Claudius Galenus

“ And I do not think that anyone, however slow his intellect, will now be at a loss to understand any of these points,—how, for instance, the stomach or intestines get nourished, or in what manner anything makes its way inwards from the outer surface of the body. Seeing that all parts have the faculty of attracting what is suitable or well-disposed and of eliminating what is troublesome or irritating, it is not surprising that opposite movements should occur in them consecutively—as may be clearly seen in the case of the heart, in the various arteries, in the thorax, and lungs. ”

“ I have, however, pointed out in the first book that it is impossible to assign any other cause for the secretion of urine or bile. Now, when we find that the uterus, the stomach and the bladder by the liver carry out attraction and expulsion through one and the same duct, we need no longer feel surprised that Nature should also frequently discharge waste-substances into the stomach through the veins. ”

“ And sometimes the surplusage of nutriment in the liver is a reason why the animal is not hungry; for when the stomach has better and more available food it requires nothing from extraneous sources, but if ever it is in need and is at a loss how to supply the need, it becomes filled with waste-matters; these are certain biliary, phlegmatic [mucous] and serous fluids, and are the only substances that the liver yields in response to the traction of the stomach, on the occasions when the latter too is in want of nutriment. ”

“ Thus, as was said at the beginning, all the observed facts testify that there must exist in almost all parts of the animal a certain inclination towards, or, so to speak, an appetite for their own special quality, and an aversion to, or, as it were, a hatred of the foreign quality. And it is natural that when they feel an inclination they should attract, and that when they feel aversion they should expel. ”

“ It has been made clear in the preceding discussion that nutrition occurs by an alteration or assimilation of that which nourishes to that which receives nourishment, and that there exists in every part of the animal a faculty which in view of its activity we call, in general terms, alterative, or, more specifically, assimilative and nutritive. ”

“ Thus, by nature and in all men alike, the heart is stronger than the liver at attracting what is serviceable to it and rejecting what is not so; similarly the liver is stronger than the intestines and stomach, and the arteries than the veins. In each of us personally, however, liver has stronger drawing power at one time, and the stomach at another. For when there is much nutriment contained in the alimentary canal and the appetite and craving of the liver is violent, then the viscus exerts far the strongest traction. ”

“ Suppose we had some food in our hands and were snatching it from one another; if we were equally in want, the stronger would be likely to prevail, but if he had satisfied his appetite, and was holding what was over carelessly, or was anxious to share it with somebody, and if the weaker was excessively desirous of it, there would be nothing to prevent the latter from getting it all. In a similar manner the stomach easily attracts nutriment from the liver when it [the stomach] has a sufficiently strong craving for it, and the appetite of the viscus is satisfied. ”

“ In fact, just as we ourselves, in our eagerness to grasp more quickly something lying before us, sometimes stretch out our whole bodies along with our hands, so also the stomach stretches itself forward along with the gullet, which is, as it were, its hand. And thus, in these animals in whom those three factors co-exist—an excessive propensity for food, a small gullet, and ample mouth proportions—in these, any slight tendency to movement forwards brings the whole stomach into the mouth. ”

“ The stomach does not appear to exercise any traction. Now the fact is that the stomach possesses two coats, which certainly exist for some purpose; they extend as far as the mouth, the internal one remaining throughout similar to what it is in the stomach, and the other one tending to become of a more fleshy nature in the gullet. Now simple observation will testify that these coats [the mucous and the muscular coats] have their fibres inserted in contrary directions. And, although Erasistratus did not attempt to say for what reason they are like this, I am going to do so. ”

“ In all animals, when the appetite is very intense, the stomach rises up, so that some people who have a clear perception of this condition say that their stomach “creeps out” of them; in others, who are still masticating their food and have not yet worked it up properly in the mouth, the stomach obviously snatches away the food from them against their will. ”

“ Now it is impossible to speak of both organs at once, so we shall deal with each in turn, beginning with the one which is capable of demonstrating the retentive faculty most plainly. For the stomach retains the food until it has quite digested it, and the uterus retains the embryo until it brings it to completion, but the time taken for the completion of the embryo is many times more than that for the digestion of food. ”

“ Put together, therefore, the two facts—that the arteries have this motion, and that everything, when it dilates, draws neighbouring matter into itself—and you will find nothing strange in the fact that those arteries which reach the skin draw in the outer air when they dilate, while those which anastomose at any point with the veins attract the thinnest and most vaporous part of the blood which these contain, and as for those arteries which are near the heart, it is on the heart itself that they exert their traction. ”

“ It is not to be wondered at, therefore, that only a very little [nutrient matter] such, namely, as has been accurately elaborated—gets from the stomach into the arteries, since these first become filled with lighter matter. We must understand that there are two kinds of attraction, that by which a vacuum becomes refilled and that caused by appropriateness of quality; air is drawn into bellows in one way, and iron by the lodestone in another. ”

“ Thus those who are troubled with this symptom expect, with good reason, that they will also be unable to digest adequately; proper digestion cannot take place in a weak stomach. In such people also, the mass of food may be plainly seen to remain an abnormally long time in the stomach, as would be natural if their digestion were slow.
Indeed, the chief way in which these people will surprise one is in the length of time that not food alone but even fluids will remain in their stomachs. ”

“ And those especially who have a dislike to some particular kind of food, sometimes take it under compulsion, and then promptly bring it up; or, if they force themselves to keep it down, they are nauseated and feel their stomach turned up, and endeavouring to relieve itself of its discomfort. ”

“ A wonderful device of Nature’s also is this—that, when the foetus is alive, the os uteri is closed with perfect accuracy, but if it dies, the os at once opens up to the extent which is necessary for the foetus to make its exit. ”

“ Most assuredly the intestines have the advantage of the stomach in none of these respects. For what possible reason, then, will objectors have it that bread may often remain a whole night in the stomach and still preserve its original qualities, whereas when once it is projected into the intestines, it straightway becomes ordure? ”

“ Numerous conduits distributed through the various limbs bring them pure blood, much like the garden water-supply, and, further, the intervals between these conduits have been wonderfully arranged by Nature from the outset so that the intervening parts should be plentifully provided for when absorbing blood, and that they should never be deluged by a quantity of superfluous fluid running in at unsuitable times. ”

“ This curtailment of length, indeed, is well seen in the act of swallowing: the larynx is seen to rise upwards to exactly the same degree that the gullet is drawn downwards; while, after the process of swallowing has been completed and the gullet is released from tension, the larynx can be clearly seen to again. This is because the inner coat of the stomach, which has the longitudinal fibres and which also lines the gullet and mouth, extends to the interior of the larynx, and it is thus impossible for it to be drawn down by the stomach without the larynx being involved in the traction. ”

“ Here, then, once more, we must observe well the Art [artistic tendency] of Nature—how she has not merely placed in each organ the capabilities of useful activities, but has also fore-ordained the times both of rest and movement. ”

“ What prevents us, then, from taking up these first and considering their activities, conducting the enquiry on our own persons in regard to those activities which are obvious without dissection, and, in the case of those which are more obscure, dissecting animals which are near to man; not that even animals unlike him will not show, in a general way, the faculty in question, but because in this manner we may find out at once what is common to all and what is peculiar to ourselves, and so may become more resourceful in the diagnosis and treatment of disease. ”

“ For the slightest mechanical movements determine this expulsive faculty, which apparently acts through the transverse fibres, and which is very rapidly transmitted from the source of motion to the opposite extremities. It is, therefore, neither unlikely nor impossible that, when the part adjoining the skin becomes suddenly oppressed by an unwonted cold, it should at once be weakened and should find that the liquid previously deposited beside it without discomfort had now become more of a burden than a source of nutrition, and should therefore strive to put it away. ”

“ Still less need we be astonished if a certain amount of the food should, during long fasts, be drawn back from the liver into the stomach through the same veins by which it was yielded up to the liver during absorption of nutriment. ”

“ But if the nutritive juice, so presented, does not remain in the part, but withdraws to another one, and keeps flowing away, and constantly changing and shifting its position, neither adhesion nor complete assimilation will take place in front of them. Here too, then, the [animal’s] nature has need of some other faculty for ensuring a prolonged stay of the presented juice at the part, and this not a faculty which comes in from somewhere outside but one which is resident in the part which is to be nourished. ”

“ For opposite movements of matter, active and passive, must necessarily follow opposite faculties; that is to say, every part, after it has attracted its special nutrient juice and has retained and taken benefit of it hastens to get rid of all the surplusage as quickly and effectively as possible, and this it does in accordance with the mechanical tendency of this surplus matter. Hence the stomach clears away by vomiting those superfluities which come to the surface of its contents, whilst the sediment it clears away by diarrhoea. ”

“ It has also been shown that assimilation is preceded by adhesion, and this, again, by presentation, the latter stage being, as one might say, the end or goal of the activity corresponding to the attractive faculty. For the actual bringing up of nutriment from the veins into each of the parts takes place through the activation of the attractive faculty, whilst to have been finally brought up and presented to the part is the actual end for which we desired such an activity; it is attracted in order that it may be presented. After this, considerable time is needed for the nutrition of the animal ”

“ This is why the fibres throughout the intestines are circular in both coats—they only contract peristaltically, they do not exercise traction. The stomach, again, has some of its fibres longitudinal for the purpose of traction and the others transverse for the purpose of peristalsis. For just as the movements in the muscles take place when each of the fibres becomes tightened and drawn towards its origin, such also is what happens in the stomach; when the transverse fibres tighten, the breadth of the cavity contained by them becomes less ”

“ Thus it is in no way surprising that wine is taken up more rapidly than water, owing to its appropriateness of quality, and, further, that the white clear kind of wine is absorbed more rapidly owing to its thinness, while black turbid wine is checked on the way and retarded because of its thickness. ”

“ For while food does not change its original quality so fast that it is already ordure as soon as it falls into the small intestine, on the other hand the bile even more readily than the urine becomes altered in quality as soon as ever it leaves the veins, and rapidly undergoes change and putrefaction. ”

“ But there being no traction, the whole length remains equal in such cases. And for this reason it is easier to swallow than to vomit, for deglutition results the coats of the stomach being brought into action, the inner one exerting a pull and the outer one helping by peristalsis and propulsion, whereas emesis occurs from the outer coat alone functioning, without there being any kind of pull towards the mouth. For, although the swallowing of food is ordinarily preceded by a feeling of desire on the part from the mouth-parts for the experience ”

“ For everything connected with the pregnancy proceeds properly, the eliminative faculty remains quiescent as though it did not exist, but if anything goes wrong in connection either with the chlorion or any of the other membranes or with the foetus itself, and its completion is entirely despaired of, then the uterus no longer awaits the nine-months period, but the retentive faculty forthwith ceases and allows the heretofore inoperative faculty to come into action. ”

“ And, in many women who exercise such a faculty immoderately, violent cause forcible prolapse of the whole womb; here almost the same thing happens as frequently occurs in wresting—bouts and struggles, when in our eagerness to overturn and throw others we are ourselves upset along with them; for similarly when the uterus is forcing the embryo forward it sometimes becomes entirely prolapsed, and particularly when the ligaments connecting it with the spine happen to be naturally lax. ”