properties of the body part involved. The temperature and moisture levels indicate preservation needs. Treatment should also consider the patient’s age, sex, and seasonal influences, as certain conditions can be harder to treat at specific times of the year.

Two historical examples illustrate the clever use of treatment strategies for psychological conditions. In one case, a man believed he had no head; physicians placed a heavy helmet on him. Because the helmet made his head so heavy, the patient was no longer able to deny the existence of it. In another, a man thought he had horns; doctors resorted to scraping his skull and pretending to remove horns from it, thereby curing the patient of his worries, despite causing great physical harm that was otherwise unnecessary.

Nature produces unusual diseases and extraordinary cures. In Apulia, Italy, the venomous tarantula can incapacitate victims quickly. Without prompt treatment, they may die, fall into a coma, or suffer lifelong insanity. Remarkably, locals employ music therapy as a cure. After a bite, musicians play, prompting the victim to dance energetically. This vigorous movement helps expel the venom through perspiration. Alexander recounts an instance where a dancer collapsed when the music stopped but revived immediately when it resumed, continuing until the venom was purged. Some individuals, even after partial recovery, would leap and dance upon hearing music again, unable to stop until fully healed.

Theophrastus and Aulus Gellius noted that music alleviates pain from gout and sciatica. Sacred scripture also supports this, recounting how David soothed King Saul with his harp when Saul was tormented by an evil spirit. This intersection of music and healing underscores the profound impact of sound on both mental and physical ailments.

Herodotus recounts the story of Croesus, the King of Lydia, whose son was mute for many years. When an enemy approached Croesus with a drawn sword, his son cried out to protect his father. This desperate plea broke his silence, allowing him to speak clearly for the first time. Moved by the young man’s words, the enemy sheathed his sword, sparing King Croesus’s life. From that day forward, the young man retained his ability to speak.

Plutarch tells the story of Prometheus the Thessalian, who suffered from an incurable ulcer until he was wounded in battle. Remarkably, this new injury initiated a healing process, curing both the wound and the ulcer. Similarly, Livy recounts Quintus Fabius Maximus, who endured years of quartan fever without relief from conventional treatments. He finally gave up and went into battle ready to die. The excitement of fighting stirred his body to heal.

A Frenchman in Poland was suffering from a recurring quartan fever. While walking along the bank of the River Wixell to alleviate his discomfort, he was jokingly pushed into the river by a friend. Although both knew he could swim, the shock was so great that he never suffered from the fever again.

Captain S. Arbin, despite suffering from a bout of quartan ague at the time, insisted on joining a battle. He was shot through the side of his neck during the fight, which instilled in him such a fear of death that the fever’s heat was quelled by his cold fear, and he never suffered from the ague again.

John Berlam was a fellow citizen who had been paralyzed on one side of his body for many years. When his house caught fire and flames approached his bed, he was overcome with fear, which enabled him to suddenly rise with all his strength. He jumped out of a window from the top of his house and miraculously recovered full strength and movement, thereafter walking upright without any pain.

John Sobiratius had been lame for a long time due to contracted nerves in his legs that prevented him from walking. One day, driven by intense anger at a servant he was trying to beat, he exerted himself so much that it stretched the nerves in his legs, allowing him to stand and walk upright without pain, a condition that persisted for the rest of his life after being bent for six years.

Galen was treating a man who had severed an artery near his ankle. In saving the man from the threat of an aneurysm, Galen also unwittingly alleviated a severe hip pain that had plagued the patient for four long years. This unexpected relief from sciatica occurred as a result of the bleeding from the opened artery on the same side, a fortunate outcome rather than the intended goal, yet it aligns closely with other tales of serendipitous cures.

A man named Phalereus, who, after suffering from violent coughing fits that caused him to spit blood, found himself at a loss when all remedies failed. Worn down by his affliction, he boldly entered the fray of battle unarmed, where he sustained a wound to his chest. This injury caused him to bleed profusely, ultimately bringing an end to his spitting of blood, as the wound healed and the vein that had been unable to contain the blood became solidified.

In July of 1572 in Paris, a certain gentleman of modest and courteous demeanor fell into a relentless fever that drove him to madness. In a fit of desperation, he leapt headfirst from a two-story window, landing first on the shoulder of Vaterra, the physician to the Duke of Alençon, before hitting the pavement below. This fall resulted in severe bruising of his ribs and hip, yet miraculously restored him to his senses. Among those present during this incident were Valterra and several other physicians. A similar event occurred with another man from Gascony, who experienced a comparable affliction while staying at Agrippa’s house on the cobbled street.

Othomannus, a doctor, recounted to me the case of a carpenter from Broquer, a village in Switzerland. This man, driven to madness, jumped from a high window into a river. Remarkably, after being pulled from the water, he regained his senses almost immediately.

However, if we are to transform such accidents into methods of healing, I would not recommend throwing the patient out of a window. Instead, I would prefer to plunge them abruptly and without warning into a large cistern filled with cold water, headfirst, and I would not retrieve them until they had swallowed a good amount of water. This sudden immersion and the shock of fear might help to drive the source of their madness from the higher faculties down to the lower ones. The plausibility of this approach is evident in the aforementioned examples, as well as in cases where individuals bitten by rabid dogs are often submerged in water to cure their fear of it.

Charlatans posing as surgeons often boast of their skills among the uninformed. They falsely claim to inherit the knowledge of setting broken or dislocated bones, as if it were a birthright. This notion is absurd; when we are born, our minds are blank slates requiring effort and dedication to learn various sciences. It is as unlikely for someone to possess surgical skill simply due to their parentage as it is for someone who has never faced the rigors of battle to know how to ride a horse, simply because they are born to a renowned warrior. 

A more dangerous breed of impostor claims they can realign bones merely by speaking fanciful charms, requiring only a patient’s name and belt. It is astonishing that people believe such folly, ignoring the principles established by ancient physicians like Hippocrates, who outlined the essential steps to set bones properly. Ancient practitioners recognized the need for tools and bindings, acknowledging that hands alone may not suffice for such complex tasks. It is madness for impostors to claim they can achieve what requires skill and instruments through mere words. 

Recently, a new deception emerged in Germany, where individuals grind a stone called Bembruch into powder and administer it as a cure for bone injuries. Others instruct patients to bring in the weapons that caused their injuries, claiming to treat the weapons while the patients go about their business. The idea that an inanimate object could respond to medicine is absurd and dangerous.

During the last assault on the Castle of Hesdin, I witnessed a case involving the elder Lord of Martigues, who was shot in the chest. Despite the consensus among physicians that his wound was fatal, a rogue Spaniard claimed he could heal him. Out of desperation, he was hired. The impostor used the Lord’s shirt to create a cross over the wounds and recited incantations, assuring the patient of his recovery. Tragically, the Lord died within two days, and the impostor vanished to escape execution.

There are others who claim they can heal wounds using only dressings or incantations, and while some achieve success with simple injuries, more complex wounds require professional care. Those who trust these impostors risk their health and the welfare of others. It is the duty of wise magistrates to curb the activities of such frauds.

Witches and magicians boast of their ability to cure ailments, but their methods are rooted in trickery and forbidden practices, undermining the noble art of medicine. Such individuals should be banished by law, as warned by Mosaic Law. 

In contrast, the miracles performed by Jesus Christ and His saints belong to a divine realm. We must believe in these miracles with unwavering faith, as they showcase the power of God to heal beyond nature and human skill. We earnestly beseech God to protect us from unclean spirits and the deceit of the devil, urging us to aspire to heavenly things, anchoring our hopes and safety in Him alone. Amen.