The Kidneys

The truth in the doctrines of Hippocrates may be gauged from:

• how his opponents are at variance with obvious facts
• the various subjects of natural research themselves—the functions of animals, and the rest.

For those people who do not believe that there exists in any part of the animal a faculty for attracting its own special quality80 are compelled repeatedly to deny obvious facts.81

Asclepiades, the physician, did this in the case of the kidneys.

The kidneys are organs for secreting [separating out] the urine.

This was the belief of Hippocrates, Diocles, Erasistratus, Praxagoras, and all other physicians of eminence.

Every butcher is aware of this. He daily observes both the position of the kidneys and the duct (termed the ureter) which runs from each kidney into the bladder. From this arrangement, he infers their characteristic use and faculty.

People who suffer either from frequent dysuria or from retention of urine call themselves “nephritics”84.

• They feel pain in the loins and pass sandy matter in their water.

I do not think that Asclepiades ever:

• saw a stone which had been passed by one of these sufferers, or
• observed that this was preceded by a sharp pain in the region between kidneys and bladder as the stone traversed the ureter, or
• when the stone was passed, both the pain and the retention at once ceased.

His theory accounts for the presence of urine in the bladder.

• He puts aside these broad, clearly visible routes,85
• He postulates others which are narrow and invisible

He thinks that the fluid which we drink passes into the bladder by being resolved into vapours.

• When these have been again condensed, it regains its previous form, and turns from vapour into fluid.

The bladder is just a sponge. It is not a compact and impervious body with two very strong coats.

This is because he thinks that the vapours pass through these coats.

“But,” says he, “of course the peritoneal coat is more impervious than the bladder, and this is why it keeps out the vapours, while the bladder admits them.”

Yet if he had ever practised anatomy, he might have known that the outer coat of the bladder springs from the peritoneum and is essentially the same as it, and that the inner coat, which is peculiar to the bladder, is more than twice as thick as the former.

Perhaps, however, it is not the thickness or thinness of the coats, but the situation of the bladder, which is the reason for the vapours being carried into it?

On the contrary, even if it were probable for every other reason that the vapours accumulate there, yet the situation of the bladder would be enough in itself to prevent this.

For the bladder is situated below, whereas vapours have a natural tendency to rise upwards; thus they would fill all the region of the thorax and lungs long before they came to the bladder.

But why do I mention the situation of the bladder, peritoneum, and thorax?

Surely, when the vapours have passed through the coats of the stomach and intestines, it is in the space between these and the peritoneum87 that they will collect and become liquefied (just as in dropsical subjects it is in this region that most of the water gathers).88 Otherwise the vapours must necessarily pass straight forward through everything which in any way comes in contact with them, and will never come to a standstill.

But, if this be assumed, then they will traverse not merely the peritoneum but also the epigastrium, and will become dispersed into the surrounding air; otherwise they will certainly collect under the skin.

Even these considerations, however, our present-day Asclepiadeans attempt to answer, despite the fact that they always get soundly laughed at by all who happen to be present at their disputations on these subjects—so difficult an evil to get rid of is this sectarian partizanship, so excessively resistant to all cleansing processes, harder to heal than any itch!

Thus, one of our Sophists who is a thoroughly hardened disputer and as skilful a master of language as there ever was, once got into a discussion with me on this subject; so far from being put out of countenance by any of the above-mentioned considerations, he even expressed his surprise that I should try to overturn obvious facts by ridiculous arguments!

“For,” said he, “one may clearly observe any day in the case of any bladder, that, if one fills it with water or air and then ties up its neck and squeezes it all round, it does not let anything out at any point, but accurately retains all its contents.

nd surely,” said he, “if there were any large and perceptible channels coming into it from the kidneys the liquid would run out through these when the bladder was squeezed, in the same way that it entered?”89 Having abruptly made these and Pg 57 similar remarks in precise and clear tones, he concluded by jumping up and departing—leaving me as though I were quite incapable of finding any plausible answer!

The fact is that those who are enslaved to their sects are not merely devoid of all sound knowledge, but they will not even stop to learn! Instead of listening, as they ought, to the reason why liquid can enter the bladder through the ureters, but is unable to go back again the same way,—instead of admiring Nature’s artistic skill90—they refuse to learn; they even go so far as to scoff, and maintain that the kidneys, as well as many other things, have been made by Nature for no purpose!91

And some of them who had allowed themselves to be shown the ureters coming from the kidneys and becoming implanted in the bladder, even had the audacity to say that these also existed for no purpose; and others said that they were spermatic ducts, and that this was why they were inserted into the neck of the bladder and not into its cavity.

When, therefore, we had demonstrated to them the real spermatic ducts92 entering the neck of the bladder lower down than the ureters, we supposed that, if we had not done so before, we would now at least draw them away from their false assumptions, and convert them forthwith to the opposite view.

But even this they presumed to dispute, and said that it was not to be wondered at that the semen should remain longer in these latter ducts, these being more constricted, and that it should flow quickly down the ducts which came from the kidneys, seeing that these were well dilated.

We were, therefore, further compelled to show them in a still living animal, the urine plainly running out through the ureters into the bladder; even thus we hardly hoped to check their nonsensical talk.

Now the method of demonstration is as follows. One has to divide the peritoneum in front of the ureters, then secure these with ligatures, and next, having bandaged up the animal, let him go (for he will not continue to urinate). After this one loosens the external bandages and shows the bladder empty and the ureters quite full and distended—in fact almost on the point of rupturing; on removing the ligature from them, one then plainly sees the bladder becoming filled with urine.

When this has been made quite clear, then, before the animal urinates, one has to tie a ligature round his penis and then to squeeze the bladder all over; still nothing goes back through the ureters to the kidneys. Here, then, it becomes obvious that not only in a dead animal, but in one which is still living, the ureters are prevented from receiving back the urine from the bladder.

These observations having been made, one now loosens the ligature from the animal’s penis and allows him to urinate, then again ligatures one of the ureters and leaves the other to discharge into the bladder.

Allowing, then, some time to elapse, one now demonstrates that the ureter which was ligatured is obviously full and distended on the side next to the kidneys, while the other one—that from which the ligature had been taken—is itself flaccid, but has filled the bladder with urine. Then, again, one must divide the full ureter, and demonstrate how the urine spurts out of it, like blood in the operation of venesection; and after this one cuts through the other also, and both being thus divided, one bandages up the animal externally.

Then when enough time seems to have elapsed, one takes off the bandages; the bladder will now be found empty, and the whole region between the intestines and the peritoneum full of urine, as if the animal were suffering from dropsy. Now, if anyone will but test this for himself on an animal, I think he will strongly condemn the rashness of Asclepiades, and if he also learns the reason why nothing regurgitates from the bladder into the ureters, I think he will be persuaded by this also of the forethought and art shown by Nature in relation to animals.93

Now Hippocrates, who was the first known to us of all those who have been both physicians and philosophers inasmuch as he was the first to recognize what Nature effects, expresses his admiration of her, and is constantly singing her praises and calling her “just.” Alone, he says, she suffices for the animal in every respect, performing of her own accord and without any teaching all that is required. Being such, she has, as he supposes, certain faculties, one attractive of what is appropriate,94 and another eliminative of what is foreign, and she nourishes the animal, makes it grow, and expels its diseases by crisis.95 Therefore he says that there is in our bodies a concordance in the movements of air and fluid, and that everything is in sympathy.

According to Asclepiades, however, nothing is naturally in sympathy with anything else, all substance being divided and broken up into inharmonious elements and absurd “molecules.” Necessarily, then, besides making countless other statements in opposition to plain fact, he was ignorant of Nature’s faculties, both that attracting what is appropriate, and that expelling what is foreign.

Thus he invented some wretched nonsense to explain blood-production and anadosis,96 and, being utterly unable to find anything to say regarding the clearing-out97 of superfluities, he did not hesitate to join issue with obvious facts, and, in this matter of urinary secretion, to deprive both the kidneys and the ureters of their activity, by assuming that there were certain invisible channels opening into the bladder. It was, of course, a grand and impressive thing to do, to mistrust the obvious, and to pin one’s faith in things which could not be seen!

Also, in the matter of the yellow bile, he makes an even grander and more spirited venture; for he says this is actually generated in the bile-ducts, not merely separated out.

How comes it, then, that in cases of jaundice two things happen at the same time—that the dejections contain absolutely no bile, and that the whole body becomes full of it? He is forced here again to talk nonsense, just as he did in regard to the urine. He also talks no less nonsense about the black bile and the spleen, not understanding what was said by Hippocrates; and he attempts in stupid—I might say insane—language, to contradict what he knows nothing about.

He neither was able to cure a kidney ailment, nor jaundice, nor a disease of black bile.

nor would he agree with the view held not merely by Hippocrates but by all men regarding drugs—that some of them purge away yellow bile, and others black, some again phlegm, and others the thin and watery superfluity98; he held that all the substances evacuated99 were produced by the drugs themselves, just as yellow bile is produced by the biliary passages!

It matters nothing, according to this extraordinary man, whether we give a hydragogue or a cholagogue in a case of dropsy, for these all equally purge99 and dissolve the body, and produce a solution having such and such an appearance, which did not exist as such before!100

Must we not, therefore, suppose he was either mad, or entirely unacquainted with practical medicine? For who does not know that if a drug for attracting phlegm be given in a case of jaundice it will not even evacuate four cyathi101 of phlegm? Similarly also if one of the hydragogues be given. A cholagogue, on the other hand, clears away a great quantity of bile, and the skin of patients so treated at once becomes clear. I myself have, in many cases, after treating the liver condition, then removed the disease by means of a single purgation; whereas, if one had employed a drug for removing phlegm one would have done no good.

Hippocrates is not the only one who knows this to be so.

Those who take experience alone as their starting-point102 know otherwise; they, as well as all physicians who are engaged in the practice of medicine, are of this opinion. Asclepiades, however is an exception; he would hold it a betrayal of his assumed “elements”103 to confess the truth about such matters.

For if a single drug were to be discovered which attracted such and such a humour only, there would obviously be danger of the opinion gaining ground that there is in every body104 a faculty which attracts its own particular quality.

He therefore says that safflower,105 the Cnidian berry,106 and Hippophaes,107 do not draw phlegm from the body, but actually make it. Moreover, he holds that the flower and scales of bronze, and burnt bronze itself, and germander,108 and wild mastich109 dissolve the body into water, and that dropsical patients derive benefit from these substances, not because they are purged by them, but because they are rid of substances which actually help to increase the disease; for, if the medicine does not evacuate110 the dropsical fluid contained in the body, but generates it, it aggravates the condition further. Moreover, scammony, according to the Asclepiadean argument, not only fails to evacuate110 the bile from the bodies of jaundiced subjects, but actually turns the useful blood into bile, and dissolves the body; in fact it does all manner of evil and increases the disease.

And yet this drug may be clearly seen to do good to numbers of people! “Yes,” says he, “they derive benefit certainly, but merely in proportion to the evacuation.” … But if you give these cases a drug which draws off phlegm they will not be benefited.

This is so obvious that even those who make experience alone their starting-point111 are aware of it; and these people make it a cardinal point of their teaching to trust to no arguments, but only to what can be clearly seen. In this, then, they show good sense; whereas Asclepiades goes far astray in bidding us distrust our senses where obvious facts plainly overturn his hypotheses. Much better would it have been for him not to assail obvious facts, but rather to devote himself entirely to these.

Is it, then, these facts only which are plainly irreconcilable with the views of Asclepiades? Is not also the fact that in summer yellow bile is evacuated in greater quantity by the same drugs, and in winter phlegm, and that in a young man more bile is evacuated, and in an old man more phlegm?

Each drug attracts something which already exists, and does not generate something previously non-existent.

Thus if you give in the summer season a drug which attracts phlegm to a young man of a lean and warm habit, who has lived neither idly nor too luxuriously, you will with great difficulty evacuate a very small quantity of this humour, and you will do the man the utmost harm. On the other hand, if you give him a cholagogue, you will produce an abundant evacuation and not injure him at all.

Do we still, then, disbelieve that each drug attracts that humour which is proper to it?112

Possibly the adherents of Asclepiades will assent to this—or rather, they will—not possibly, but certainly—declare that they disbelieve it, lest they should betray their darling prejudices.