Main Index Galen Book I a Book I b Book III

On the Natural Faculties

By Galen

Translated by Arthur John Brock


BOOK TWO

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 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 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. 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, 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 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 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!

3. 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 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 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 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. 

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. 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 plated, 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. 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 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; 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?

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 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. 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 liver 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. 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 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 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 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 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 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 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 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 impraticable 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 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 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. Let us, then, consider together how it is attracted. How else than
in the way that iron is attracted by 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. 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 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 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 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. 

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 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 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 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 poi 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 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 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 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 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
the 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 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, 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 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. 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 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 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 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 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 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 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 the 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 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 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 in its
normal condition, 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 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 the from 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 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, 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 mentioned 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, 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. 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, while the other part is useless and contrary to 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 treatise I have written on the humours according to Praxagoras,
to Praxagoras, son of authority Nicarchus; although this authority
makes as many as ten humours, not 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. 

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