Claudius Galenus

“ 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! ”

“ 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. ”

“ 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. ”

“ Who, in fact, does not know that anything which is overcooked grows at first salty and afterwards bitter? And if you will boil honey itself, far the sweetest of 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. ”

“ 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 dycrasiae 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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, and did not produce it by undergoing change in the animal body, then they would produce it similarly in all bodies ”

“ 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. ”

“ 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? ”

“ 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. ”

“ 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. ”

“ Now, if on the other 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? ”

“ 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 contaminated 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 adjoining quantum of fluid should flow in and fill the place of the fluid evacuated. ”

“ 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 not 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, 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 [5] 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 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. ”

“ 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 on 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 ”

“ 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 ”

“ 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? ”

“ 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. ”

“ 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 ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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 purposefully 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. ”

“ 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. ”