1 1 In the previous book we demonstrated that not only Erasistratus, but also all others who would say anything to the purpose about urinary secretion, must acknowledge that the kidneys possess some faculty which attracts to them this particular quality existing in the urine. Besides this we drew attention to the fact that the urine is not carried through the kidneys into the bladder by one method, the blood into parts of the animal by another, and the yellow bile separated out on yet another principle. For when once there has been demonstrated in any one organ, the drawing, or so‑called epispastic faculty, there is then no difficulty in transferring it to the rest. Certainly Nature did not give a power such as this to the kidneys without giving it also to the vessels which abstract the biliary fluid, nor did she give it to the latter without also it to each of the other parts. And, assuredly, if this is true, we must marvel that Erasistratus should make statements concerning the delivery of nutriment from the food-canal which are p119 so false as to be detected even by Asclepiades. Now, Erasistratus considers it absolutely certain that, if anything flows from the veins, one of two things must happen: either a completely empty space will result, or the contiguous quantum of fluid will run in and take the place of that which has been evacuated. Asclepiades, however, holds that not one of two, but one of three things must be said to result in the emptied vessels: either there will be an entirely empty space, or the contiguous portion will flow in, or the vessel will contract. For whereas, in the case of reeds and tubes it is true to say that, if these be submerged in water, and are emptied of the air which they contain in their lumens, then either a completely empty space will be left, or the contiguous portion will move onwards; in the case of veins this no longer holds, since their coats can collapse and so fall in upon the interior cavity. It may be seen, then, how false this hypothesis — by Zeus, I cannot call it a demonstration! — of Erasistratus is.
And, from another point of view, even if it were true, it is superfluous, if the stomach has the power of compressing the veins, as he himself supposed, and the veins again of contracting upon their contents and propelling them forwards. For, apart from other considerations, no plethora would ever take place in the body, if delivery of nutriment resulted merely from the tendency of a vacuum to become refilled. Now, if the compression of the stomach becomes weaker the further it goes, and cannot reach to an p121 indefinite distance, and if, therefore, there is need of some other mechanism to explain why the blood is conveyed in all directions, then the principle of the refilling of a vacuum may be looked on as a necessary addition; there will not, however, be a plethora in any of the parts coming after the liver, or, if there be, it will be in the region of the heart and lungs; for the heart alone of the parts which come after the liver draws the nutriment into its right ventricle, thereafter sending it through the arterioid vein to the lungs (for Erasistratus himself will have it that, owing to the membranous excrescences, no other parts save the lungs receive nourishment from the heart). If, however, in order to explain how plethora comes about, we suppose the force of compression by the stomach to persist indefinitely, we have no further need of the principle of the refilling of a vacuum, especially if we assume contraction of the veins in addition — as is, again, agreeable to Erasistratus himself.
2 1 Let me draw his attention, then, once again, even if he does not wish it, to the kidneys, and let me state that these confute in the very clearest manner such people as object to the principle of attraction. Nobody has ever said anything plausible, nor, as we previously showed, has anyone been able to discover, p123 by any means, any other cause for the secretion of urine; we necessarily appear mad if we maintain that the urine passes into the kidneys in the form of vapour, and we certainly cut a poor figure when we talk about the tendency of a vacuum to become refilled; this idea is foolish in the case of blood, and impossible, nay, perfectly nonsensical, in the case of the urine.
This, then, is one blunder made by those who dissociate themselves from the principle of attraction. Another is that which they make about the secretion of yellow bile. For in this case, too, it is not a fact that when the blood runs past the mouths [stomata] of the bile-ducts there will be a thorough separation out [secretion] of biliary waste-matter. "Well," say they, "let us suppose that it is not secreted but carried with the blood all over the body." But, you sapient folk, Erasistratus himself supposed that Nature took thought for the animals' future, and was workmanlike in her method; and at the same time he maintained that the biliary fluid was useless in every way for the animals. Now these two things are incompatible. For how could Nature be still looked on as exercising forethought for the animal when she allowed a noxious humour such as this to be carried off and distributed with the blood? . . .
This, however, is a small matter. I shall again point out here the greatest and most obvious error. For if the yellow bile adjusts itself to the narrower vessels and stomata, and the blood to the wider ones, for no other reason than that blood is thicker and bile thinner, and that the stomata of the veins are p125 wider and those of the bile-ducts narrower, then it is clear that this watery and serous superfluity, too, will run out into the bile-ducts quicker than does the bile, exactly in proportion as it is thinner than the bile! How is it, then, that it does not run out? "Because," it may be said, "urine is thicker than bile!" This was what one of our Erasistrateans ventured to say, herein clearly disregarding the evidence of his senses, although he had trusted these in the case of the bile and blood. For, if it be that we are to look on bile as thinner than blood because it runs more, then, since the serous residue passes through fine linen or lint or a sieve more easily even than does bile, by these tokens bile must also be thicker than the watery fluid. For here, again, there is no argument which will demonstrate that bile is thinner than the serous superfluities.
But when a man shamelessly goes on using circumlocutions, and never acknowledges when he has had a fall, he is like the amateur wrestlers, who, when they have been overthrown by the experts and are lying on their backs on the ground, so far from recognizing their fall, actually seize their victorious adversaries by the necks and prevent them from getting away, thus supposing themselves to be the winners!
p127 3 1 Thus, every hypothesis of channels as an explanation of natural functioning is perfect nonsense. For, if there were not an inborn faculty given by Nature to each one of the organs at the very beginning, then animals could not continue to live even for a few days, far less for the number of years which they actually do. For let us suppose they were under no guardianship, lacking in creative ingenuity and forethought; let us suppose they were steered only by material forces, and not by any special faculties (the one attracting what is proper to it, another rejecting what is foreign, and yet another causing alteration and adhesion of the matter destined to nourish it); if we suppose this, I am sure it would be ridiculous for us to discuss natural, or, still more, psychical, activities — or, in fact, life as a whole.
For there is not a single animal which could live or endure for the shortest time if, possessing within itself so many different parts, it did not employ faculties which were attractive of what is appropriate, eliminative of what is foreign, and alterative of what is destined for nutrition. On the other hand, if we have these faculties, we no longer need channels, little or big, resting on an unproven hypothesis, for explaining the secretion of urine and bile, and the conception of some favourable situation (in which point alone Erasistratus shows some common sense, since he does regard all the parts of the body as p129 having been well and truly placed and shaped by Nature).
But let us suppose he remained true to his own statement that Nature is "artistic" — this Nature which, at the beginning, well and truly shaped and disposed all the parts of the animal, and, after carrying out this function (for she left nothing undone), brought it forward to the light of day, endowed with certain faculties necessary for its very existence, and, thereafter, gradually increased it until it reached its due size. If he argued consistently on this principle, I fail to see how he can continue to refer natural functions to the smallness or largeness of canals, or to any other similarly absurd hypothesis. For this Nature which shapes and gradually adds to the parts is most certainly extended throughout their whole substance. Yes indeed, she shapes and nourishes and increases them through and through, not on the outside only. For Praxiteles and Phidias and all the other statuaries used merely to decorate their material on the outside, in so far as they were able to touch it; but its inner parts they left unembellished, unwrought, unaffected by art or forethought, since they were unable to penetrate therein and to reach and handle all portions of the material. It is not so, however, with Nature. Every part of a bone she makes bone, every part of the flesh she makes flesh, and so with fat and all the rest; there is no part which she has not touched, elaborated, and embellished. Phidias, on the other hand, could not turn wax into ivory and gold, nor yet gold into wax: for each of these remains as it was at the commencement, and becomes a perfect statue p131 simply by being clothed externally in a form and artificial shape. But Nature does not preserve the original character of any kind of matter; if she did so, then all parts of the animal would be blood — that blood, namely, which flows to the semen from the impregnated female and which is, so to speak, like the statuary's wax, a single uniform matter, subjected to the artificer. From this blood there arises no part of the animal which is as red and moist [as blood is], for bone, artery, vein, nerve, cartilage, fat, gland, membrane, and marrow are not blood, though they arise from it.
I would then ask Erasistratus himself to inform me what the altering, coagulating, and shaping agent is. He would doubtless say, "Either Nature or the semen," meaning the same thing in both cases, but explaining it by different devices. For that which was previously semen, when it begins to procreate and to shape the animal, becomes, so to say, a special nature. For in the same way that Phidias possessed the faculties of his art even before touching his material, and then activated these in connection with this material (for every faculty remains inoperative in the absence of its proper material), so it is with the semen: its faculties it possessed from the beginning, while its activities it does not receive from its material, but it manifests them in connection therewith.
And, of course, if it were to be overwhelmed with a great quantity of blood, it would perish, while if it were to be entirely deprived of blood p133 it would remain inoperative and would not turn into a nature. Therefore, in order that it may not perish, but may become a nature in place of semen, there must be an afflux to it of a little blood — or, rather, one should not say a little, but a quantity commensurate with that of the semen. What is it then that measures the quantity of this afflux? What prevents more from coming? What ensures against a deficiency? What is this third overseer of animal generation that we are to look for, which will furnish the semen with a due amount of blood? What would Erasistratus have said if he had been alive, and had been asked this question? Obviously, the semen itself. This, in fact, is the artificer analogous with Phidias, whilst the blood corresponds to the statuary's wax.
Now, it is not for the wax to discover for itself how much of it is required; that is the business of Phidias. Accordingly the artificer will draw to itself as much blood as it needs. Here, however, we must pay attention and take care not unwittingly to credit the semen with reason and intelligence; if we were to do this, we would be making neither semen nor a nature, but an actual living animal. And if we retain these two principles — that of proportionate attraction and that of the non-participation of intelligence — we shall ascribe to the semen a faculty for attracting blood similar to that possessed by the lodestone for iron. Here, then, again, in the case of the semen, as in so many previous instances, we have been compelled to acknowledge some kind of attractive faculty.
p135 And what is the semen? Clearly the active principle of the animal, the material principle being the menstrual blood. Next, seeing that the active principle employs this faculty primarily, therefore, in order that any one of the things fashioned by it may come into existence, it [the principle] must necessarily be possessed of its own faculty. How, then, was Erasistratus unaware of it, if the primary function of the semen be to draw to itself a due proportion of blood? Now, this fluid would be in due proportion if it were so thin and vaporous, that, as soon as it was drawn like dew into every part of the semen, it would everywhere cease to display its own particular character; for so the semen will easily dominate and quickly assimilate it — in fact, will use it as food. It will then, I imagine, draw to itself a second and a third quantum, and thus by feeding it acquires for itself considerable bulk and quantity. In fact, the alterative faculty has now been discovered as well, although about this also has not written a word. And, thirdly the shaping faculty will become evident, by virtue of which the semen firstly surrounds itself with a thin membrane like a kind of superficial condensation; this is what was described by Hippocrates in the sixth-day birth, which, according to his statement, fell from the singing-girl and resembled the pellicle of an egg. And following this all the other stages will occur, such as are described by him in his work "On the Child's Nature."
But if each of the parts formed were to remain as small as when it first came into existence, of what use would that be? They have, then, to grow. p137 Now, how will they grow? By becoming extended in all directions and at the same time receiving nourishment. And if you will recall what I previously said about the bladder which the children blew up and rubbed, you will also understand my meaning better as expressed in what I am now about to say.
Imagine the heart to be, at the beginning, so small as to differ in no respect from a millet-seed, or, if you will, a bean; and consider how otherwise it is to become large than by being extended in all directions and acquiring nourishment throughout its whole substance, in the way that, as I showed a short while ago, the semen is nourished. But even this was unknown to Erasistratus — the man who sings the artistic skill of Nature! He imagines that animals grow like webs, ropes, sacks, or baskets, each of which has, woven on to its end or margin, other material similar to that of which it was originally composed.
But this, most sapient sir, is not growth, but genesis! For a bag, sack, garment, house, ship, or the like is said to be still coming into existence [undergoing genesis] so long as the appropriate form for the sake of which it is being constructed by the artificer is still incomplete. Then, when does it grow? Only when the basket, being complete, with a bottom, a mouth, and a belly, as it were, as well as the intermediate parts, now becomes larger in all these respects. "And how can this happen?" someone will ask. Only by our basket suddenly becoming an animal or a plant; for growth belongs to living things alone. Possibly you imagine that a house grows when it is being built, or a basket when being p139 plaited, or a garment when being woven? It is not so, however. Growth belongs to that which has already been completed in respect to its form, whereas the process by which that which is still becoming attains its form is termed not growth but genesis. That which is, grows, while that which is not, becomes.
4 1 This also was unknown to Erasistratus, whom nothing escaped, if his followers speak in any way truly in maintaining that he was familiar with the Peripatetic philosophers. Now, in so far as he acclaims Nature as being an artist in construction, even I recognize the Peripatetic teachings, but in other respects he does not come near them. For if anyone will make himself acquainted with the writings of Aristotle and Theophrastus, these will appear to him to consist of commentaries on the Nature-lore [physiology] of Hippocrates — according to which the principles of heat, cold, dryness and moisture act upon and are acted upon by one another, the hot principle being the most active, and the cold coming next to it in power; all this was stated in the first place by Hippocrates and secondly by Aristotle. Further, it is at once the Hippocratic and the Aristotelian teaching that the parts which receive that nourishment throughout their whole substance, and that, similarly, processes of mingling and alteration involve the entire substance. Moreover, that digestion is a species of p141 alteration — a transmutation of the nutriment into the proper quality of the thing receiving it; that blood-production also is an alteration, and nutrition as well; that growth results from extension in all directions, combined with nutrition; that alteration is effected mainly by the warm principle, and that therefore digestion, nutrition, and the generation of the various humours, as well as the qualities of the surplus substances, result from the innate heat; all these and many other points besides in regard to the aforesaid faculties, the origin of diseases, and the discovery of remedies, were correctly stated first by Hippocrates of all writers whom we know, and were in the second place correctly expounded by Aristotle. Now, if all these views meet with the approval of the Peripatetics, as they undoubtedly do, and if none of them satisfy Erasistratus, what can the Erasistrateans possibly mean by claiming that their leader was associated with these philosophers? The fact is, they revere him as a god, and think that everything he says is true. If this be so, then we must suppose the Peripatetics to have strayed very far from truth, since they approve of none of the ideas of Erasistratus. And, indeed, the disciples of the latter produce his connection with the Peripatetics in order to furnish his Nature-lore with a respectable pedigree.
Now, let us reverse our argument and put it in a different way from that which we have just employed. For if the Peripatetics were correct in their teaching about Nature, there could be nothing more absurd than the contentions of Erasistratus. And, I will leave it to the Erasistrateans themselves to decide; p143 they must either advance the one proposition or the other. According to the former one the Peripatetics had no accurate acquaintance with Nature, and according to the second, Erasistratus. It is my task, then, to point out the opposition between the two doctrines, and theirs to make the choice. . . .
But they certainly will not abandon their reverence for Erasistratus. Very well, then; let them stop talking about the Peripatetic philosophers. For among the numerous physiological teachings regarding the genesis and destruction of animals, their health, their diseases, and the methods of treating these, there will be found one only which is common to Erasistratus and the Peripatetics — namely, the view that Nature does everything for some purpose, and nothing in vain.
But even as regards this doctrine their agreement is only verbal; in practice Erasistratus makes havoc of it a thousand times over. For, according to him, the spleen was made for no purpose, as also the omentum; similarly, too, the arteries which are inserted into kidneys — although these are practically the largest of all those that spring from the great artery [aorta]! And to judge by the Erasistratean argument, there must be countless other useless structures; for, if he knows nothing at all about these structures, he has little more anatomical knowledge than a butcher, while, if he is acquainted with them and yet does not state their use, he clearly imagines that they were made for no purpose, like the spleen. Why, however, should I discuss these structures fully, belonging as they do to the treatise "On the Use of Parts," which I am personally about to complete?
p145 Let us, then, sum up again this same argument, and, having said a few words more in answer to the Erasistrateans, proceed to our next topic. The fact is, these people seem to me to have read none of Aristotle's writings, but to have heard from others how great an authority he was on "Nature," and that those of the Porch follow in the steps of his Nature-lore; apparently they then discovered a single one of the current ideas which is common to Aristotle and Erasistratus, and made up some story of a connection between Erasistratus and these people. That Erasistratus, however, has no share in the Nature-lore of Aristotle is shown by an enumeration of the aforesaid doctrines, which emanated first from Hippocrates, secondly from Aristotle, thirdly from the Stoics (with a single modification, namely, that for them the qualities are bodies). Perhaps, however, they will maintain that it was in the matter of logic that Erasistratus associated himself with the Peripatetic philosophers? Here they show ignorance of the fact that these philosophers never brought forward false or inconclusive arguments, while the Erasistratean books are full of them.
So perhaps somebody may already be asking, in some surprise, what possessed Erasistratus that he turned so completely from the doctrines of Hippocrates, and why it is that he takes away the attractive faculty from the biliary passages in the liver — for we have sufficiently discussed the kidneys — alleging [as the cause of bile-secretion] a favourable situation, the narrowness of vessels, and a p147 common space into which the veins from the gateway [of the liver] conduct the unpurified blood, and from which, in the first place, the [biliary] passages take over the bile, and secondly, the [branches] of the vena cava take over the purified blood. For it would not only have done him no harm to have mentioned the idea of attraction, but he would thereby have been able to get rid of countless other disputed questions.
5 1 At the actual moment, however, the Erasistrateans are engaged in a considerable battle, not only with others but also amongst themselves, and so they cannot explain the passage from the first book of the "General Principles," in which Erasistratus says, "Since there are two kinds of vessels opening at the same place, the one kind extending to the gall-bladder and the other to the vena cava, the result is that, of the nutriment carried up from the alimentary canal, that part which fits both kinds of stomata is received into both kinds of vessels, some being carried into the gall-bladder, and the rest passing over into the vena cava." For it is difficult to say what we are to understand by the words "opening at the same place" which are written at the beginning of this passage. Either they mean there is a junction between the termination of the vein which is on the concave surface of the liver and two other vascular terminations (that of the vessel on the convex surface of the liverJJJ p149 and that of the bile-duct), or, if not, then we must suppose that there is, as it were, a common space for all three vessels, which becomes filled from the lower vein, and empties itself both into the bile-duct and into the branches of the vena cava. Now, there are many difficulties in both of these explanations, but if I were to state them all, I should find myself inadvertently writing an exposition of the teaching of Erasistratus, instead of carrying out my original undertaking. There is, however, one difficulty common to both these explanations, namely, that the whole of the blood does not become purified. For it ought to fall into the bile-duct as into a kind of sieve, instead of going (running, in fact, rapidly) past it, into the larger stoma, by virtue of the impulse of anadosis.
Are these, then, the only inevitable difficulties in which the argument of Erasistratus becomes involved through his disinclination to make any use of the attractive faculty, or is it that the difficulty is greatest here, and also so obvious that even a child could not avoid seeing it?
6 1 And if one looks carefully into the matter one will find that even Erasistratus' reasoning on the subject of nutrition, which he takes up in the second book of his "General Principles," fails to escape this same difficulty. For, having conceded one premise to the principle that matter tends to fill a vacuum, as we previously showed, he was only able to draw a conclusion in the case of the veins and their contained blood. That is to say, when p151 blood is running away through the stomata of the veins, and is being dispersed, then, since an absolutely empty space cannot result, and the veins cannot collapse (for this was what he overlooked), it was therefore shown to be necessary that the adjoining quantum of fluid should flow in and fill the place of the fluid evacuated. It is in this way that we may suppose the veins to be nourished; they get the benefit of the blood which they contain. But how about the nerves? For they do not also contain blood. One might obviously say that they draw their supply from the veins. But Erasistratus will not have it so. What further contrivance, then, does he suppose? He says that a nerve has within itself veins and arteries, like a rope woven by Nature out of three different strands. By means of this hypothesis he imagined that his theory would escape from the idea of attraction. For if the nerve contain within itself a blood-vessel it will no longer need the adventitious flow of other blood from the real vein lying adjacent; this fictitious vessel, perceptible only in theory, will suffice it for nourishment.
But this, again, is succeeded by another similar difficulty. For this small vessel will nourish itself, but it will not be able to nourish this adjacent simple nerve or artery, unless these possess some innate proclivity for attracting nutriment. For how could the nerve, being simple, attract its nourishment, as do the composite veins, by virtue of the tendency p153 of a vacuum to become refilled? For, although according to Erasistratus, it contains within itself a cavity of sorts, this is not occupied with blood, but with psychic pneuma, and we are required to imagine the nutriment introduced, not into this cavity, but into the vessel containing it, whether it needs merely to be nourished, or to grow as well. How, then, are we to imagine it introduced? For this simple vessel [i.e. nerve] is so small — as are also the other two — that if you prick it at any part with the finest needle you will tear the whole three of them at once. Thus there could never be in it a perceptible space entirely empty. And an emptied space which merely existed in theory could not compel the adjacent fluid to come and fill it.
At this point, again, I should like Erasistratus himself to answer regarding this small elementary nerve, whether it is actually one and definitely continuous, or whether it consists of many small bodies, such as those assumed by Epicurus, Leucippus, and Democritus. For I see that the Erasistrateans are at variance on this subject. Some of them consider it one and continuous, for otherwise, as they say, he would not have called it simple; and some venture to resolve it into yet other elementary bodies. But if it be one and continuous, then what is evacuated from it in the so‑called insensible transpiration of the p155 physicians will leave no empty space in it; otherwise it would not be one body but many, separated by empty spaces. But if it consists of many bodies, then we have "escaped by the back door," as the saying is, to Asclepiades, seeing that we have postulated certain inharmonious elements. Once again, then, we must call Nature "inartistic"; for this necessarily follows the assumption of such elements.
For this reason some of the Erasistrateans seem to me to have done very foolishly in reducing the simple vessels to elements such as these. Yet it makes no difference to me, since the theory of both parties regarding nutrition will be shown to be absurd. For in these minute simple vessels constituting the large perceptible nerves, it is impossible, according to the theory of those who would keep the former continuous, that any "refilling of a vacuum" should take place, since no vacuum can occur in a continuum even if anything does run away; for the parts left come together (as is seen in the case of water) and again become one, taking up the whole space of that which previously separated them. Nor will any "refilling" occur if we accept the argument of the other Erasistrateans, since none of their elements need it. For this principle only holds of things which are perceptible, and not of those which exist merely in theory; this Erasistratus expressly acknowledges, for he states that it is not a vacuum such as this, interspersed in small portions among the corpuscles, that his various treatises deal with, but a vacuum which is clear, perceptible, complete in itself, large in size, evident, or however else one cares to term it (for, what Erasistratus himself says is, that "there cannot be a p157 perceptible space which is entirely empty"; while I, for my part, being abundantly equipped with terms which are equally elucidatory, at least in relation to the present topic of discussion, have added them as well).
Thus it seems to me better that we also should help the Erasistrateans with some contribution, since we are on the subject, and should advise those who reduce the vessel called primary and simple by Erasistratus into other elementary bodies to give up their opinion; for not only do they gain nothing by it, but they are also at variance with Erasistratus in this matter. That they gain nothing by it has been clearly demonstrated; for this hypothesis could not escape the difficulty regarding nutrition. And it also seems perfectly evident to me that this hypothesis is not in consonance with the view of Erasistratus, when it declares that what he calls simple and primary is composite, and when it destroys the principle of Nature's artistic skill. For, if we do not grant a certain unity of substance to these simple structures as well, and if we arrive eventually at inharmonious and indivisible elements, we shall most assuredly deprive Nature of her artistic skill, as do all the physicians and philosophers who start from this hypothesis. For, according to such a hypothesis, Nature does not precede, but is secondary to the parts of the animal. Now, it is not the province of what comes secondarily, but of what pre-exists, to shape and to construct. Thus we must necessarily suppose that the faculties of Nature, by which she p159 shapes the animal, and makes it grow and receive nourishment, are present from the seed onwards; whereas none of these inharmonious and non-partite corpuscles contains within itself any formative, incremental, nutritive, or, in a word, any artistic power; it is, by hypothesis, unimpressionable and untransformable, whereas, as we have previously shown, none of the processes mentioned takes place without transformation, alteration, and complete intermixture. And, owing to this necessity, those who belong to these sects are unable to follow out the consequences of their supposed elements, and they are all therefore forced to declare Nature devoid of art. It is not from us, however, that the Erasistrateans should have learnt this, but from those very philosophers who lay most stress on a preliminary investigation into the elements of all existing things.
Now, one can hardly be right in supposing that Erasistratus could reach such a pitch of foolishness as to be recognizing the logical consequences of this theory, and that, while assuming Nature to be artistically creative, he would at the same time break up substance into insensible, inharmonious, and untransformable elements. If, however, he will grant that there occurs in the elements a process of alteration and transformation, and that there exists in them unity and continuity, then that simple vessel of his (as he himself names it) will turn out to be single and uncompounded. And the simple vein will receive nourishment from itself, and the nerve and artery from the vein. How, and in what p161 way? For, when we were at this point before, we drew attention to the disagreement among the Erasistrateans, and we showed that the nutrition of these simple vessels was impracticable according to the teachings of both parties, although we did not hesitate to adjudicate in their quarrel and to do Erasistratus the honour of placing him in the better sect.
Let our argument, then, be transferred again to the doctrine which assumes this elementary nerve to be a single, simple, and entirely unified structure, and let us consider how it is to be nourished; for what is discovered here will at once be found to be common also to the school of Hippocrates.
It seems to me that our enquiry can be most rigorously pursued in subjects who are suffering from illness and have become very emaciated, since in these people all parts of the body are obviously atrophied and thin, and in need of additional substance and feeding-up; for the same reason the ordinary perceptible nerve, regarding which we originally began this discussion, has become thin, and requires nourishment. Now, this contains within itself various parts, namely, a great many of these primary, invisible, minute nerves, a few simple arteries, and similarly also veins. Thus, all its elementary nerves have themselves also obviously become emaciated; for, if they had not, neither would the nerve as a whole; and of course, in such a case, the whole nerve cannot require nourishment without each of these requiring it too. Now, if on the one hand they stand in need of feeding-up, and if on the p163 other the principle of the refilling of a vacuum can give them no help — both by reason of the difficulties previously mentioned and the actual thinness, as I shall show — we must then seek another cause for nutrition.
How is it, then, that the tendency of a vacuum to become refilled is unable to afford nourishment to one in such a condition? Because its rule is that only so much of the contiguous matter should succeed as has flowed away. Now this is sufficient for nourishment in the case of those who are in good condition, for, in them, what is presented must be equal to what has flowed away. But in the case of those who are very emaciated and who need a great restoration of nutrition, unless what was presented were many times greater than what has been emptied out, they would never be able to regain their original habit. It is clear, therefore, that these parts will have to exert a greater amount of attraction, in so far as their requirements are greater. And I fail to understand how Erasistratus does not perceive that here again he is putting the cart before the horse. Because, in the case of the sick, there must be a large amount of presentation in order to feed them up, he argues that the factor of "refilling" must play an equally large part. And how could much presentation take place if it were not preceded by an abundant delivery of nutriment? And if he calls the conveyance of food through the veins delivery, and its assumption by each of these simple and visible nerves and arteries not delivery but distribution, as some people have thought fit to name it, and then ascribes conveyance p165 through the veins to the principle of vacuum refilling alone, let him explain to us the assumption of food by the hypothetical elements. For it has been shown that at least in relation to these there is no question of the refilling of a vacuum being in operation, and especially where the parts are very attenuated. It is worth while listening to what Erasistratus says about these cases in the second book of his "General Principles": "In the ultimate simple [vessels], which are thin and narrow, presentation takes place from the adjacent vessels, the nutriment being attracted through the sides of the vessels and deposited in the empty spaces left by the matter which has been carried away." Now, in this statement firstly I admit and accept the words "through the sides." For, if the simple nerve were actually to take in the food through its mouth, it could not distribute it through its whole substance; for the mouth is dedicated to the psychic pneuma. It can, however, take it in through its sides from the adjacent simple vein. Secondly, I also accept in Erasistratus' statement the expression which precedes "through the sides." What does this say? "The nutriment being attracted through the sides of the vessels." Now I, too, agree that it is attracted, but it has been previously shown that this is not through the tendency of evacuated matter to be replaced.
7 1 Let us, then, consider together how it is attracted. How else than in the way that iron is attracted by p167 the lodestone, the latter having a faculty attractive of this particular quality [existing in iron]? But if the beginning of anadosis depends on the squeezing action of the stomach, and the whole movement thereafter on the peristalsis and propulsive action of the veins, as well as on the traction exerted by each of the parts which are undergoing nourishment, then we can abandon the principle of replacement of evacuated matter, as not being suitable for a man who assumes Nature to be a skilled artist; thus we shall also have avoided the contradiction of Asclepiades though we cannot refute it: for the disjunctive argument used for the purposes of demonstration is, in reality, disjunctive not of two but of three alternatives; now, if we treat the disjunction as a disjunction of two alternatives, one of the two propositions assumed in constructing our proof must be false; and if as a disjunctive of three alternatives, no conclusion will be arrived at.
8 1 Now Erasistratus ought not to have been ignorant of this if he had ever had anything to do with the Peripatetics — even in a dream. Nor, similarly, should he have been unacquainted with the genesis of the humours, about which, not having even anything moderately plausible to say, he thinks to deceive us by the excuse that the consideration of such matters is not the least useful. Then, in Heaven's name, is it useful to know how food is digested in the stomach, but unnecessary to know how bile comes into existence p169 in the veins? Are we to pay attention merely to the evacuation of this humour, and not to its genesis? As though it were not far better to prevent its excessive development from the beginning than to give ourselves all the trouble of expelling it! And it is a strange thing to be entirely unaware as to whether its genesis is to be looked on as taking place in the body, or whether it comes from without and is contained in the food. For, if it was right to raise this problem, why should we not make investigations concerning the blood as well — whether it takes its origin in the body, or is distributed through the food as is maintained by those who postulate homoeomeries? Assuredly it would be much more useful to investigate what kinds of food are suited, and what kinds unsuited, to the process of blood-production rather than to enquire into what articles of diet are easily mastered by the activity of the stomach, and what resist and contend with it. For the choice of the latter bears reference merely to digestion, while that of the former is of importance in regard to the generation of useful blood. For it is not equally important whether the aliment be imperfectly chylified in the stomach or whether it fail to be turned into useful blood. Why is Erasistratus not ashamed to distinguish all the various kinds of digestive failure and all the occasions which give rise to them, whilst in reference to the errors of blood-production he does not utter a single word — nay, not a syllable? Now, there is certainly to be found in the veins both thick and thin blood; in some people it is redder, in others yellower, in some blacker, in others more of the nature of phlegm. And one who realizes that it p171 may smell offensively not in one way only, but in a great many different respects (which cannot be put into words, although perfectly appreciable to the senses), would, I imagine, condemn in no measured terms the carelessness of Erasistratus in omitting a consideration so essential to the practice of our art.
Thus it is clear what errors in regard to the subject of dropsies logically follow this carelessness. For, does it not show the most extreme carelessness to suppose that the blood is prevented from going forward into the liver owing to the narrowness of the passages, and that dropsy can never occur in any other way? For, to imagine that dropsy is never caused by the spleen or any other part, but always by induration of the liver, is the standpoint of a man whose intelligence is perfectly torpid and who is quite out of touch with things that happen every day. For, not merely once or twice, but frequently, we have observed dropsy produced by chronic haemorrhoids which have been suppressed, or which, through immoderate bleeding, have given the patient a severe chill; similarly, in women, the complete disappearance of the monthly discharge, or an undue evacuation such as is caused by violent bleeding from the womb, often provoke dropsy; and in some of them the so‑called female flux ends in this disorder. I leave out of account p173 the dropsy which begins in the flanks or in any other susceptible part; this clearly confutes Erasistratus' assumption, although not so obviously as does that kind of dropsy which is brought about by an excessive chilling of the whole constitution; this, which is the primary reason for the occurrence of dropsy, results from a failure of blood-production, very much like the diarrhoea which follows imperfect digestion of food; certainly in this kind of dropsy neither the liver nor any other viscus becomes indurated.
The learned Erasistratus, however, overlooks — nay, despises — what neither Hippocrates, Diocles, Praxagoras, nor indeed any of the best philosophers, whether Plato, Aristotle, or Theophrastus; he passes by whole functions as though it were but a trifling and casual department of medicine which he was neglecting, without deigning to argue whether or not these authorities are right in saying that the bodily parts of all animals are governed by the Warm, the Cold, the Dry and the Moist, the one pair being active the other passive, and that among these the Warm has most power in connection with all functions, but especially with the genesis of the humours. Now, one cannot be blamed for not agreeing with all these great men, nor for imagining that one knows more than they; but not to consider such distinguished teaching worthy either of contradiction or even mention shows an extraordinary arrogance.
p175 Now, Erasistratus is thoroughly small-minded and petty to the last degree in all his disputations — when, for instance, in his treatise "On Digestion," he argues jealously with those who consider that this is a process of putrefaction of the food; and, in his work "On Anadosis," with those who think that the anadosis of blood through the veins results from the contiguity of the arteries; also, in his work "On Respiration," with those who maintain that the air is forced along by contraction. Nay, he did not even hesitate to contradict those who maintain that the urine passes into the bladder in a vaporous state, as also those who say that imbibed fluids are carried into the lung. Thus he delights to choose always the most valueless doctrines, and to spend his time more and more in contradicting these; whereas on the subject of the origin of blood (which is in no way less important than the chylification of food in the stomach) he did not deign to dispute with any of the ancients, nor did he himself venture to bring forward any other opinion, despite the fact that at the beginning of his treatise on "General Principles" he undertook to say how all the various natural functions take place, and through what parts of the animal! Now, is it possible that, when the faculty which naturally digests food is weak, the animal's digestion fails, whereas the faculty which turns the digested food into blood cannot suffer any kind of impairment? Are we to suppose this latter faculty alone to be as tough as steel and unaffected by circumstances? Or is it that weakness of this faculty will result in something p177 else than dropsy? The fact, therefore, that Erasistratus, in regard to other matters, did not hesitate to attack even the most trivial views, whilst in this he neither dared to contradict his predecessors nor to advance any new view of his own, proves plainly that he recognized the fallacy of his own way of thinking.
For what could a man possibly say about blood who had no use for innate heat? What could he say about yellow or black bile, or phlegm? Well, of course, he might say that the bile could come directly from without, mingled with the food! Thus Erasistratus practically says so in the following words: "It is of no value in practical medicine to find out whether fluid of this kind arises from the elaboration of food in the stomach-region, or whether it reaches the body because it is mixed with the food taken in from outside." But my very good Sir, you most certainly maintain also that this humour has to be evacuated from the animal, and that it causes great pain if it be not evacuated. How, then, if you suppose that no good comes from the bile, do you venture to say that an investigation into its origin is of no value in medicine?
Well, let us suppose that it is contained in the food, and not specifically secreted in the liver (for you hold these two things possible). In this case, it will certainly make a considerable difference whether the ingested food contains a minimum or a maximum of bile; for the one kind is harmless, whereas that containing a large quantity of bile, owing to the fact that it cannot be properly purified p179 in the liver, will result in the various affections — particularly jaundice — which Erasistratus himself states to occur where there is much bile. Surely, then, it is most essential for the physician to know in the first place, that the bile is contained in the food itself from outside, and, secondly, that for example, beet contains a great deal of bile, and bread very little, while olive oil contains most, and wine least of all, and all the other articles of diet different quantities. Would it not be absurd for any one to choose voluntarily those articles which contain more bile, rather than those containing less?
What, however, if the bile is not contained in the food, but comes into existence in the animal's body? Will it not also be useful to know what state of the body is followed by a greater, and what by a smaller occurrence of bile? For obviously it is in our power to alter and transmute morbid states of the body — in fact, to give them a turn for the better. But if we did not know in what respect they were morbid or in what way they diverged from the normal, how should we be able to ameliorate them?
Therefore it is not useless in treatment, as Erasistratus says, to know the actual truth about the genesis of bile. Certainly it is not impossible, or even difficult to discover that the reason why honey produces yellow bile is not that it contains a large quantity of this within itself, but because it [the honey] undergoes change, becoming altered and transmuted into bile. For it would be bitter to the taste if it contained bile from the outset, and it would produce an equal quantity of bile p181 in every person who took it. The facts, however, are not so. For in those who are in the prime of life, especially if they are warm by nature and are leading a life of toil, the honey changes entirely into yellow bile. Old people, however, it suits well enough, inasmuch as the alteration which it undergoes is not into bile, but into blood. Erasistratus, however, in addition to knowing nothing about this, shows no intelligence even in the division of his argument; he says that it is of no practical importance to investigate whether the bile is contained in the food from the beginning or comes into existence as a result of gastric digestion. He ought surely to have added something about its genesis in liver and veins, seeing that the old physicians and philosophers declare that it along with the blood is generated in these organs. But it is inevitable that people who, from the very outset, go astray, and wander from the right road, should talk such nonsense, and should, over and above this, neglect to search for the factors of most practical importance in medicine.
Having come to this point in the argument, I should like to ask those who declare that Erasistratus was very familiar with the Peripatetics, whether they know what Aristotle stated and demonstrated with regard to our bodies being compounded out of the Warm, the Cold, the Dry and the Moist, and how he says that among these the Warm is the most active, and that those animals which are by nature warmest have abundance of blood, whilst those that are colder are entirely lacking in blood, and consequently in winter lie idle and motionless, lurking p183 in holes like corpses. Further, the question of the colour of the blood has been dealt with not only by Aristotle but also by Plato. Now I, for my part, as I have already said, did not set before myself the task of stating what has been so well demonstrated by the Ancients, since I cannot surpass these men either in my views or in my method of giving them expression. Doctrines, however, which they either stated without demonstration, as being self-evident (since they never suspected that there could be sophists so degraded as to contemn the truth in these matters), or else which they actually omitted to mention at all — these I propose to discover and prove.
Now in reference to the genesis of the humours, I do not know that any one could add anything wiser than what has been said by Hippocrates, Aristotle, Praxagoras, Philotimus and many other among the Ancients. These men demonstrated that when the nutriment becomes altered in the veins by the innate heat, blood is produced when it is in moderation, and the other humours when it is not in proper proportion. And all the observed facts agree with this argument. Thus, those articles of food, which are by nature warmer are more productive of bile, while those which are colder produce more phlegm. Similarly of the periods of life, those which are naturally warmer tend more to bile, and the colder more to phlegm. Of occupations also, localities and seasons, and, above all, of natures themselves, the colder are more phlegmatic, and the warmer more p185 bilious. Also cold diseases result from and warmer ones from yellow bile. There is not a single thing to be found which does not bear witness to the truth of this account. How could it be otherwise? For, seeing that every part functions in its own special way because of the manner in which the four qualities are compounded, it is absolutely necessary that the function [activity] should be either completely destroyed, or, at least hampered, by any damage to the qualities, and that thus the animal should fall ill, either as a whole, or in certain of its parts.
Also the diseases which are primary and most generic are four in number, and differ from each other in warmth, cold, dryness and moisture. Now, Erasistratus himself confesses this, albeit unintentionally; for when he says that the digestion of food becomes worse in fever, not because the innate heat has ceased to be in due proportion, as people previously supposed, but because the stomach, with its activity impaired, cannot contract and triturate as before — then, I say, one may justly ask him what it is that has impaired the activity of the stomach.
Thus, for example, when a bubo develops following an accidental wound gastric digestion does not become impaired until the patient has become fevered; neither the bubo nor the sore of itself impedes in any way or damages the activity of the stomach. But if fever occurs, the digestion at once deteriorates, and we are also right in saying that the activity of the stomach at once becomes impaired. We must add, however, by what p187 it has been impaired. For the wound was not capable of impairing it, nor yet the bubo, for, if they had been, then they would have caused this damage before the fever as well. If it was not these that caused it, then it was the excess of heat (for these two symptoms occurred besides the bubo — an alteration in the arterial and cardiac movements and an excessive development of natural heat). Now the alteration of these movements will not merely not impair the function of the stomach in any way: it will actually prove an additional help among those animals in which, according to Erasistratus, the pneuma, which is propelled through the arteries and into the alimentary canal, is of great service in digestion; there is only left, then, the disproportionate heat to account for the damage to the gastric activity. For the pneuma is driven in more vigorously and continuously, and in greater quantity now than before; thus in this case, the animal whose digestion is promoted by pneuma will digest more, whereas the remaining factor — abnormal heat — will give them indigestion. For to say, on the one hand, that the pneuma has a certain property by virtue of which it promotes digestion, and then to say that this property disappears in cases of fever, is simply to admit the absurdity. For when they are again asked what it is that has altered the pneuma, they will only be able to reply, "the abnormal heat," and particularly if it be the pneuma in the food canal which is in p189 question (since this does not come in any way near the bubo).
Yet why do I mention those animals in which the property of the pneuma plays an important part, when it is possible to base one's argument upon human beings, in whom it is either of no importance at all, or acts quite faintly and feebly? But Erasistratus himself agrees that human beings digest badly in fevers, adding as the cause that the activity of the stomach has been impaired. He cannot, however, advance any other cause of this impairment than abnormal heat. But if it is not by accident that the abnormal heat impairs this activity, but by virtue of its own essence and power, then this abnormal heat must belong to the primary diseases. But, indeed, if disproportion of heat belongs to the primary diseases, it cannot but be that a proportionate blending [eucrasia] of the qualities produces the normal activity. For a disproportionate blend [dyscrasia] can only become a cause of the primary diseases through derangement of the eucrasia. That is to say, it is because the [normal] activities arise from the eucrasia that the primary impairments of these activities necessarily arise from derangement.
I think, then, it has been proved to the satisfaction of those who are capable of seeing logical consequences, that, even according to Erasistratus' own argument, the cause of the normal functions is eucrasia of the Warm. Now, this being so, there is nothing further to prevent us from saying p191 that, in the case of each function, eucrasia is followed by the more, and dyscrasia by the less favourable alternative. And, therefore, if this be the case, we must suppose blood to be the outcome of proportionate, and yellow bile of disproportionate heat. So we naturally find yellow bile appearing in greatest quantity in ourselves at the warm periods of life, in warm countries, at warm seasons of the year, and when we are in a warm condition; similarly in people of warm temperaments, and in connection with warm occupations, modes of life, or diseases.
And to be in doubt as to whether this humour has the genesis in the human body or is contained in the food is what you would expect from one who has — I will not say failed to see that, when those who are perfectly healthy have, under the compulsion of circumstances, to fast contrary to custom, their mouths become bitter and their urine bile-coloured, while they suffer from gnawing pains in the stomach — but has, as it were, just made a sudden entrance into the world, and is not yet familiar with the phenomena which occur there. Who, in fact, does not know that anything which is overcooked grows at first salt and afterwards bitter? And if you will boil honey itself, far the sweetest of all things, you can demonstrate that even this becomes quite bitter. For what may occur as a result of boiling in the case of other articles which are not warm by nature, exists naturally in honey; for this reason it does not become sweeter on being boiled, since exactly the same quantity of heat as is needed for the production of sweetness exists from beforehand in the honey. Therefore the external heat, p193 which would be useful for insufficiently warm substances, becomes in the honey a source of damage, in fact an excess; and it is for this reason that honey, when boiled, can be demonstrated to become bitter sooner than the others. For the same reason it is easily transmuted into bile in those people who are naturally warm, or in their prime, since warm when associated with warm becomes readily changed into a disproportionate combination and turns into bile sooner than into blood. Thus we need a cold temperament and a cold period of life if we would have honey brought to the nature of blood. Therefore Hippocrates not improperly advised those who were naturally bilious not to take honey, since they were obviously of too warm a temperament. So also, not only Hippocrates, but all physicians say that honey is bad in bilious diseases but good in old age; some of them having discovered this through the indications afforded by its nature, and others simply through experiment, for the Empiricist physicians too have made precisely the same observation, namely, that honey is good for an old man and not for a young one, that it is harmful for those who are naturally bilious, and serviceable for those who are phlegmatic. In a word, in bodies which are warm either through nature, disease, time of life, season of the year, locality, or occupation, honey is productive of bile, whereas in opposite circumstances it produces blood.
But surely it is impossible that the same article of diet can produce in certain persons bile and in others blood, if it be not that the genesis of these humours is p195 accomplished in the body. For if all articles of food contained bile from the beginning and of themselves, and did not produce it by undergoing change in the animal body, then they would produce it similarly in all bodies; the food which was bitter to the taste would, I take it, be productive of bile, while that which tasted good and sweet would not generate even the smallest quantity of bile. Moreover, not only honey but all other sweet substances are readily converted into bile in the aforesaid bodies which are warm for any of the reasons mentioned.
Well, I have somehow or other been led into this discussion, — not in accordance with my plan, but compelled by the course of the argument. This subject has been treated at great length by Aristotle and Praxagoras, who have correctly expounded the view of Hippocrates and Plato.
9 1 For this reason the things that we have said are not to be looked upon as proofs but rather as indications of the dulness of those who think differently, and who do not even recognise what is agreed on by everyone and is a matter of daily observation. As for the scientific proofs of all this, they are to be drawn from these principles of which I have already spoken — namely, that bodies act upon and are acted upon by each other in virtue of the Warm, Cold, Moist and Dry. And if one is p197 speaking of any activity, whether it be exercised by vein, liver, arteries, heart, alimentary canal, or any part, one will be inevitably compelled to acknowledge that this activity depends upon the way in which the four qualities are blended. Thus I should like to ask the Erasistrateans why it is that the stomach contracts upon the food, and why the veins generate blood. There is no use in recognizing the mere fact of contraction, without also knowing the cause; if we know this, we shall also be able to rectify the failures of function. "This is no concern of ours," they say; "we do not occupy ourselves with such causes as these; they are outside the sphere of the practitioner, and belong to that of the scientific investigator." Are you, then, going to oppose those who maintain that the cause of the function of every organ is a natural eucrasia, that the dyscrasia is itself known as a disease, and that it is certainly by this that the activity becomes impaired? Or, on the other hand, will you be convinced by the proofs which the ancient writers furnished? Or will you take a midway course between these two, neither perforce accepting these arguments as true nor contradicting them as false, but suddenly becoming sceptics — Pyrrhonists, in fact? But if you do this you will have to shelter yourselves behind the Empiricist teaching. For how are you going to be successful in treatment, if you do not understand the real essence of each disease? Why, then, did you not call yourselves Empiricists from the beginning? Why do you confuse us by announcing that you are p199 investigating natural activities with a view to treatment? If the stomach is, in a particular case, unable to exercise its peristaltic and grinding functions, how are we going to bring it back to the normal if we do not know the cause of its disability? What I say is that we must cool the over-heated stomach and warm the chilled one; so also we must moisten the one which has become dried up, and conversely; so, too, in combinations of these conditions; if the stomach becomes at the same time warmer and drier than normally, the first principle of treatment is at once to chill and moisten it; and if it become colder and moister, it must be warmed and dried; so also in other cases. But how on earth are the followers of Erasistratus going to act, confessing as they do that they make no sort of investigation into the cause of disease? For the fruit of the enquiry into activities is that by knowing the causes of the dyscrasiae one may bring them back to the normal, since it is of no use for the purposes of treatment merely to know what the activity of each organ is.
Now, it seems to me that Erasistratus is unaware of this fact also, that the actual disease is that condition of the body which, not accidentally, but primarily and of itself, impairs the normal function. How, then, is he going to diagnose or cure diseases if he is entirely ignorant of what they are, and of what kind and number? As regards the stomach, certainly, Erasistratus held that one should at least p201 investigate how it digests the food. But why was not investigation also made as to the primary originative cause of this? And, as regards the veins and the blood, he omitted even to ask the question "how?"
Yet neither Hippocrates nor any of the other physicians or philosophers whom I mentioned a short while ago thought it right to omit this; they say that when the heat which exists naturally in every animal is well blended and moderately moist it generates blood; for this reason they also say that the blood is a virtually warm and moist humour, and similarly also that yellow bile is warm and dry, even though for the most part it appears moist. (For in them the apparently dry would seem to differ from the virtually dry.) Who does not know that brine and sea-water preserve meat and keep it uncorrupted, whilst all other water — the drinkable kind — readily spoils and rots it? And who does not know that when yellow bile is contained in large quantity in the stomach, we are troubled with an unquenchable thirst, and that when we vomit this up, we at once become much freer from thirst than if we had drunk very large quantities of fluid? Therefore this humour has been very properly termed warm, and also virtually dry. And, similarly, phlegm has been called cold and moist; for about this also clear proofs have been given by Hippocrates and the other Ancients.
Prodicus also, when in his book "On the Nature of Man" he gives the name "phlegm" to that element in the humours which has been burned or, as it were, over-roasted, while using p203 a different terminology, still keeps to the fact just as the others do; this man's innovations in nomenclature have also been amply done justice to by Plato. Thus, the white-coloured substance which everyone else calls phlegm, and which Prodicus calls blenna [mucus], is the well-known cold, moist humour which collects mostly in old people and in those who have been chilled in some way, and not even a lunatic could say that this was anything else than cold and moist.
If, then, there is a warm and moist humour, and another which is warm and dry, and yet another which is moist and cold, is there none which is virtually cold and dry? Is the fourth combination of temperaments, which exists in all other things, non-existent in the humours alone? No; the black bile is such a humour. This, according to intelligent physicians and philosophers, tends to be in excess, as regards seasons, mainly in the fall of the year, and, as regards ages, mainly after the prime of life. And, similarly, also they say that there are cold and dry modes of life, regions, constitutions, and diseases. Nature, they suppose, is not defective in this single combination; like the three other combinations, it extends everywhere.
At this point, also, I would gladly have been able to ask Erasistratus whether his "artistic" Nature has not constructed any organ for clearing away a humour such as this. For whilst there are two organs for the excretion of urine, and another of considerable size for that of yellow bile, does the p205 humour which is more pernicious than these wander about persistently in the veins mingled with the blood? Yet Hippocrates says, "Dysentery is a fatal condition if it proceeds from black bile"; while that proceeding from yellow bile is by no means deadly, and most people recover from it; this proves how much more pernicious and acrid in its potentialities is black than yellow bile. Has Erasistratus, then, not read the book, "On the Nature of Man," any more than any of the rest of Hippocrates' writings, that he so carelessly passes over the consideration of the humours? Or, does he know it, and yet voluntarily neglect one of the finest studies in medicine? Thus he ought not to have said anything about the spleen, nor have stultified himself by holding that an artistic Nature would have prepared so large an organ for no purpose. As a matter of fact, not a matter of fact, not only Hippocrates and Plato — who are no less authorities on Nature than is Erasistratus — say that this viscus also is one of those which cleanse the blood, but there are thousands of the ancient physicians and philosophers as well who are in agreement with them. Now, all of these the high and mighty Erasistratus affected to despise, and he neither contradicted them nor even so much as mentioned their opinion. Hippocrates, indeed, says that the spleen wastes in those people in whom the body is in good condition, and all those physicians also who base themselves on experience agree with this. Again, in those cases in which the spleen is large and is increasing from p207 internal suppuration, it destroys the body and fills it with evil humours; this again is agreed on, not only by Hippocrates, but also by Plato and many others, including the Empiric physicians. And the jaundice which occurs when the spleen is out of order is darker in colour, and the cicatrices of ulcers are dark. For, generally speaking, when the spleen is drawing the atrabiliary humour into itself to a less degree than is proper, the blood is unpurified, and the whole body takes on a bad colour. And when does it draw this in to a less degree than proper? Obviously, when it [the spleen] is in a bad condition. Thus, just as the kidneys, whose function it is to attract the urine, do this badly when they are out or order, so also the spleen, which has in itself a native power of attracting an atrabiliary quality, if it ever happens to be weak, must necessarily exercise this attraction badly, with the result that the blood becomes thicker and darker.
Now all these points, affording as they do the greatest help in the diagnosis and in the cure of disease were entirely passed over by Erasistratus, and he pretended to despise these great men — he who does not despise ordinary people, but always jealously attacks the most absurd doctrines. Hence, it was clearly because he had nothing to say against the statements made by the Ancients regarding the function and utility of the spleen, and also because he could discover nothing new himself, that he ended by saying nothing at all. I, however, for my part, have demonstrated, firstly from the causes by which everything throughout nature is governed (by p209 the causes I mean the Warm, Cold, Dry and Moist) and secondly, from obvious bodily phenomena, that there must needs be a cold and dry humour. And having in the next place drawn attention to the fact that this humour is black bile [atrabiliary] and that the viscus which clears it away is the spleen — having pointed this out by help of as few as possible of the proofs given by ancient writers, I shall now proceed to what remains of the subject in hand.
What else, then, remains but to explain clearly what it is that happens in the generation of the humours, according to the belief and demonstration of the Ancients? This will be more clearly understood from a comparison. Imagine, then, some new wine which has been not long ago pressed from the grape, and which is fermenting and undergoing alteration through the agency of its contained heat. Imagine next two residual substances produced during this process of alteration, the one tending to be light and air-like and the other to be heavy and more of the nature of earth; of these the one, as I understand, they call the flower and the other the lees. Now you may correctly compare yellow bile to the first of these, and black bile to the latter, although these humours have not the same appearance when the animal is in normal health as that which they often show when it is not so; for then the yellow bile becomes vitelline, being so termed because it becomes like the yolk of an egg, both in colour and density; and again, even the black bile itself becomes much more malignant than when p211 in its normal condition,JJJ but no particular name has been given to [such a condition of] the humour, except that some people have called it corrosive or acetose, because it also becomes sharp like vinegar and corrodes the animal's body — as also the earth, if it be poured out upon it — and it produces a kind of fermentation and seething, accompanied by bubbles — an abnormal putrefaction having become added to the natural condition of the black humour. It seems to me also that most of the ancient physicians give the name black humour and not black bile to the normal portion of this humour, which is discharged from the bowel and which also frequently rises to the top [of the stomach-contents]; and they call black bile that part which, through a kind of combustion and putrefaction, has had its quality changed to acid. There is no need, however, to dispute about names, but we must realise the facts, which are as follow:-
In the genesis of blood, everything in the nutriment which belongs naturally to the thick and earth-like part of the food, and which does not take on well the alteration produced by the innate heat — all this the spleen draws into itself. On the other hand, that part of the nutriment which is roasted, so to speak, or burnt (this will be the warmest and sweetest part of it, like honey and fat), becomes yellow bile, and is cleared away through the so‑called biliary vessels; now, this is thin, moist, and fluid, not like what it is when, having been roasted to an excessive degree, it becomes yellow, fiery, and thick, like the yolk of p213 eggs; for this latter is already abnormal, while the previously mentioned state is natural. Similarly with the black humour: that which does not yet produce, as I say, this seething and fermentation on the ground, is natural, while that which has taken over this character and faculty is unnatural; it has assumed an acridity owing to the combustion caused by abnormal heat, and has practically become transformed into ashes. In somewhat the same way burned lees differ from unburned. The former is a warm substance, able to burn, dissolve, and destroy the flesh. The other kind, which has not yet undergone combustion, one may find the physicians employing for the same purposes that one uses the so‑called potter's earth and other substances which have naturally a combined drying and chilling action.
Now the vitelline bile also may take on the appearance of this combusted black bile, if ever it chance to be roasted, so to say, by fiery heat. And all the other forms of bile are produced, some from the blending of those mentioned, others being, as it were, transition-stages in the genesis of these or in their conversion into one another. And they differ in that those first mentioned are unmixed and unique, while the latter forms are diluted with various kinds of serum. And all the serums in the humours are waste substances, and the animal body needs to be purified from them. There is, however, a natural use for the humours first mentioned, both thick and thin; the blood is purified both by the spleen and by the bladder beside the liver, and a part of each of the two humours is put away, of such quantity and p215 quality that, if it were carried all over the body, it would do a certain amount of harm. For that which is decidedly thick and earthy in nature, and has entirely escaped alteration in the liver, is drawn by the spleen into itself; the other part which is only moderately thick, after being elaborated [in the liver], is carried all over the body. For the blood in many parts of the body has need of a certain amount of thickening, as also, I take it, of the fibres which it contains. And the use of these has been discussed by Plato,JJJ and it will also be discussed by me in such of my treatises as may deal with the use of parts. And the blood also needs, not least, the yellow humour, which has as yet not reached the extreme stage of combustion; in the treatises mention ed it will be pointed out what purpose is subserved by this.
Now nature has made no organ for clearing away phlegm, this being cold and moist, and, as it were, half-digested nutriment; such a substance, therefore, does not need to be evacuated, but remains in the body and undergoes alteration there. And perhaps one cannot properly give the name of phlegm to the surplus-substance which runs down from the brain,JJJ but one should call it mucus [blenna] or coryza — as, in fact, it is actually termed; in any case it will be pointed out, in the treatise "On the Use of Parts," how Nature has provided for the evacuation of this substance. Further, the device provided by Nature which ensures that the phlegm which forms in the stomach and intestines may be evacuated in the most rapid and effective way possible — this also will be described in that commentary. p217 As to that portion of the phlegm which is carried in the veins, seeing that this is of service to the animal it requires no evacuation. Here too, then, we must pay attention and recognise that, just as in the case of each of the two kinds of bile, there is one part which is useful to the animal and in accordance with its nature, so also is it with the phlegm; such of it as is sweet is useful to the animal and according to nature, while, as to such of it as has become bitter or salt, that part which is bitter is completely undigested, while that part which is salt has undergone putrefaction. and the term "complete indigestion" refers of course to the second digestion — that which takes place in the veins; it is not a failure of the first digestion — that in the alimentary canal — for it would not have become a humour at the outset if it had escaped this digestion also.
It seems to me that I have made enough reference to what has been said regarding the genesis and destruction of humours by Hippocrates, Plato, Aristotle, Praxagoras, and Diocles, and many others among the Ancients; I did not deem it right to transport the whole of their final pronouncements into this treatise. I have said only so much regarding each of the humours as will stir up the reader, unless he be absolutely inept, to make himself familiar with the writings of the Ancients, and will help him to gain more easy access to them. In another treatiseJJJ I have written on the humours according to Praxagoras, son of Nicarchus; although this authority makes as many as ten humours, not p219 including the blood (the blood itself being an eleventh), this is not a departure from the teaching of Hippocrates; for Praxagoras divides into species and varieties the humours which Hippocrates first mentioned, with the demonstration proper to each.
Those, then, are to be praised who explain the points which have been duly mentioned, as also those who add what has been left out; for it is not possible for the same man to make both a beginning and an end. Those, on the other hand, deserve censure who are so impatient that they will not wait to learn any of the things which have been duly mentioned, as do also those who are so ambitious that, in their lust after novel doctrines, they are always attempting some fraudulent sophistry, either purposely neglecting certain subjects, as Erasistratus does in the case of the humours, or unscrupulously attacking other people, as does this same writer as well as many of the more recent authorities.
But let this discussion come to an end here, and I shall add in the third book all that remains.
1 1 It has been made clear in the preceding discussion that nutrition occurs by an alteration or assimilation of that which nourishes to that which receives nourishment, and that there exists in every part of the animal a faculty which in view of its activity we call, in general terms, alterative, or, more specifically, assimilative and nutritive. It was also shown that a sufficient supply of the matter which the part being nourished makes into nutriment for itself is ensured by virtue of another faculty which naturally attracts its proper juice [humour] that juice is proper to each part which is adapted for assimilation, and that the faculty which attracts the juice is called, by reason of its activity, attractive or epispastic. It has also been shown that assimilation is preceded by adhesion, and this, again, by presentation, the latter stage being, as one might say, the end or goal of the activity corresponding to the attractive faculty. For the actual bringing up of nutriment from the veins into each of the parts takes place through the activation of the attractive faculty, whilst to p225 have been finally brought up and presented to the part is the actual end for which we desired such an activity; it is attracted in order that it may be presented. After this, considerable time is needed for the nutrition of the animal; whilst a thing may be even rapidly attracted, on the other hand to become adherent, altered, and entirely assimilated to the part which is being nourished and to become a part of it, cannot take place suddenly, but requires a considerable amount of time. But if the nutritive juice, so presented, does not remain in the part, but withdraws to another one, and keeps flowing away, and constantly changing and shifting its position, neither adhesion nor complete assimilation will take place in any of them. Here too, then, the [animal's] nature has need of some other faculty for ensuring a prolonged stay of the presented juice at the part, and this not a faculty which comes in from somewhere outside but one which is resident in the part which is to be nourished. This faculty, again, in view of its activity our predecessors were obliged to call retentive.
Thus our argument has clearly shown the necessity for the genesis of such a faculty, and whoever has an appreciation of logical sequence must be firmly persuaded from what we have said that, if it be laid down and proved by previous demonstration that Nature is artistic and solicitous for the animal's welfare, it necessarily follows that she must also possess a faculty of this kind.
p227 2 1 Since, however, it is not our habit to employ this kind of demonstration alone, but to add thereto cogent and compelling proofs drawn from obvious facts, we will also proceed to the latter kind in the present instance: we will demonstrate that in certain parts of the body the retentive faculty is so obvious that its operation can be actually recognised by the senses, whilst in other parts it is less obvious to the senses, but is capable even here of being detected by the argument.
Let us begin our exposition, then, by first dealing systematically for a while with certain definite parts of the body, in reference to which we may accurately test and enquire what sort of thing the retentive faculty is.
Now, could one begin the enquiry in any better way than with the largest and hollowest organs? Personally I do not think one could. It is to be expected that in these, owing to their size, the activities will show quite clearly, whereas with respect to the small organs, even if they possess a strong faculty of this kind, its activation will not at once be recognisable to sense.
Now those parts of the animal which are especially hollow and large are the stomach and the organ which is called the womb or uterus. What prevents us, then, from taking up these first and considering their activities, conducting the enquiry on our own p229 persons in regard to those activities which are obvious without dissection, and, in the case of those which are more obscure, dissecting animals which are near to man; not that even animals unlike him will not show, in a general way, the faculty in question, but because in this manner we may find out at once what is common to all and what is peculiar to ourselves, and so may become more resourceful in the diagnosis and treatment of disease.
Now it is impossible to speak of both organs at once, so we shall deal with each in turn, beginning with the one which is capable of demonstrating the retentive faculty most plainly. For the stomach retains the food until it has quite digested it, and the uterus retains the embryo until it brings it to completion, but the time taken for the completion of the embryo is many times more than that for the digestion of food.
3 1 We may expect, then, to detect the retentive faculty in the uterus more clearly in proportion to the longer duration of its activity as compared with that of the stomach. For, as we know, it takes nine months in most women for the foetus to attain maturity in the womb, this organ having its neck quite closed, and entirely surrounding the embryo together with the chorion. Further, it is the utility of the function which determines the closure of the os and the stay of the foetus in the uterus. For it is not casually nor without reason that Nature has made p231 the uterus capable of contracting upon, and of retaining the embryo, but in order that the latter may arrive at a proper size. When, therefore, the object for which the uterus brought its retentive faculty into play has been fulfilled, it then stops this faculty and brings it back to a state of rest, and employs instead of it another faculty hitherto quiescent — the propulsive faculty. In this case again the quiescent and active states are both determined by utility; when this calls, there is activity; when it does not, there is rest.
Here, then, once more, we must observe well the Art [artistic tendency] of Nature — how she has not merely placed in each organ the capabilities of useful activities, but has also fore-ordained the times both of rest and movement. For everything connected with the pregnancy proceeds properly, the eliminative faculty remains quiescent as though it did not exist, but if anything goes wrong in connection either with the chorion or any of the other membranes or with the foetus itself, and its completion is entirely despaired of, then the uterus no longer awaits the nine-months period, but the retentive faculty forthwith ceases and allows the heretofore inoperative faculty to come into action. Now it is that something is done — in fact, useful work effected — by the eliminative or propulsive faculty (for so it, too, has been called, receiving, like the rest, its names from the corresponding activities).
Further, our theory can, I think, demonstrate both together; for seeing that they succeed each other, and that the one keeps giving place to the other according as utility demands, it seems not unreasonable p233 to accept a common demonstration also for both. Thus it is the work of the retentive faculty to make the uterus contract upon the foetus at every point, so that, naturally enough, when the midwives palpate it, the os is found to be closed, whilst the pregnant women themselves, during the first days — and particularly on that on which conception takes place — experience a sensation as if the uterus were moving and contracting upon itself. Now, if both of these things occur — if the os closes apart from inflammation or any other disease, and if this is accompanied by a feeling of movement in the uterus — then the women believe that they have received the semen which comes from the male, and that they are retaining it.
Now we are not inventing this for ourselves: one may say the statement is based on prolonged experience of those who occupy themselves with such matters. Thus Herophilus does not hesitate to state in his writings that up to the time of labour the os uteri will not admit so much as the tip of a probe, that it no longer opens to the slightest degree if pregnancy has begun — that, in fact, it dilates more widely at the times of the menstrual flow. With him are in agreement all the others who have applied themselves to this subject; and particularly Hippocrates, who was the first of all physicians and philosophers to declare that the os uteri closes during pregnancy and inflammation, albeit in pregnancy it does not depart from its own nature, whilst in inflammation it becomes hard.
p235 In the case of the opposite (the eliminative) faculty, the os opens, whilst the whole fundus approaches as near as possible to the os, expelling the embryo as it does so; and along with the fundus the contiguous parts — which form as it were a girdle round the whole organ — cooperate in the work; they squeeze upon the embryo and propel it bodily outwards. And, in many women who exercise such a faculty immoderately, violent pains cause forcible prolapse of the whole womb; here almost the same thing happens as frequently occurs in wresting-bouts and struggles, when in our eagerness to overturn and throw others we are ourselves upset along with them; for similarly when the uterus is forcing the embryo forward it sometimes becomes entirely prolapsed, and particularly when the ligaments connecting it with the spine happen to be naturally lax.
A wonderful device of Nature's also is this — that, when the foetus is alive, the os uteri is closed with perfect accuracy, but if it dies, the os at once opens up to the extent which is necessary for the foetus to make its exit. The midwife, however, does not make the parturient woman get up at once and sit down on the [obstetric] chair, but she begins by palpating the os as it gradually dilates, and the first thing she says is that it has dilated "enough to admit the little finger," then that "it is bigger now," and as we make enquiries from time to time, she answers that the size of the dilatation is increasing. And when it is sufficient to allow of the transit of the foetus, she then makes the patient get up from her bed and p237 sit on the chair, and bids her make every effort to expel the child. Now, this additional work which the patient does of herself is no longer the work of the uterus but of the epigastric muscles, which also help us in defaecation and micturition.
4 1 Thus the two faculties are clearly to be seen in the case of the uterus; in the case of the stomach they appear as follows: — Firstly in the condition of gurgling, which physicians are persuaded, and with reason, to be a symptom of weakness of the stomach; for sometimes when the very smallest quantity of food has been ingested this does not occur, owing to the fact that the stomach is contracting accurately upon the food and constricting it at every point; sometimes when the stomach is full the gurglings yet make themselves heard as though it were empty. For if it be in a natural condition, employing its contractile faculty in the ordinary way, then, even if its contents be very small, it grasps the whole of them and does not leave any empty space. When it is weak, however, being unable to lay hold of its contents accurately, it produces a certain amount of vacant space, and amount of vacant space, and allows the liquid contents to flow about in different directions in accordance with its changes of shape, and so to produce gurglings.
Thus those who are troubled with this symptom expect, with good reason, that they will also be unable to digest adequately; proper digestion cannot take place in a weak stomach. In such people also, the mass of food may be plainly seen to remain p239 an abnormally long time in the stomach, as would be natural if their digestion were slow. Indeed, the chief way in which these people will surprise one is in the length of time that not food alone but even fluids will remain in their stomachs. Now, the actual cause of this is not, as one would imagine, that the lower outlet of the stomach, being fairly narrow, will allow nothing to pass before being reduced to a fine state of division. There are a great many people who frequently swallow large quantities of big fruit-stones; one person who was holding a gold ring in his mouth, inadvertently swallowed it; another swallowed a coin, and various people have swallowed various hard and indigestible objects; yet all these people easily passed by the bowel what they had swallowed, without there being any subsequent symptoms. Now surely if narrowness of the gastric outlet were the cause of untriturated food remaining for an abnormally long time, none of these articles I have mentioned would ever have escaped. Furthermore, the fact that it is liquids which remain longest in these people's stomachs is sufficient to put the idea of narrowness of the outlet out of court. For, supposing a rapid descent were dependent upon emulsification, then soups, milk, and barley-emulsion would at once pass along in every case. But as a matter of fact this is not so. For in people who are extremely asthenic it is just these fluids which remain undigested, which accumulate and produce gurglings, and which oppress and overload the stomach, whereas in strong persons not merely do none of these things happen, but even a large quantity of bread or meat passes rapidly down.
p241 And it is not only because the stomach is distended and loaded and because the fluid runs from one part of it to another accompanied by gurglings — it is not only for these reasons that one would judge that there was an unduly long continuance of the food in it, in those people who are so disposed, but also from the vomiting. Thus, there are some who vomit up every particle of what they have eaten, not after three or four hours, but actually in the middle of the night, a lengthy period having elapsed since their meal.
Suppose you fill any animal whatsoever with liquid food — an experiment I have often carried out in pigs, to whom I give a sort of mess of wheaten flour and water, there after cutting them open after three or four hours; if you will do this yourself, you will find the food still in the stomach. For it is not chylification which determines the length of its stay here — since this can also be effected outside the stomach; the determining factor is digestion which is a different thing from chylification, as are blood-production and nutrition. For, just as it has been shown that these two processes depend upon a change of qualities, similarly also the digestion of food in the stomach involves a transmutation of it into the quality proper to that which is receiving nourishment. Then, when it is completely digested, the lower outlet opens and the food is quickly ejected through it, even if there should be amongst it abundance of stones, bones, grape-pips, or other things which cannot be reduced to chyle. And you may observe this p243 yourself in an animal, if you will try to hit upon the time at which the descent of food from the stomach takes place. But even if you should fail to discover the time, and nothing was yet passing down, and the food was still undergoing digestion in the stomach, still even then you would find dissection not without its uses. You will observe, as we have just said, that the pylorus is accurately closed, and that the whole stomach is in a state of contraction upon the food very much as the womb contracts upon the foetus. For it is never possible to find a vacant space in the uterus, the stomach, or in either of the two bladders — that is, either in that called bile-receiving or in the other; whether their contents be abundant or scanty, their cavities are seen to be replete and full, owing to the fact that their coats contract constantly upon the contents — so long, as least, as the animal is in a natural condition.
Now Erasistratus for some reason declares that it is the contractions of the stomach which are the cause of everything — that is to say, of the softening of the food, the removal of waste matter, and the absorption of the food when chylified [emulsified].
Now I have personally, on countless occasions, divided the peritoneum of a still living animal and have always found all the intestines contracting peristaltically upon their contents. The condition of the stomach, however, is found less simple; as regards the substances freshly swallowed, it had grasped these accurately both above and below, in fact at every point, and was as devoid of movement p245 as though it had grown round and become united with the food. At the same time I found the pylorus persistently closed and accurately shut, like the os uteri on the foetus.
In the cases, however, where digestion had been completed the pylorus had opened, and the stomach was undergoing peristaltic movements, similar to those of the intestines.
5 1 Thus all these facts agree that the stomach, uterus, and bladders possess certain inborn faculties which are retentive of their own proper qualities and eliminative of those that are foreign. For it has been already shown that the bladder by the liver draws bile into itself, while it is also quite obvious that it eliminates this daily into the stomach. Now, of course, if the eliminative were to succeed the attractive faculty and there were not a retentive faculty between the two, there would be found, on every occasion that animals were dissected, an equal quantity of bile in the gall-bladder. This however, we do not find. For the bladder is sometimes observed to be very full, sometimes quite empty, while at other times you find in it various intermediate degrees of fulness, just as is the case with the other bladder — that which receives the urine; for even without resorting to anatomy we may observe that the urinary bladder continues to collect urine up to the time that it becomes uncomfortable through the increasing quantity of urine or the irritation caused by its acidity — the presumption p247 thus being that here, too, there is a retentive faculty.
Similarly, too, the stomach, when, as often happens, it is irritated by acidity, gets rid of the food, although still undigested, earlier than proper; or again, when oppressed by the quantity of its contents, or disordered from the co-existence of both conditions, it is seized with diarrhoea. Vomiting also is an affection of the upper [part of the] stomach analogous to diarrhoea, and it occurs when the stomach is overloaded or is unable to stand the quality of the food or surplus substances which it contains. Thus, when such a condition develops in the lower parts of the stomach, while the parts about the inlet are normal, it ends in diarrhoea, whereas if this condition is in the upper stomach, the lower parts being normal, it ends in vomiting.
6 1 This may often be clearly in those who are disinclined for food; when obliged to eat, they have not the strength to swallow, and, even if they force themselves to do so, they cannot retain the food, but at vomit it up. And those especially who have a dislike to some particular kind of food, sometimes take it under compulsion, and then promptly bring it up; or, if they force themselves to keep it down, they are nauseated and feel their stomach turned up, and endeavouring to relieve itself of its discomfort.
Thus, as was said at the beginning, all the observed facts testify that there must exist in almost all parts of the animal a certain inclination towards, or, so to p249 speak, an appetite for their own special quality, and an aversion to, or, as it were, a hatred of the foreign quality. And it is natural that when they feel an inclination they should attract, and that when they feel aversion they should expel.
From these facts, then, again, both the attractive and the propulsive faculties have been demonstrated to exist in everything.
But if there be an inclination or attraction, there will also be some benefit derived; for no existing thing attracts anything else for the mere sake of attracting, but in order to benefit by what is acquired by the attraction. And of course it cannot benefit by it if it cannot retain it. Herein, then, again, the retentive faculty is shown to have its necessary origin: for the stomach obviously inclines towards its own proper qualities and turns away from those that are foreign to it.
But if it aims at and attracts its food and benefits by it while retaining and contracting upon it, we may also expect that there will be some termination to the benefit received, and that thereafter will come the time for the exercise of the eliminative faculty.
7 1 But if the stomach both retains and benefits by its food, then it employs it for the end for which it [the stomach] naturally exists. And it exists to partake of that which is of a quality befitting and proper to p251 it. Thus it attracts all the most useful parts of the food in a vaporous and finely divided condition, storing this up in its own coats, and applying it to them. And when it is sufficiently full it puts away from it, as one might something troublesome, the rest of the food, this having itself meanwhile obtained some profit from its association with the stomach. For it is impossible for two bodies which are adapted for acting and being acted upon to come together without either both acting or being acted upon, or else one acting and the other being acted upon. For if their forces are equal they will act and be acted upon equally, and if the one be much superior in strength, it will exert its activity upon its passive neighbour; thus, while producing a great and appreciable effect, it will itself be acted upon either little or not at all. But it is herein also that the main difference lies between nourishing food and a deleterious drug; the latter masters the forces of the body, whereas the former is mastered by them.
There cannot, then, be food which is suited for the animal which is not also correspondingly subdued by the qualities existing in the animal. And to be subdued means to undergo alteration. Now, some parts are stronger in power and others weaker; therefore, while all will subdue the nutriment which is proper to the animal, they will not all do so equally. Thus the stomach will subdue and alter its food, but not to the same extent as will the liver, veins, arteries, and heart.
We must therefore observe to what extent it does alter it. The alteration is more than that which p253 occurs in the mouth, but less than that in the liver and veins. For the latter alteration changes the nutriment into the substance of blood, whereas that in the mouth obviously changes it into a new form, but certainly does not completely transmute it. This you may discover in the food which is left in the intervals between the teeth, and which remains there all night; the bread is not exactly bread, nor the meat meat, for they have a smell similar to that of the animal's mouth, and have been disintegrated and dissolved, and have had the qualities of the animal's flesh impressed upon them. And you may observe the extent of the alteration which occurs to food in the mouth if you will chew some cornº and then apply it to an unripe [undigested] boil: you will see it rapidly transmuting — in fact entirely digesting — the boil, though it cannot do anything of the kind if you mix it with water. And do not let this surprise you; this phlegm [saliva] in the mouth is also a cure for lichens; it even rapidly destroys scorpions; while, as regards the animals which emit venom, some it kills at once, and others after an interval; to all of them in any case it does great damage. Now, the masticated food is all, firstly, soaked in and mixed up with this phlegm; and secondly, it is brought into contact with the actual skin of the mouth; thus it undergoes more change than the food which is wedged into the vacant spaces between the teeth.
But just as masticated food is more altered than the latter kind, so is food which has been swallowed more altered than that which has been merely masticated. p255 Indeed, there is no comparison between these two processes; we have only to consider what the stomach contains — phlegm, bile, pneuma, [innate] heat, and, indeed the whole substance of the stomach. And if one considers along with this the adjacent viscera like a lot of burning hearths around a great cauldron — to the right the liver, to the left the spleen, the heart above, and along with it the diaphragm (suspended and in a state of constant movement), and the omentum sheltering them all — you may believe what an extraordinary alteration it is which occurs in the food taken into the stomach.
How could it easily become blood if it were not previously prepared by means of a change of this kind? It has already been shown that nothing is altered all at once from one quality to its opposite. How then could bread, beef, beans, or any other food turn into blood if they had not previously undergone some other alteration? And how could the faeces be generated right away in the small intestine? For what is there in this organ more potent in producing alteration than the factors in the stomach? Is it the number of the coats, or the way it is surrounded by neighbouring viscera, or the time that the food remains in it, or some kind of innate heat which it contains? Most assuredly the intestines have the advantage of the stomach in none of these respects. For what possible reason, then, will objectors have it that bread may often remain a whole night in the stomach and still preserve its original qualities, whereas when once it is projected into the p257 intestines, it straightway becomes ordure? For, if such a long period of time is incapable of altering it, neither will the short period be sufficient, or, if the latter is enough, surely the longer time will be much more so! Well, then, can it be that, while the nutriment does undergo an alteration in the stomach, this is a different kind of alteration and one which is not dependent on the nature of the organ which alters it? Or if it be an alteration of this latter kind, yet one perhaps which is not proper to the body of the animal? This is still more impossible. Digestion was shown to be nothing else than an alteration to the quality proper to that which is receiving nourishment. Since, then, this is what digestion means and since the nutriment has been shown to take on in the stomach a quality appropriate to the animal which is about to be nourished by it, it has been demonstrated adequately that nutriment does undergo digestion in the stomach.
And Asclepiades is absurd when he states that the quality of the digested food never shows itself either in eructations or in the vomited matter, or on dissection. For of course the mere fact that the food smells of the body shows that it has undergone gastric digestion. But this man is so foolish that, when he hears the Ancients saying that the food is converted in the stomach into something "good," he thinks it proper to look out not for what is good in its possible effects, but for what is good to the taste: this is like saying that apples (for so one has to argue with him) become more apple-like [in flavour] in the stomach, or honey more honey-like!
p259 Erasistratus, however, is still more foolish and absurd, either through not perceiving in what sense the Ancients said that digestion is similar to the process of boiling, or because he purposely confused himself with sophistries. It is, he says, inconceivable that digestion, involving as it does such trifling warmth, should be related to the boiling process. This is as if we were to suppose that it was necessary to put the fires of Etna under the stomach before it could manage to alter the food; or else that, while it was capable of altering the food, it did not do this by virtue of its innate heat, which of course was moist, so that the word boil was used instead of bake.
What he ought to have done, if it was facts that he wished to dispute about, was to have tried to show, first and foremost, that the food is not transmuted or altered in quality by the stomach at all, and secondly, if he could not be confident of this, he ought to have tried to show that this alteration was not of any advantage to the animal. If, again, he were unable even to make this misrepresentation, he ought to have attempted to confute the postulate concerning the active principles — to show, in fact, that the functions taking place in the various parts do not depend on the way in which the Warm, Cold, Dry, and Moist are mixed, but on some other factor. And if he had not the audacity to misrepresent facts even so far as this, still he should have tried at least to show that the Warm is not the most active of all the principles which play a part in things governed by Nature. But if he was unable to demonstrate this any more than any of the previous propositions, then he ought not to have made himself ridiculous by quarrelling uselessly p261 with a mere name — as though Aristotle had not clearly stated in the fourth book of his "Meteorology," as well as in many other passages, in what way digestion can be said to be allied to boiling, and also that the latter expression is not used in its primitive or strict sense.
But, as has been frequently said already, the one starting-point of all this is a thorough-going enquiry into the question of the Warm, Cold, Dry and Moist; this Aristotle carried out in the second of his books "On Genesis and Destruction," where he shows that all the transmutations and alterations throughout the body take place as a result of these principles. Erasistratus, however, advanced nothing against these or anything else that has been said above, but occupied himself merely with the word "boiling."
8 1 Thus, as regards digestion, even though he neglected everything else, he did at least attempt to prove his point — namely, that digestion in animals differs from boiling carried on outside; in regard to the question of deglutition, however, he did not go even so far as this. What are his words?
"The stomach does not appear to exercise any traction." Now the fact is that the stomach possesses two coats, which certainly exist for some purpose; they extend as far as the mouth, the internal one remaining throughout similar to what it is in the stomach, and the other one tending to become of a more fleshy u263nature in the gullet. Now simple observation will testify that these coats have their fibres inserted in contrary directions. And, although Erasistratus did not attempt to say for what reason they are like this, I am going to do so.
The inner coat has its fibres straight, since it exists for the purpose of traction. The outer coat has its fibres transverse, for the purpose of peristalsis. In fact, the movements of each of the mobile organs of the body depend on the setting of the fibres. Now please test this assertion first in the muscles themselves; in these the fibres are most distinct, and their movements visible owing to their vigour. And after the muscles, pass to the physical organs, and you will see that they all move in correspondence with their fibres. This is why the fibres throughout the intestines are circular in both coats — they only contract peristaltically, they do not exercise traction. The stomach, again, has some of its fibres longitudinal for the purpose of traction and the others transverse for the purpose of peristalsis. For just as the movements in the muscles take place when each of the fibres becomes tightened and drawn towards its origin, such also is what happens in the stomach; when the transverse fibres tighten, the breadth of p265 the cavity contained by them becomes less; and when the longitudinal fibres contract and draw in upon themselves, the length must necessarily be curtailed. This curtailment of length, indeed, is well seen in the act of swallowing: the larynx is seen to rise upwards to exactly the same degree that the gullet is drawn downwards; while, after the process of swallowing has been completed and the gullet is released from tension, the larynx can be clearly seen to again. This is because the inner coat of the stomach, which has the longitudinal fibres and which also lines the gullet and the mouth, extends to the interior of the larynx, and it is thus impossible for it to be drawn down by the stomach without the larynx being involved in the traction.
Further, it will be found acknowledged in Erasistratus's own writings that the circular fibres (by which the stomach as well as other parts performs its contractions) do not curtail its length, but contract and lessen its breadth. For he says that the stomach contracts peristaltically round the food during the whole period of digestion. But if it contracts, without in any way being diminished in length, this is because downward traction of the gullet is not a property of the movement of circular peristalsis. For what alone happens, as Erasistratus himself said, is that when the upper parts contract the lower ones dilate. And everyone knows that this can be plainly seen happening even in a dead man, if water be poured down his throat; this symptom results from the passage of matter through a narrow p267 channel; it would be extraordinary if the channel did not dilate when a mass was passing through it. Obviously then the dilatation of the lower parts along with the contraction of the upper is common both to dead bodies, when anything whatsoever is passing through them, and to living ones, whether they contract peristaltically round their contents or attract them.
Curtailment of length, on the other hand, is peculiar to organs which possess longitudinal fibres for the purpose of attraction. But the gullet was shown to be pulled down; for otherwise it would not have drawn upon the larynx. It is therefore clear that the stomach attracts food by the gullet.
Further, in vomiting, the mere passive conveyance of rejected matter up to the mouth will certainly itself suffice to keep open those parts of the oesophagus which are distended by the returned food; as it occupies each part in front [above], it first dilates this, and of course leaves the part behind [below] contracted. Thus, in this respect at least, the condition of the gullet is precisely similar to what it is in the act of swallowing. But there being no traction, the whole length remains equal in such cases.
And for this reason it is easier to swallow than to vomit, for deglutition results the coats of the stomach being brought into action, the inner one exerting a pull and the outer one helping by peristalsis and propulsion, whereas emesis occurs from the outer coat alone functioning, without there p269 being any kind of pull towards the mouth. For, although the swallowing of food is ordinarily preceded by a feeling of desire on the part of the stomach, there is in the case of vomiting no corresponding desire from the mouth-parts for the experience; the two are opposite dispositions of the stomach itself; it yearns after and tends towards what is advantageous and proper to it, it loathes and rids itself of what is foreign. Thus the actual process of swallowing occurs very quickly in those who have a good appetite for such foods as are proper to the stomach; this organ obviously draws them in and down before they are masticated; whereas in the case of those who are forced to take a medicinal draught or who take food as medicine, the swallowing of these articles is accomplished with distress and difficulty.
From what has been said, then, it is clear that the inner coat of the stomach (that containing longitudinal fibres) exists for the purpose of exerting a pull the from to stomach, and that it is only in deglutition that it is active, whereas the external coat, which contains transverse fibres, has been so constituted in order that it may contract upon its contents and propel them forward; this coat furthermore, functions in vomiting no less than in swallowing. The truth of my statement is also borne out by what happens in the channae and synodonts; the stomachs of these animals are sometimes found in their mouths, as also Aristotle writes in his History p271 of Animals; he also adds the causcause of this: he says that it is owing to their voracity.
The facts are as follows. In all animals, when the appetite is very intense, the stomach rises up, so that some people who have a clear perception of this condition say that their stomach "creeps out" of them; in others, who are still masticating their food and have not yet worked it up properly in the mouth, the stomach obviously snatches away the food from them against their will. In those animals, therefore, which are naturally voracious, in whom the mouth cavity is of generous proportions, and the stomach situated close to it (as in the case of the synodont and channa), it is in no way surprising that, when they are sufficiently hungry and are pursuing one of the smaller animals, and are just on the point of catching it, the stomach should, under the impulse of desire, spring into the mouth. And this cannot possibly take place in any other way than by the stomach drawing the food to itself by means of the gullet, as though by a hand. In fact, just as we ourselves, in our eagerness to grasp more quickly something lying before us, sometimes stretch out our whole bodies along with our hands, so also the stomach stretches itself forward along with the gullet, which is, as it were, its hand. And thus, in these animals in whom those three factors co-exist — an excessive propensity for food, a small gullet, and ample mouth proportions — in these, any slight tendency to movement forwards brings the whole stomach into the mouth.
Now the constitution of the organs might itself suffice to give a naturalist an indication of their functions. For Nature would never have purposelessly p273 constructed the oesophagus of two coats with contrary dispositions; they must also have each been meant to have a different action. The Erasistratean school, however, are capable of anything rather than of recognizing the effects of Nature. Come, therefore, let us demonstrate to them by animal dissection as well that each of the two coats does exercise the activity which I have stated. Take an animal, then; lay bare the structures surrounding the gullet, without severing any of the nerves, arteries, or veins which are there situated; next divide with vertical incisions, from the lower jaw to the thorax, the outer coat of the oesophagus (that containing transverse fibres); then give the animal food and you will see that it still swallows although the peristaltic function has been abolished. If, again, in another animal, you cut through both coats with transverse incisions, you will observe that this animal also swallows although the inner coat is no longer functioning. From this it is clear that the animal can also swallow by either of the two coats, although not so well as by both. For the following also, in addition to other points, may be distinctly observed in the dissection which I have described — that during deglutition the gullet becomes slightly filled with air which is swallowed along with the food, and that, when the outer coat is contracting, this air is easily forced with the p275 food into the stomach, but that, when there only exists an inner coat, the air impedes the conveyance of p275 food, by distending this coat and hindering its action.
But Erasistratus said nothing about this, nor did he point out that the oblique situation of the gullet clearly confutes the teaching of those who hold that it is simply by virtue of the impulse from above that food which is swallowed reaches the stomach. The only correct thing he said was that many of the long-necked animals bend down to swallow. Hence, clearly, the observed fact does not show how we swallow but how we do not swallow. For from this observation it is clear that swallowing is not due merely to the impulse from above; it is yet, however, not clear whether it results from the food being attracted by the stomach, or conducted by the gullet. For our part, however, having enumerated all the different considerations — those based on the constitution of the organs, as well as those based on the other symptoms which, as just mentioned, occur both before and after the gullet has been exposed — we have thus sufficiently proved that the inner coast exists for the purpose of attraction and the outer for the purpose of propulsion.
Now the original task we set before ourselves was to demonstrate that the retentive faculty exists in every one of the organs, just as in the previous book we proved the existence of the attractive, and, over and above this, the alterative faculty. Thus, in the natural course of our argument, we have demonstrated these four faculties existing in the stomach — the attractive faculty in connection with swallowing, the retentive with digestion, the expulsive with vomiting and with the descent of digested food into the small intestine — and digestion itself we have shown to be a process of alteration.
p277 9 1 Concerning the spleen, also, we shall therefore have no further doubts as to whether it attracts what is proper to it, rejects what is foreign, and has a natural power of altering and retaining all that it attracts; nor shall we be in any doubt as to the liver, veins, arteries, heart, or any other organ. For these four faculties have been shown to be necessary for every part which is to be nourished; this is why we have called these faculties the handmaids of nutrition. For just as human faeces are most pleasing to dogs, so the residual matters from the liver are, some of them, proper to the spleen, others to the gall-bladder, and others to the kidneys.
10 1 I should not have cared to say anything further as to the origin of these [surplus substances] after Hippocrates, Plato, Aristotle, Diocles, Praxagoras, and Philotimus, nor indeed should I even have said anything about the faculties, if any of our predecessors had worked out this subject thoroughly.
While, however, the statements which the Ancients made on these points were correct, they yet omitted to defend their arguments with logical proofs; of course they never suspected that there could be sophists so shameless as to try to contradict obvious facts. More recent physicians, again, have been p279 partly conquered by the sophistries of these fellows and have given credence to them; whilst others who attempted to argue with them appear to me to lack to a great extent the power of the Ancients. For this reason I have attempted to put together my arguments in the way in which it seems to me the Ancients, had any of them been still alive, would have done, in opposition to those who would overturn the finest doctrines of our art.
I am not, however, unaware that I shall achieve either nothing at all or else very little. For I find that a great many things which have been conclusively demonstrated by the Ancients are unintelligible to the bulk of the Moderns owing to their ignorance — nay, that, by reason of their laziness, they will not even make an attempt to comprehend them; and even if any of them have understood them, they have not given them impartial examination.
The fact is that he whose purpose is to know anything better than the multitude do must far surpass all others both as regards his nature and his early training. And when he reaches early adolescence he must become possessed with an ardent love for truth, like one inspired; neither day nor night may he cease to urge and strain himself in order to learn thoroughly all that has been said by the most illustrious of the Ancients. And when he has learnt this, then for a prolonged period he must test and prove it, observing what part of it is in agreement, and what in disagreement with obvious fact; thus he will choose this and turn away from that. To such an one my hope has been that my treatise would prove of the very greatest assistance. . . . p281 Still, such people may be expected to be quite few in number, while, as for the others, this book will be as superfluous to them as a tale told to an ass.
11 1 For the sake, then, of those who are aiming at truth, we must complete this treatise by adding what is still wanting in it. Now, in people who are very hungry, the stomach obviously attracts or draws down the food before it has been thoroughly softened in the mouth, whilst in those who have no appetite or who are being forced to eat, the stomach is displeased and rejects the food. And in a similar way of the other organs possesses both faculties — that of attracting what is proper to it, and that of rejecting what is foreign. Thus, even if there be any organ which consists of only one coat (such as the two bladders, the uterus, and the veins), it yet possesses both kinds of fibres, the longitudinal and the transverse.
But further, there are fibres of a third kind — the oblique — which are much fewer in number than the two kinds already spoken of. In the organs consisting of two coats this kind of fibre is found in the one coat only, mixed with the longitudinal fibres; but in the organs composed of one coat it is found along with the other two kinds. Now, these are of the greatest help to the action of the faculty which we have named retentive. For during this period the part needs to be tightly contracted and stretched over its contents at every point — the p283 stomach during the whole period of digestion,JJJ and the uterus during that of gestation.
Thus too, the coat of a vein, being single, consists of various kinds of fibres; whilst the outer coat of an artery consists of circular fibres, and its inner coat mostly of longitudinal fibres, but with a few oblique ones also amongst them. Veins thus resemble the uterus or the bladder as regards the arrangement of their fibres, even though they are deficient in thickness; similarly arteries resemble the stomach. Alone of all organs the intestines consist of two coats of which both have their fibres transverse. Now the proof that it was for the best that all the organs should be naturally such as they are (that, for instance, the intestines should be composed of two coats) belongs to the subject of the use of parts; thus we must not now desire to hear about matters of this kind nor why the anatomists are at variance regarding the number of coats in each organ. For these questions have been sufficiently discussed in the treatise "On Disagreement in Anatomy." And the problem as to why each organ has such and such a character will be discussed in the treatise "On the Use of Parts."
12 1 It is not, however, our business to discuss either of these questions here, but to consider duly the natural faculties, which, to the number of four, exist in each organ. Returning then, to this point, let us p285 recall what has already been said, and set a crown to the whole subject by adding what is still wanting. For when every part of the animal has been shewn to draw into itself the juice which is proper to it (this being practically the first of the natural faculties), the next point to realise is that the part does not get rid either of this attracted nutriment as a whole, or even of any superfluous portion of it, until either the organ itself, or the major part of its contents also have their condition reversed. Thus, when the stomach is sufficiently filled with the food and has absorbed and stored away the most useful part of it in its own coats, it then rejects the rest like an alien burden. The same happens to the bladders, when the matter attracted into them begins to give trouble either because it distends them through its quantity or irritates them by its quality.
And this also happens in the case of the uterus; for it is either because it can no longer bear to be stretched that it strives to relieve itself of its annoyance, or else because it is irritated by the quality of the fluids poured out into it. Now both of these conditions sometimes occur with actual violence, and then miscarriage takes place. But for the most part they happen in a normal way, this being then called not miscarriage but delivery or parturition. Now abortifacient drugs or certain other conditions which destroy the embryo or rupture certain of its membranes are followed by abortion, and similarly also when the uterus is in pain from being in a bad state of tension; and, as has been well said by Hippocrates, excessive movement on the part of the embryo itself brings on labour. Now pain¶ p287 is common to all these conditions, and of this there are three possible causes — either excessive bulk, or weight, or irritation; bulk when the uterus can no longer support the stretching, weight when the contents surpass its strength, and irritation when the fluids which had previously been pent up in the membranes, flow out, on the rupture of these, into the uterus itself, or else when the whole foetus perishes, putrefies, and is resolved into pernicious ichors, and so irritates and bites the coat of the uterus.
In all organs, then, both their natural effects and their disorders and maladies plainly take place on analogous lines, some so clearly and manifestly as to need no demonstration, and others less plainly, although not entirely unrecognizable to those who are willing to pay attention.
Thus, to take the case of the stomach: the irritation is evident here because this organ possesses most sensibility, and among its other affections those producing nausea and the so‑called heartburn clearly demonstrate the eliminative faculty which expels foreign matter. So also in the case of the uterus and the urinary bladder; this latter also may be plainly observed to receive and accumulate fluid until it is so stretched by the amount of this as to be incapable of enduring the pain; or it may be the quality of the urine which irritates it; for every superfluous substance which lingers in the body must obviously putrefy, some in a shorter, and some in a longer time, and thus it becomes pungent, acrid, and burdensome to the organ which contains it. This p289 does not apply, however, in the case of the bladder alongside the liver, whence it is clear that it possesses fewer nerves than do the other organs. Here too, however, at least the physiologist must discover an analogy. For since it was shown that the gall-bladder attracts its own special juice, so as to be often found full, and that it discharges it soon after, this desire to discharge must be either due to the fact that it is burdened by the quantity or that the bile has changed in quality to pungent and acrid. For while food does not change its original quality so fast that it is already ordure as soon as it falls into the small intestine, on the other hand the bile even more readily than the urine becomes altered in quality as soon as ever it leaves the veins, and rapidly undergoes change and putrefaction. Now, if there be clear evidence in relation to the uterus, stomach, and intestines, as well as to the urinary bladder, that there is either some distention, irritation, or burden inciting each of these organs to elimination, there is no difficulty in imagining this in the case of the gall-bladder also, as well as in the other organs, — to which obviously the arteries and veins also belong.
13 1 Nor is there any further difficulty in ascertaining that it is through the same channel that both attraction and discharge take place at different times. For obviously the inlet to the stomach does not merely p291 conduct food and drink into this organ, but in the condition of nausea it performs the neck of the bladder which is beside the liver, albeit single, both fills and empties the bladder. Similarly the canal of the uterus affords an entrance to the semen and an exit to the foetus.
But in this latter case, again, whilst the eliminative faculty is evident, the attractive faculty is not so obvious to most people. It is, however, the cervix which Hippocrates blames for inertia of the uterus when he says: — "Its orifice has no power of attracting semen."
Erasistratus, however, and Asclepiades reached such heights of wisdom that they deprived not merely the stomach and the womb of this faculty but also the bladder by the liver, and the kidneys as well. I have, however, pointed out in the first book that it is impossible to assign any other cause for the secretion of urine or bile.
Now, when we find that the uterus, the stomach and the bladder by the liver carry out attraction and expulsion through one and the same duct, we need no longer feel surprised that Nature should also frequently discharge waste-substances into the stomach through the veins. Still less need we be astonished if a certain amount of the food should, during long fasts, be drawn back from the liver into the stomach through the same veins by which it was yielded up to the liver during absorption of nutriment. To disbelieve such things p293 would of course be like refusing to believe that purgative drugs draw their appropriate humours from all over the body by the same stomata through which absorption previously takes place, and to look for separate stomata for absorption and purgation respectively. As a matter of fact one and the same stoma subserves two distinct faculties, and these exercise their pull at different times in opposite directions — first it subserves the pull of the liver and, during catharsis, that of the drug. What is there surprising, then, in the fact that the veins situated between the liver and the region of the stomach fulfil a double service or purpose? Thus, when there is abundance of nutriment contained in the food-canal, it is carried up to the liver by the veins mentioned; and when the canal is empty and in need of nutriment, this is again attracted from the liver by the same veins.
For everything appears to attract from and to go shares with everything else, and, as the most divine Hippocrates has said, there would seem to be a consensus in the movements of fluids and vapours. Thus the stronger draws and the weaker is evacuated.
Now, one part is weaker or stronger than another either absolutely, by nature, and in all cases, or else it becomes so in such and such a particular instance. Thus, by nature and in all men alike, the heart is stronger than the liver at attracting what is serviceable to it and rejecting what is not so; similarly the liver is stronger than the intestines and stomach, and p295 the arteries than the veins. In each of us personally, however, liver has stronger drawing power at one time, and the stomach at another. For when there is much nutriment contained in the alimentary canal and the appetite and craving of the liver is violent, then the viscus exerts far the strongest traction. Again, when the liver is full and distended and the stomach empty and in need, then the force of the traction shifts to the latter.
Suppose we had some food in our hands and were snatching it from one another; if we were equally in want, the stronger would be likely to prevail, but if he had satisfied his appetite, and was holding what was over carelessly, or was anxious to share it with somebody, and if the weaker was excessively desirous of it, there would be nothing to prevent the latter from getting it all. In a similar manner the stomach easily attracts nutriment from the liver when it [the stomach] has a sufficiently strong craving for it, and the appetite of the viscus is satisfied. And sometimes the surplusage of nutriment in the liver is a reason why the animal is not hungry; for when the stomach has better and more available food it requires nothing from extraneous sources, but if ever it is in need and is at a loss how to supply the need, it becomes filled with waste-matters; these are certain biliary, phlegmatic [mucous] and serous fluids, and are the only substances that the liver yields in response to the traction of the stomach, on the occasions when the latter too is in want of nutriment.
Now, just as the parts draw food from each other, so also they sometimes deposit their excess substances p297 in each other, and just as the stronger prevailed when the two were exercising traction, so it is also when they are depositing; this is the cause of the so‑called fluxions, for every part has a definite inborn tension, by virtue of which it expels its superfluities, and, therefore, when one of these parts, — owing, of course, to some special condition — becomes weaker, there will necessarily be a confluence into it of the superfluities from all the other parts. The strongest part deposits its surplus matter in all the parts near it; these again in other parts which are weaker; these next into yet others; and this goes on for a long time, until the superfluity, being driven from one part into another, comes to rest in one of the weakest of all; it cannot flow from this into another part, because none of the stronger ones will receive it, while the affected part is unable to drive it away.
When, however, we come to deal again with the origin and cure of disease, it will be possible to find there also abundant proofs of all that we have correctly indicated in this book. For the present, however, let us resume again the task that lay before us, i.e. to show that there is nothing surprising in nutriment coming from the liver to the intestines and stomach by way of the very veins through which it had previously been yielded up from these organs into the liver. And in many people who have suddenly and completely given up active exercise, or who have had a limb cut off, there occurs at certain periods an evacuation of blood by way of the intestines — as Hippocrates has also pointed out somewhere. This causes no further trouble but sharply purges the whole body and evacuates the plethoras; p299 the passage of the superfluities is effected, of course, through the same veins by which absorption took place.
Frequently also in disease Nature purges the animal through these same veins — although in this case the discharge is not sanguineous, but corresponds to the humour which is at fault. Thus in cholera the entire body is evacuated by way of the veins leading to the intestines and stomach.
To imagine that matter of different kinds is carried in one direction only would characterise a man who was entirely ignorant of all the natural faculties, and particularly of the eliminative faculty, which is the opposite of the attractive. For opposite movements of matter, active and passive, must necessarily follow opposite faculties; that is to say, every part, after it has attracted its special nutrient juice and has retained and taken the benefit of it hastens to get rid of all the surplusage as quickly and effectively as possible, and this it does in accordance with the mechanical tendency of this surplus matter.
Hence the stomach clears away by vomiting those superfluities which come to the surface of its contents, whilst the sediment it clears away by diarrhoea. And when the animal becomes sick, this means that the stomach is striving to be evacuated by vomiting. And the expulsive faculty has in it so violent and forcible an element that in cases of ileus [volvulus], when the lower exit is completely closed, vomiting of faeces occurs; yet such surplus matter could not be emitted from the mouth without having first traversed the whole of the small intestine, the jejunum, the pylorus, the stomach, and the oesophagus. What is there to wonder at, then, if something p301 should also be transferred from the extreme skin-surface and so reach the intestines and stomach? This also was pointed out to us by Hippocrates, who maintained that not merely pneuma or excess-matter, but actual nutriment is brought down from the outer surface to the original place from which it was taken up. For the slightest mechanical movements determine this expulsive faculty, which apparently acts through the transverse fibres, and which is very rapidly transmitted from the source of motion to the opposite extremities. It is, therefore, neither unlikely nor impossible that, when the part adjoining the skin becomes suddenly oppressed by an unwonted cold, it should at once be weakened and should find that the liquid previously deposited beside it without discomfort had now become more of a burden than a source of nutrition, and should therefore strive to put it away. Finally, seeing that the passage outwards was shut off by the condensation [of tissue], it would turn to the remaining exit and would thus forcibly expel all the waste-matter at once into the adjacent part; this would do the same to the part following it; and the process would not cease until the transference finally terminated at the inner of the veins.
Now, movements like these come to an end fairly soon, but those resulting from internal irritants (e.g., in the administration of purgative drugs or in cholera) become much stronger and more lasting; they persist as long as the condition of things about the mouths of the veins continues, that is, so long as p303 these continue to attract what is adjacent. For this condition causes evacuation of the contiguous part, and that again of the part next to it, and this never stops until the extreme surface is reached; thus, as each part keeps passing on matter to its neighbour, the original affection very quickly arrives at the extreme termination. Now this is also the case in ileus; the inflamed intestine is unable to support either the weight or the acridity of the waste substances and so does its best to excrete them, in fact to drive them as far away as possible. And, being prevented from effecting an expulsion downwards when the severest part of the inflammation is there, it expels the matter into the adjoining part of the intestines situated above. Thus the tendency of the eliminative faculty is step by step upwards, until the superfluities reach the mouth.
Now this will be also spoken of at greater length in my treatise on disease. For the present, however, I think I have shown clearly that there is a universal conveyance or transference from one thing into another, and that, as Hippocrates used to say, there exists in everything a consensus in the movement of air and fluids. And I do not think that anyone, however slow his intellect, will now be at a loss to understand any of these points, — how, for instance, the stomach or intestines get nourished, or in what manner anything makes its way inwards from the outer surface of the body. Seeing that all parts have the faculty of attracting what is suitable or well-disposed and of eliminating what is troublesome or irritating, it is not surprising that opposite movements should occur in them consecutively — as may p305 be clearly seen in the case of the heart, in the various arteries, in the thorax, and lungs. In all these the active movements of the organs and therewith the passive movements of [their contained] matters may be seen taking place almost every second in opposite directions. Now, you are not astonished when the trachea-artery alternately draws air into the lungs and gives it out, and when the nostrils and the whole mouth act similarly; nor do you think it strange or paradoxical that the air is dismissed through the very channel by which it was admitted just before. Do you, then, feel a difficulty in the case of the veins which pass down from the liver into the stomach and intestines, and do you think it strange that nutriment should at once be yielded up to the liver and drawn back from it into the stomach by the same veins? You must define what you mean by this expression "at once." If you mean "at the same time" this is not what we ourselves say; for just as we take in a breath at one moment and give it out again at another, so at one time the liver draws nutriment from the stomach, and at another the stomach from the liver. But if your expression "at once" means that in one and the same animal a single organ subserves the transport of matter in opposite directions, and if it is this which disturbs you, consider inspiration and expiration. For of course these also take place through the same organs, albeit they differ in their manner of movement, and in the way in which the matter is conveyed through them.
p307 Now the lungs, the thorax, the arteries rough and smooth, the heart, the mouth, and the nostrils reverse their movements at very short intervals and change the direction of the matters they contain. On the other hand, the veins which pass down from the liver to the intestines and stomach reverse the direction not at such short intervals, but sometimes once in many days.
The whole matter, in fact, is as follows: — Each of the organs draws into itself the nutriment alongside it, and devours all the useful fluid in it, until it is thoroughly satisfied; this nutriment, as I have already shown, it stores up in itself, afterwards making it adhere and then assimilating it — that is, it becomes nourished by it. For it has been demonstrated with sufficient clearness already that there is something which necessarily precedes actual nutrition, namely adhesion, and that before this again comes presentation. Thus as in the case of the animals themselves the end of eating is that the stomach should be filled, similarly in the case of each of the parts, the end of presentation is the filling of this part with its appropriate liquid. Since, therefore, every part has, like the stomach, a craving to be nourished, it too envelops its nutriment and clasps it all round as the stomach does. And this [action of the stomach], as has been already said, is necessarily followed by the digestion of the food, although it is not to make it suitable for the other parts that the stomach contracts upon it; if it did so, it would no longer be a physiological organ, but an animal possessing reason p309 and intelligence, with the power of choosing the better [of two alternatives].
But while the stomach contracts for the reason that the whole body possesses a power of attracting and of utilising appropriate qualities, as has already been explained, it also happens that, in this process, the food undergoes alteration; further, when filled and saturated with the fluid pabulum from the food, it thereafter looks on the food as a burden; thus it at once gets of the excess — that is to say, drives it gets downwards — itself turning to another task, namely that of causing adhesion. And during this time, while the nutriment is passing along the whole length of the intestine, it is caught up by the vessels which pass into the intestine; as we shall shortly demonstrate, most of it is seized by the veins, but a little also by the arteries; at this stage also it becomes presented to the coats of the intestines.
Now imagine the whole economy of nutrition divided into three periods. Suppose that in the first period the nutriment remains in the stomach and is digested and presented to the stomach until satiety is reached, also that some of it is taken up from the stomach to the liver.
During the second period it passes along the intestines and becomes presented both to them and to the liver — again until the stage of satiety — while a small part of it is carried all over the body. During this period, also imagine that what was presented to the stomach in the first period becomes now adherent to it.
During the third period the stomach has reached p311 the stage of receiving nourishment; it now entirely assimilates everything that had become adherent to it: at the same time in the intestines and liver there takes place adhesion of what had been before presented, while dispersal [anadosis] is taking place to all parts of the body, as also presentation. Now, if the animal takes food immediately after these [three stages] then, during the time that the stomach is again digesting and getting the benefit of this by presenting all the useful part of it to its own coats, the intestines will be engaged in final assimilation of the juices which have adhered to them, and so also will the liver: while in the various parts of the body there will be taking place adhesion of the portions of nutriment presented. And if the stomach is forced to remain without food during this time, it will draw its nutriment from the veins in the mesentery and liver; for it will not do so from the actual body of the liver (by body of the liver I mean first and foremost its flesh proper, and after this all the vessels contained in it), for it is irrational to suppose that one part would draw away from another part the juice already contained in it, especially when adhesion and final assimilation of that juice were already taking place; the juice, however, that is in the cavity of the veins will be abstracted by the part which is stronger and more in need.
It is in this way, therefore, that the stomach, when it is in need of nourishment and the animal has nothing to eat, seizes it from the veins in the liver. Also in the case of the spleen we have shown in a former passage how it draws all material from p313 the liver that tends to be thick, and by working it up converts it into more useful matter. There is nothing surprising, therefore, if, in the present instance also, some of this should be drawn from the spleen into such organs as communicate with it by veins, e.g. the omentum, mesentery, small intestine, colon, and the stomach itself. Nor is it surprising that the spleen should disgorge its surplus matters into the stomach at one time, while at another time it should draw some of its appropriate nutriment from the stomach.
For, as has already been said, speaking generally, everything has the power at different times of attracting from and of adding to everything else. What happens is just as if you might imagine a number of animals helping themselves at will to a plentiful common stock of food; some will naturally be eating when others have stopped, some will be on the point of stopping when others are beginning, some eating together, and others in succession. Yes, by Zeus! and one will often be plundering another, if he be in need while the other has an abundant supply ready to hand. Thus it is in no way surprising that matter should make its way back from the outer surface of the body to the interior, or should be carried from the liver and spleen into the stomach by the same vessels by which it was carried in the reverse direction.
In the case of the arteries this is clear enough, as also in the case of heart, thorax, and lungs; for, since all of these dilate and contract alternately, it must needs be that matter is subsequently discharged back into the parts from which it was p315 previously drawn. Now Nature foresaw this necessity, and provided the cardiac openings of the vessels with membranous attachments, to prevent their contents from being carried backwards. How and in what manner this takes place will be stated in my work "On the Use of Parts," where among other things I show that it is impossible for the openings of the vessels to be closed so accurately that nothing at all can run back. Thus it is inevitable that the reflux into the venous artery (as will also be made clear in the work mentioned) should be much greater than through the other openings. But what it is important for our present purpose to recognise is that every thing possessing a large and appreciable cavity must, when it dilates, abstract matter from all its neighbours, and, when it contracts, must squeeze matter back into them. This should all be clear from what has already been said in this treatise and from what Erasistratus and I myself have demonstrated elsewhere respecting the tendency of a vacuum to become refilled.
Put together, therefore, the two facts — that the arteries have this motion, and that everything, when p317 it dilates, draws neighbouring matter into itself — and you will find nothing strange in the fact that those arteries which reach the skin draw in the outer air when they dilate, while those which anastomose at any point with the veins attract the thinnest and most vaporous part of the blood which these contain, and as for those arteries which are near the heart, it is on the heart itself that they exert their traction. For, by virtue of the tendency by which a vacuum becomes refilled, the lightest and thinnest part obeys the tendency before that which is heavier and thicker. Now the lightest and thinnest of anything in the body is firstly pneuma, secondly vapour, and in the third place that part of the blood which has been accurately elaborated and refined.
These, then, are what the arteries draw into themselves on every side; those arteries which reach the skin draw in the outer air (this being near them and one of the lightest of things); as to the other arteries, those which pass up from the heart into the neck, and that which lies along the spine, as also such arteries as are near these — draw mostly from the heart itself; and those which are farther from the heart and skin necessarily draw the lightest part of the blood out of the veins. So also the traction exercised by the diastole of the arteries which go to the stomach and intestines takes place at the expense of the heart itself and the numerous veins in its neighbourhood; for these arteries cannot get anything worth speaking of from the thick heavy nutriment contained in the intestines and stomach, since they first become filled with lighter elements. For if you let down a tube into a vessel p319 full of water and sand, and suck the air out of the tube with your mouth, the sand cannot come up to you before the water, for in accordance with the principle of the refilling of a vacuum the lighter matter is always the first to succeed to the evacuation.
15 1 It is not to be wondered at, therefore, that only a very little [nutrient matter] such, namely, as has been accurately elaborated — gets from the stomach into the arteries, since these first become filled with lighter matter. We must understand that there are two kinds of attraction, that by which a vacuum becomes refilled and that caused by appropriateness of quality; air is drawn into bellows in one way, and iron by the lodestone in another. And we must also understand that the traction which results from evacuation acts primarily on what is light, whilst that from appropriateness of quality acts frequently, it may be, on what is heavier (if this should be naturally more nearly related). Therefore, in the case of the heart and the arteries, it is in so far as they are hollow organs, capable of diastole, that they always attract the lighter matter first, while, in so far as they require nourishment, it is actually into their coats (which are the real bodies of these organs) that the appropriate matter is drawn. Of the blood, then, which is taken into their cavities when they dilate, that part which is most proper to them and p321 most able to afford nourishment is attracted by their actual coats.
Now, apart from what has been said, the following is sufficient proof that something is taken over from the veins into the arteries. If you will kill an animal by cutting though a number of its large arteries, you will find the veins becoming empty along with the arteries: now, this could never occur if there were not anastomoses between them. Similarly, also, in the heart itself, the thinnest portion of the blood is drawn from the right ventricle into the left, owing to there being perforations in the septum between them: these can be seen for a great part [of their length]; they are like a kind of fossae [pits] with wide mouths, and they get constantly narrower; it is not possible, however, actually to observe their extreme terminations, owing both to the smallness of these and to the fact that when the animal is dead all the parts are chilled and shrunken.JJJ Here, too, however, our argument,JJJ starting from the principle that nothing is done by Nature in vain, discovers these anastomoses between the ventricles of the heart; for it could not be at random redeem and by chance that there occurred fossae ending thus in narrow terminations.
And secondly [the presence of these anastomoses has been assumed] from the fact that, of the two orifices in the right ventricle, the one conducting blood in and the other our, the formerJJJ is much the larger. For, the fact that the insertion of the vena cava into the heartJJJ is larger than the p323 vein which is inserted into the lungsJJJ suggests that not all the blood which the vena cava gives to the heart is driven away again from the heart of that lungs. Nor can it be said that any of the blood is expended in the nourishment of the actual body of the heart, since there is another veinJJJ which breaks up in it and which does not take its origin nor get its share of blood from the heart itself. And even if a certain amount is so expended, still the vein leading to the lungs is not to such a slight extent smaller than that inserted into the heart as to make it likely that the blood is used as nutriment for the heart: the disparity is much too great for such an explanation. It is, therefore, clear that something is taken over into the left ventricle.JJJ
Moreover, of the two vessels connected with it, that which brings pneuma into it from the lungsJJJ is much smaller than the great outgrowing arteryJJJ from which the arteries all over the body originate; this would suggest that it not merely gets pneuma from the lungs, but that it also gets blood from the right ventricle through the anastomoses mentioned.
Now it belongs to the treatise "On the Use of Parts" to show that it was best that some parts of the body should be nourished by pure, thin, and vaporous blood, and others by thick, turbid blood, and that in this matter also Nature has overlooked nothing. Thus it is not desirable that these matters be further discussed. Having mentioned, p325 however, that there are two kinds of attraction, certain bodies exerting attraction along wide channels during diastole (by virtue of the principle by which a vacuum becomes refilled) and others exerting it by virtue of their appropriateness of quality, we must next remark that the former bodies can attract even from a distance, while the latter can only do so from among things which are quite close to them; the very longest tube let down into water can easily draw up the liquid into the mouth, but if you withdraw iron to a distance from the lodestone or corn from the jar (an instance of this kind has in fact already been given)JJJ no further attraction can take place.
This you can observe most clearly in connection with garden conduits. For a certain amount of moisture is distributed from these into every part lying close at hand but it cannot reach those lying further off: therefore one has to arrange the flow of water into all parts of the garden by cutting a number of small channels leading from the large one. The intervening spaces between these small channels are made of such a size as will, presumably, best allow them [the spaces] to satisfy their needs by drawing from the liquid which flows to them from every side. So also is it in the bodies of animals. Numerous conduits distributed through the various limbs bring them pure blood, much like the garden water-supply, and, further, the intervals between these conduits have been wonderfully arranged by Nature from the outset took the intervening parts should be plentifully provided for when absorbing blood, and that they should never p327 be deluged by a quantity of superfluous fluid running in at unsuitable times.
For the way in which they obtain nourishment is somewhat as follows. In the bodyJJJ which is continuous throughout, such as Erasistratus supposes his simple vessel to be, it is the superficial parts which are the first to make use of the nutriment with which they are brought into contact; then the parts coming next draw their share from these by virtue of their contiguity; and again others from these; and this does not stop until the quality of the nutrient substance has been distributed among all parts of the corpuscle in question. And for such parts as need the humour which is destined to nourish them to be altered still further, Nature has provided a kind of storehouse, either in the form of a central cavity or else as separate caverns,JJJ or something analogous to caverns. Thus the flesh of the viscera and of the muscles is nourished from the blood directly, this having undergone merely a slight alteration; the bones, however, in order to be nourished, very great change, and what blood is to flesh marrow is to bone; in the case of the small bones, which do not possess central cavities, this marrow is distributed in their caverns, whereas in the larger bones which do contain central cavities the marrow is all concentrated in these. For, as was pointed out in the first book, things having a similar substance can easily change into one another, whereas it is impossible for those which are very different to be assimilated to one another without intermediate stages.
Such a one in respect to p329 cartilage is the myxoid substance which surrounds it, and in respect to ligaments, membranes, and nerves the viscous liquid dispersed inside them; for each of these consists of numerous fibres, which are homogeneous — in fact, actual sensible elements; and in the intervals between these fibres is dispersed the humour most suited for nutrition; this they drawn from the blood in the veins, choosing the most appropriate possible, and now they are assimilating it step by step and changing it into their own substance. All these considerations, then, agree with one another, and bear sufficient witness to the truth of what has been already demonstrated; there is thus no need to prolong the discussion further. For, from what has been said, anyone can readily discover in what way all the particular [vital activities] come about. For instance, we could in this way ascertain why it is that in the case of many people who are partaking freely of wine, the fluid which they have drunk is rapidly absorbed through the body and almost the whole of it is passed by the kidneys within a very short time. For here, too, the rapidity with which the fluid is absorbed depends on appropriateness of quality, on the thinness of the fluid, on the width of the vessels and their mouths, and on the efficiency of the attractive faculty. The parts situated near the alimentary canal, by virtue of their appropriateness of quality, draw in the imbibed food for their own purposes, then the parts next to them p331 in their turn snatch it away, then those next again take it from these, until it reaches the vena cava, whence finally the kidneys attract that part of it which is proper to them. Thus it is in no way surprising that wine is taken up more rapidly than water, owing to its appropriateness of quality, and, further, that the white clear kind of wine is absorbed more rapidly owing to its thinness, while black turbid wine is checked on the way and retarded because of its thickness. These facts, also, will afford abundant proof of what has already been said about the arteries; everywhere, in fact, such blood as is both specifically appropriate and at the same time thin in consistency answers more readily to their traction than does blood which is not so; this is why the arteries which, in their diastole, absorb vapour, pneuma, and thin blood attract either none at all or very little of the juices contained in the stomach and intestines.
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