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 ispresented228must 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 ofattraction, 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 ofpresentation228in order to feed them up, he argues that the factor of “refilling”227must play an equally large part. And how could muchpresentationtake place if it were not preceded by an abundantdelivery229of 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 butdistribution,230as some people have thought fit to name it, and then ascribes conveyancethrough the veins to the principle of vacuum-refilling alone, let him explain to us the assumption of food by the hypothetical elements.231For 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.232It can, however, take it in through its sides from the adjacent simple vein. Secondly, I also accept in Erasistratus’s 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.
Let us, then, consider together how it is attracted. How else than in the way that iron is attracted bythe lodestone, the latter having a faculty attractive of this particular quality [existing in iron]?233But if the beginning of anadosis depends on the squeezing action of the stomach,234and 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 Asclepiades235though 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.
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 thehumours, 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 howbilecomes into existencein 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!236And 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 thebloodas well—whether it takes its origin in the body, or is distributed through the food as is maintained by those who postulatehomœmeries?237Assuredly it would be much more useful to investigate what kinds of food are suited, and what kinds unsuited, to the process of blood-production238rather 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 chylified239in 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 itmay 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 ofdropsieslogically 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 thenarrowness of the passages, and that dropsy can never occur in any other way? For, to imagine that dropsy is never caused by the spleen240or any other part, but always by induration of the liver,241is 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,242or which, through immoderate bleeding, have given the patient a severe chill; similarly, in women, the complete disappearance of the monthly discharge,243or 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 accountthe dropsy which begins in the flanks or in any other susceptible part; this clearly confutes Erasistratus’s 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,244very 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 Philistion245despised, 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 and 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.246Now, 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,”247he argues jealously with those who consider that this is a process of putrefaction of the food; and, in his work “On Anadosis,”248with 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,249as 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 theorigin of blood(which is in no way less important than the chylification250of 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?251Are 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 somethingelse 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 case 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.252
For what could a man possibly say about blood who had no use forinnate 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 a fluid of this kind253arises 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 purified254in 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 whatstate of the bodyis followed by a greater, and what by a smaller occurrence of bile?255For 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 whyhoneyproduces yellow bile is not that it contains a large quantity of this within itself, but because it [the honey] undergoes change, becomingalteredand 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 bilein every person who took it. The facts, however, are not so.256For 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, lurkingin holes like corpses. Further, the question of the colour of the blood has been dealt with not only by Aristotle but also by Plato.257Now 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 thegenesis of the humours, I do not know that any one could add anything wiser than what has been said by Hippocrates, Aristotle, Praxagoras, Philotimus258and 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 facts259agree 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 natures260themselves, the colder are more phlegmatic, and the warmer morebilious. Also cold diseases result from phlegm, 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;261for 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 wound262gastric digestion does not become impaireduntil after 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 whatit 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 heat263(for these two symptoms occurred besides the bubo—an alteration in the arterial and cardiac movements264and 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, thepneuma, which is propelled through the arteries and into the alimentary canal, is of great service in digestion;265there 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 inquestion (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?266But 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 theprimary diseases. But, indeed, ifdisproportionof heat belongs to the primary diseases, it cannot but be that aproportionateblending [eucrasia] of the qualities produces the normal activity.267For 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 its derangement.
I think, then, it has been proved to the satisfaction of those people who are capable of seeing logical consequences, that, even according to Erasistratus’s own argument, the cause of the normal functions is eucrasia of the Warm.268Now, this being so, there is nothing further to prevent us from sayingthat, 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 its 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.269Therefore 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,270for 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 isaccomplishedin 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.
For this reason the things that we have said are not to be looked upon as proofs but rather as indications of the dulness271of 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 spoken272—namely, that bodies act upon and are acted upon by each other in virtue of the Warm, Cold, Moist and Dry. And if one isspeaking 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 thecause; 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 thepractitioner,273and belong to that of thescientific investigator.”274Are you, then, going to oppose those who maintain that the cause of the function of every organ is a natural eucrasia,275that the dyscrasia is itself known as adisease, 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 areinvestigating 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 thecauseof its disability? What I say is276that 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 leastinvestigatehowit 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 avirtuallywarm 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 theapparentlydry would seem to differ from thevirtuallydry.) Who does not know that brine and sea-water preserve meat and keep it uncorrupted,277whilst 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,phlegmhas been called cold and moist; for about this also clear proofs have been given by Hippocrates and the other Ancients.
Prodicus278also, when in his book “On the Nature of Man” he gives the name “phlegm” (from the verb πεφλέχθαι) to that element in the humours which has been burned or, as it were, over-roasted, while usinga 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.279Thus, the white-coloured substance which everyone else callsphlegm, and which Prodicus callsblenna[mucus],280is the well-known cold, moist humour which collects mostly in old people and in those who have been chilled281in 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 virtuallycold and dry? Is the fourth combination of temperaments, which exists in all other things, non-existent in the humours alone? No; theblack bileis 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 forclearing awayahumour 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’s 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 studies282in medicine? Thus he ought not to have said anything about thespleen,283nor 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 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 experience284agree with this. Again, in those cases in which the spleen is large and is increasing frominternal suppuration, it destroys the body and fills it with evil humours;285this 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 atrabiliary286humour 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 of order, so also the spleen, which has in itself a native power of attracting an atrabiliary quality,287if 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 thecausesby which everything throughout nature is governed (bythe 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.288And 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 undergoingalterationthrough the agency of its contained heat.289Imagine 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 theflowerand the other thelees. 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 becomesvitelline,290being 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 inits normal condition,291but no particular name has been given to [such a condition of] the humour, except that some people have called itcorrosiveoracetose, 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 nameblack humourand notblack bileto 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 callblack bilethat 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 nutriment292which belongs naturally to the thick and earth-like part of the food,292and 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), becomesyellow bile, and is cleared away through the so-called biliary293vessels; now, this is thin, moist, and fluid, not like what it is when, having been roasted to anexcessivedegree, it becomes yellow, fiery, and thick, like the yolk ofeggs; 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.294In 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-calledpotter’s earthand 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 a 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 ofserum. 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 andquality 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 itself295; 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 thefibreswhich it contains. And the use of these has been discussed by Plato,296and 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 awayphlegm, 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 undergoesalterationthere. And perhaps one cannot properly give the name ofphlegmto the surplus-substance which runs down from the brain,297but one should call itmucus[blenna] orcoryza—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 treatise298I have written on the humours according to Praxagoras, son of Nicarchus; although this authority makes as many as ten humours, notincluding 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.