[It is] the common opinion of all [that] the pain is most intense on the third day of the circumcision. For expressly, after the circumcision inflicted on the Shechemites, [it] is thus written (Gen. 34 v. 25): “And behold, on the third day, when the pain of the wounds is greatest,” &c. But, first, perhaps someone might object against our Translator, both because in Hebrew [it] is said without a comparison of greater or lesser pain — “on the third day, when [they were] in pain” — and because in Greek similarly, the same comparison being omitted, ἦσαν ἐν τῷ πόνῳ [ēsan en tō ponō], that is, “they were in labor,” or pain. Then, another might ask, what [is] the cause of a pain of this kind on that day? Why not on the earlier days? Not on the later? But truly the Translator perceived and rendered that place of Genesis excellently. For when in Hebrew [it] is said “on the third day, when [they were] in pain,” [it] is understood, of course, “they are, or were.” But did they not also feel pain on the first day, when the skin was cut with the knife? Did not some pain also sometimes prick them on the second day? How, then, are they said to have been in pain on the third day? Namely, because they were in pain excellently [in a marked degree], or more than on the other earlier days. And this same [thing] is understood in the Greek. Besides, this very [thing] is clearly confirmed from Hippocrates (in the little book On Fracture, commentary 3 according to Galen’s division). For he says: “On the third and fourth day all wounds are least to be disturbed; and, to say [it] in sum, all applications of the probe [specillum] too are to be avoided on these days, and all other [things] by which wounds are irritated: for, on the whole, the third and fourth day brings exacerbations to most wounds — both [those] by which inflammations and foul matter are stirred up, and whatever [wounds] tend toward fevers.” Whence this [is] a proof of very great moment, if any [other is]. For what [things] are gravest in the art of healing, to which this [is] not common? For [it] pertains not only to ulcers, but to many other diseases too. So that the Translator seems to have expressed the force of the text more deeply, from that skill of the physicians, when he said “when the pain — not only of the wound received from circumcision, but universally, of wounds — is greatest.” What the cause of that pain is, the physician of outstanding learning, Franciscus Vallesius, investigates and expounds (in the book On Sacred Philosophy, ch. 12): “Hippocrates teaches clearly enough [that], not in these or those, but in all wounds, the pains are wont to become graver on the third and fourth day. For [Hippocrates], treating of ulcers which happen with fractures, transferred the discourse to all ulcers — nay, even to all diseases — signifying [that] all great and note-worthy ulcers (for tiny ulcers are wont to bring no exacerbations) are wont, on the third and fourth days, to become graver. But the immediate cause of this thing he himself insinuated, saying: ‘both [those] by which [wounds] are stirred to inflammation and foul matter, and whatever tend toward fevers’ — namely, because inflammations, and fluxions [flowings], and fevers are wont, on the third and fourth days, to come upon the wounded parts. For on the first day, on which one is wounded, [there] is wont to be pain only from the very division of the flesh, while [it] is wounded, or the part is handled by the surgeon’s hands; but from the treatment [it] quickly quiets, the cause of pain ceasing. For pain is not made when the part is already cut, but when [it] is being cut. For since pain is the sensation of a corrupting thing, and [since] not the affection already made, but that which is being made, moves the sensation — as soon as the external cause ceases, the part remains without pain, and (except in a few [cases], which happen to be most predisposed) without fever, until some other new cause of pain or of fevering comes on:—
(col. 526 — right column; printed “534”)
—until, namely, [when] a fluxion has been called together to the ill-affected part, an inflammation grows up, or much foul matter, and, on account of these, sometimes even a fever. And so this is the immediate cause of the said outcome. But why the fluxion does not come on before the third [day], or is not drawn out longer (which is the first proposed part of the doubt), we have not yet said; nor indeed did Hippocrates say [it], nor did Galen append [it] in [his] commentary — unless perhaps Hippocrates insinuated it, saying: ‘For [it] pertains not to ulcers only, but to many other diseases too.’ Namely, the same [cause] seems to be in ulcers and in all other diseases depending on matter and having exacerbations (since ulcers are exacerbated not on account of their own proper essence, but on account of fluxions): [and] that [cause] is the nature of the humors, which — [being] stirred and agitated — make and increase diseases. For the circuits [cycles] of diseases happen — whether quotidian, or tertian, or quartan — when [there] are in the body certain parts prepared to receive, [and] certain [parts prepared] to send. The preparation of the receiving [parts] is pain or weakness; of the sending [parts], a multitude of humors, or a vicious quality. The wounded part, therefore, is prepared to receive, for [it] is necessarily weak, nor without pain. Unless, therefore, the remaining body happen to be most emptied and most pure (for thus, perhaps, great pains will never return), nothing is lacking for the influx of the humors; and, [the humors] keeping their [own] natures, on the second day phlegm [pituita] will flow in — a mild juice, moderate, and least irritating; on the third day yellow bile — a sharp juice, biting, and exceedingly hot, with which — on account of the pain it brings and the heat — the blood necessarily runs up, and produces phlegmons [inflammations] and fevers; which, since [they] cannot grow mild within a day, but [only] most mildly within twenty-four hours — as [things] which have [their] origin from external causes — necessarily fall upon the following day, which is the fourth from the received wound.
This, therefore, is the cause by which the pains of wounds are wont to be exacerbated on the third day. And for the same cause the surgeons — as Hippocrates advises — after the first [treatment], whether the drawing-together of the lips [of the wound] or the stitching (as the matter requires), ought not, until the fourth day, to irritate the wounds, nor to touch [them] otherwise than lightly, applying [things] which ward off inflammation.” Yet how certain that cause is, let other physicians see. For, first, what cause is [there] why, after the shedding of blood, on the second day phlegm rather than bile should stir itself, and on the third day bile rather than phlegm or melancholy [black bile]?—
(col. 527 — left column; printed “535”)
—[why bile rather than phlegm or melancholy]? Then, if on three [different] days one received different wounds, [there] would be, in the same man, different motions of those humors. For by reason of the first wound all [things] would happen in the order which Vallesius has already said; by reason of the second, [there] would happen — on the day which is the third day for the first wound — a stirring of phlegm and of a gentler juice, because that is the second day for the second wound. And so, on the third wound, on the 4th day, melancholy [black bile] would be stirred by reason of the first wound; but by reason of the second, yellow bile; by reason of the third, phlegm. Nay, this could happen in the same member — if, for example, the same arm or head received different blows on three different days. Finally, those [things] which are said — even by Hippocrates — about the gravity of the pain, I think are to be taken according to common custom, and for the most part. For the Jewish circumcisers affirm to me for certain [that] the cut member sometimes heals on the second day; and [it] is sufficiently established [that] the scars and wounds of some come together and heal more quickly than [those] of others; and [there] are [those] whose skin, once injured, is scarcely and very slowly cured.