The Nature of Urine

Those near the times of Erasistratus maintain that the parts above the kidneys receive pure blood, whilst the watery residue, being heavy, tends to run downwards.

This then percolates through the kidneys themselves, is thus rendered serviceable, and is sent, as blood, to all the parts below the kidneys.

For a certain period this view found favour and flourished and was held to be true.

After a time, however, it became suspect to the Erasistrateans themselves, and finally they abandoned it because of 2 points:

1. The heaviness of the serous fluid

This was said to be produced in the vena cava. It did not exist, apparently, at the beginning, when this fluid was being carried up from the stomach to the liver.

Why, then, did it not at once run downwards when it was in these situations? And if the watery fluid is so heavy, what plausibility can anyone find in the statement that it assists in the process of anadosis?

2. The assertion that all the watery fluid falls downwards only when it is in the vena cava

How is it going to fall into the kidneys, seeing that these are not situated below, but on either side of the vena cava, and that the vena cava is not inserted into them, but merely sends a branch into each of them, as it also does into all the other parts?

This doctrine was replaced by a more foolish one saying that if oil be mixed with water and poured upon the ground, each will take a different route:

• the one flowing this way
• the other that way

And so the watery fluid runs into the kidneys, while the blood falls downwards along the vena cava.

This doctrine was already condemned.

For why, of the countless veins which spring from the vena cava, should blood flow into all the others, and the serous fluid be diverted to those going to the kidneys? They have not answered the question which was asked; they merely state what happens and imagine they have thereby assigned the reason.

The worst doctrine of all was lately invented by Lycus of Macedonia161. It is popular due to its novelty.

He asserts that urine is residual matter from the nutrition of the kidneys!162

The amount of urine passed every day shows clearly that it is the whole of the fluid drunk.

These people rapidly pass almost the same quantity as they drink.

Even Erasistratus was aware of this is his “General Principles” Book 1.

Thus Lycus is speaking only from himself.

Now it is agreed that all parts which are undergoing nutrition produce a certain amount of residue, but it is neither agreed nor is it likely, that the kidneys alone, small bodies as they are, could hold four whole congii,164 and sometimes even more, of residual matter.

For this surplus must necessarily be greater in quantity in each of the larger viscera; thus, for example, that of the lung, if it corresponds in amount to the size of the viscus, will obviously be many times more than that in the kidneys, and thus the whole of the thorax will become filled, and the animal will be at once suffocated. But if it be said that the residual matter is equal in amount in each of the other parts, where are the bladders, one may ask, through which it is excreted? For, if the kidneys produce in drinkers three and sometimes four congii of superfluous matter, that of each of the other viscera will be much more, and thus an enormous barrel will be needed to contain the waste products of them all.

Yet one often urinates practically the same quantity as one has drunk, which would show that the whole of what one drinks goes to the kidneys.

Thus the author of this third piece of trickery would appear to have achieved nothing, but to have been at once detected, and there still remains the original difficulty which was insoluble by Erasistratus and by all others except Hippocrates. I dwell purposely on this topic, knowing well that nobody else has anything to say about the function of the kidneys, but that either we must prove more foolish than the very butchers if we do not agree that the urine passes through the kidneys; or, if one acknowledges this, that then one cannot possibly give any other reason for the secretion than the principle of attraction.

Now, if the movement of urine does not depend on the tendency of a vacuum to become refilled,166 it is clear that neither does that of the blood nor that of the bile; or if that of these latter does so, then so also does that of the former. For they must all be accomplished in one and the same way, even according to Erasistratus himself.

This matter will be discussed in Book 2.

5 That is, “On the Natural Powers,” the powers of the Physis or Nature. By that Galen practically means what we would call the physiological or biological powers, the characteristic faculties of the living organism; his Physis is the subconscious vital principle of the animal or plant. Like Aristotle, however, he also ascribes quasi-vital properties to inanimate things, cf. Introduction, p. xxvii.

6 Ergon, here rendered an effect, is literally a work or deed; strictly speaking, it is something done, completed, as distinguished from energeia, which is the actual doing, the activity which produces this ergon, cf. p. 13, and Introduction, p. xxx.

7 Gk. psyche, Lat. anima.

8 Gk. physis, Lat. natura.

9 Motion (kinesis) is Aristotle’s general term for what we would rather call change. It includes various kinds of change, as well as movement proper, cf. Introduction, p. xxix.

10 “Conveyance,” “transport,” “transit”; purely mechanical or passive motion, as distinguished from alteration (qualitative change).

11 “Waxing and waning,” the latter literally phthisis, a wasting or “decline;” cf. Scotch divining, Dutch verdwijnen.

12 Becoming and perishing: Latin, generatio et corruptio.

13 “Ad substantiam productio seu ad formam processus” (Linacre).

14 “Preformationist” doctrine of Anaxagoras. To him the apparent alteration in qualities took place when a number of minute pre-existing bodies, all bearing the same quality, came together in sufficient numbers to impress that quality on the senses. The factor which united the minute quality-bearers was Nous. “In the beginning,” says Anaxagoras, “all things existed together—then came Nous and brought them into order.”

15 “De ea alteratione quae per totam fit substantiam” (Linacre).

16 The systematizer of Stoicism and successor of Zeno.

17 Note characteristic impatience with metaphysics. To Galen, as to Hippocrates and Aristotle, it sufficed to look on the qualitative differences apprehended by the senses as fundamental. Zeno of Citium was the founder of the Stoic school; on the further analysis by this school of the qualities into bodies cf. p. 144, note 3.

18 A rallying-ground: lit. a place where two glens meet.

19 Thus according to Gomperz (Greek Thinkers), the hypothesis of Anaxagoras was that “the bread … already contained the countless forms of matter as such which the human body displays. Their minuteness of size would withdraw them from our perception. For the defect or ‘weakness’ of the senses is the narrowness of their receptive area. These elusive particles are rendered visible and tangible by the process of nutrition, which combines them.”

20 Therefore the blood must have come from the bread. The food from the alimentary canal was supposed by Galen to be converted into blood in and by the portal veins, cf. p. 17.

21 By “elements” is meant all homogeneous, amorphous substances, such as metals, &c., as well as the elementary tissues.

22 Work or product. Lat. opus. cf. p. 3, note 2.

23 Operation, activation, or functioning. Lat. actio. cf. loc. cit.

24 i.e. a concomitant (secondary) or passive affection. Galen is contrasting active and passive “motion.” cf. p. 6, note 1.

25 As already indicated, there is no exact English equivalent for the Greek term physis, which is a principle immanent in the animal itself, whereas our term “Nature” suggests something more transcendent; we are forced often, however, to employ it in default of a better word. cf. p. 2, note 1.

26 In Greek anadosis. This process includes two stages: (1) transmission of food from alimentary canal to liver (rather more than our “absorption”); (2) further transmission from liver to tissues. Anadosis is lit. a yielding-up, a “delivery;” it may sometimes be rendered “dispersal.” “Distribution” (diadosis) is a further stage; cf. p. 163, note 4.

27 cf. p. 9.

28 Since heat and cold tend to cause diffusion and condensation respectively.

29 Lit. haematopoietic. cf. p. 11, note 3.

30 Lit. peptic.

31 Lit. sphygmic.

32 Genesis corresponds to the intrauterine life, or what we may call embryogeny. Alteration here means histogenesis or tissue-production; shaping or moulding (in Greek diaplasis) means the ordering of these tissues into organs (organogenesis).

33 cf. p. 25, note 4.

34 Note inadequate analogy of semen with fertilised seeds of plants (i.e. of gamete with zygote). Strictly speaking, of course, semen corresponds to pollen. cf. p. 130, note 2.

35 i.e. the four primary qualities; cf. chap. iii. supra.

36 Various secondary or derivative differences in the tissues. Note pre-eminence of sense of touch.

37 De Anima, ii. et seq.

38 Lit. homoeomerous = of similar parts throughout, “the same all through.” He refers to the elementary tissues, conceived as not being susceptible of further analysis.

39 That is, by the bodily eye, and not by the mind’s eye. The observer is here called an autoptes or “eye-witness.” Our medical term autopsy thus means literally a persona inspection of internal parts, ordinarily hidden.

40 i.e. “alteration” is the earlier of the two stages which constitute embryogeny or “genesis.” cf. p. 18, note 1.

41 The terms Galen actually uses are: ostopoietic, neuropoietic, chondropoietic.

42 As we should say, parenchyma (a term used by Erasistratus).

43 Those were all the elemental tissues that Aristotle, for example, had recognized; other tissues (e.g. flesh or muscle) he believed to be complexes of these.

44 Or tunics.

45 i.e. tissues.

46 As, for example, Aristotle had held; cf. p. 23, note 3. Galen added many new tissues to those described by Aristotle.

47 Lit. synthesis.

48 By this is meant the duodenum, considered as an outgrowth or prolongation of the stomach towards the intestines.

49 cf. p. 19, note 2.

50 Lit. the auxetic or incremental faculty.

51 i.e. to the alterative and shaping faculties (histogenetic and organogenetic).

52 If the reading is correct we can only suppose that Galen meant the embryo.

53 i.e. not the pre-natal development of tissue already described. cf. chap. vi.

54 Administration, lit. “economy.”

55 The activation or functioning of this faculty, the faculty in actual operation. cf. p. 3, note 2.

56 “Un rapport commun et une affinité” (Daremberg). “Societatem aliquam cognationemque in qualitatibus” (Linacre). cf. p. 36, note 2.

57 Lit. “necessity”; more restrictive, however, than our “law of Nature.” cf. p. 314, note 1.

58 His point is that no great change, in colours or in anything else, can take place at one step.

59 Not quite our “waste products,” since these are considered as being partly synthetic, whereas the Greek perittomata were simply superfluous substances which could not be used and were thrown aside.

60 Note “our natures,” cf. p. 12, note 4; p. 47, note 1.

61 The term οἰκεῖος, here rendered appropriate, is explained on p. 33. cf. also footnote on same page. Linacre often translated it conveniens, and it may usually be rendered proper, peculiar, own special, or own particular in English. Sometimes it is almost equal to akin, cognate, related: cf. p. 319, note 2. With Galen’s οἰκεῖος and ἀλλότριος we may compare the German terms eigen and fremd used by Aberhalden in connection with his theory of defensive ferments in the blood-serum.

62 Transit, cf. p. 6, note 1.

63 i.e. of the living organism, cf. p. 2, note 1.

64 i.e. with nutrition.

65 We might perhaps say, more shortly, “assimilation of food to feeder,” or, “of food to fed”; Linacre renders, “nutrimenti cum nutrito assimilatio.”

66 Lit. prosphysis, i.e. attachment, implantation.

67 Lit. prosthesis, “apposition.” One is almost tempted to retain the terms prosthesis and prosphysis in translation, as they obviously correspond much more closely to Galen’s physiological conceptions than any English or semi-English words can.

68 Lit. phthisis. cf. p. 6, note 2. Now means tuberculosis only.

69 More literally, “chymified.” In anasarca the subcutaneous tissue is soft, and pits on pressure. In the “white” disease referred to here (by which is probably meant nodular leprosy) the same tissues are indurated and “brawny.” The principle of certain diseases being best explained as cases of arrest at various stages of the metabolic path is recognized in modern pathology, although of course the instances given by Galen are too crude to stand.

70 The effects of oxidation attributed to the heat which accompanies it? cf. p. 141, note 1; p. 254, note 1.

71 Here follows a contrast between the Vitalists and the Epicurean Atomists. cf. p. 153 et seq.

72 A unity or continuum, an individuum.

73 Lit. to the physis or the psyche; that is, a denial of the autonomy of physiology and psychology.

74 Lit. somata.

75 For “natures” in the plural, involving the idea of a separate nature immanent in each individual, cf. p. 36, note 1.

76 A lost work.

77 For Asclepiades v. p. 49, note 5.

78 “Le corps tout entier a unité de souffle (perspiration et expiration) et unité de flux (courants, circulation des liquides)” (Daremberg). “Conspirabile et confluxile corpus esse” (Linacre). Apparently Galen refers to the pneuma and the various humours. cf. p. 293, note 2.

79 i.e. “appropriated”; very nearly “assimilated.”

80 “Attractricem convenientis qualitatis vim” (Linacre). cf. p. 36, note 2.

81 Lit. “obvious phenomena.”

82 Asclepiades of Bithynia, who flourished in the first half of the first century B.C., was an adherent of the atomistic philosophy of Democritus, and is the typical representative of the Mechanistic school in Graeco-Roman medicine; he disbelieved in any principle of individuality (“nature”) in the organism, and his methods of treatment, in accordance with his pathology, were mechano-therapeutical. cf. p. 64, note 3.

83 Diocles of Carystus was the chief representative of the Dogmatic or Hippocratic school in the first half of the fourth century B.C. Praxagoras was his disciple, and followed him in the leadership of the school. For Erasistratus, cf. p. 95 et seq.

84 Sufferers from kidney-trouble.

85 The ureters.

86 Unless otherwise stated, “peritoneum” stands for parietal peritoneum alone.

87 In the peritoneal cavity.

88 Contrast, however, anasarca, p. 41.

89 Regurgitation, however, is prevented by the fact that the ureter runs for nearly one inch obliquely through the bladder wall before opening into its cavity, and thus an efficient valve is produced.

90 On the τέχνη (artistic or creative skill) shown by the living organism (φύσις) v. pp. 25, 45, 47; Introduction, p. xxix.

91 Direct denial of Aristotle’s dictum that “Nature does nothing in vain.” We are reminded of the view of certain modern laboratory physicians and surgeons that the colon is a “useless” organ, cf. Erasistratus, p. 143.

92 The vasa deferentia.

93 “De l’habileté et de la prévoyance de la nature à l’égard des animaux” (Daremberg). cf. p. 56, note 1.

94 cf. p. 36, note 2.

95 The morbid material passed successively through the stages of “crudity,” “coction” (pepsis), and “elimination” (crisis). For “critical days” cf. p. 74, note 1.

96 This was the process by which nutriment was taken up from the alimentary canal; “absorption,” “dispersal;” cf. p. 13, note 5. The subject is dealt with more fully in chap. xvi.

97 Lit. catharsis.

98 i.e. urine.

99 On use of κενόω v. p. 67, note 9.

100 i.e. bile and phlegm had no existence as such before the drugs were given; they are the products of dissolved tissue. Asclepiades did not believe that diseases were due to a materia peccans, but to disturbances in the movements of the molecules (ὄγκοι) which constitute the body; thus, in opposition to the humoralists such as Galen, he had no use for drugs. cf. p. 49, note 5.

101 About 4 oz., or one-third of a pint.

102 The Empiricists, cf. Introduction, p. xiii.

103 His ὄγκοι or molecules.

104 He does not say “organized” or “living” body; inanimate things were also thought to possess “natures”; cf. p. 2, note 1.

105 Carthamus tinctorius.

106 Daphne Gnidium.

107 Euphorbia acanthothamnos.

108 Teucrium chamaedrys.

109 Atractylis gummifera.

110 On use of κενόω cf. p. 98, note 1.

111 Empiricist physicians.

112 Note that drugs also have “natures”; cf. p. 66, note 3, and pp. 83-84.

113 Pun here.

114 Lit. physiology, i.e. nature-lore, almost our “Natural Philosophy”; cf. Introduction, p. xxvi.

115 The ultimate particle of Epicurus was the ἄτομος or atom (lit. “non-divisible”), of Asclepiades, the ὄγκος or molecule. Asclepiades took his atomic theory from Epicurus, and he again from Democritus; cf. p. 49, note 5.

116 Lit. Herculean stone.

117 Lit. aetiology.

118 Anadosis; cf. p. 62, note 1.

119 cf. p. 45.

120 The vis conservatrix et medicatrix Naturae.

121 cf. p. 61, note 3. The crisis or resolution in fevers was observed to take place with a certain regularity; hence arose the doctrine of “critical days.”

122 These were hypothetical spaces or channels between the atoms; cf. Introduction, p. xiv.

123 He means the specific drawing power or faculty of the lodestone.

124 cf. our modern “radium-emanations.”

125 cf. Ehrlich’s hypothesis of “receptors” in explanation of the “affinities” of animal cells.

126 i.e. from the point of view of the theory.

127 cf. p. 69, note 2.

128 That is to say, the two properties should go together in all cases—which they do not.

129 Trygon pastinaca.

130 cf. p. 66, note 3.

131 The way that corn can attract moisture.

132 Specific attraction of the “proper” quality; cf. p. 85, note 3.

133 Theory of evaporation insufficient to account for it. cf. p. 104, note 1.

134 Playful suggestion of free-will in the urine.

135 Specific attraction, cf. p. 87, note 2.

136 i.e. there would be no selective action.

137 Nasal mucus was supposed to be the non-utilizable part of the nutriment conveyed to the brain, cf. p. 214, note 3.

138 He means from its origin in the liver (i.e. in the three hepatic veins). His idea was that the upper division took nutriment to heart, lungs, head, etc., and the lower division to lower part of body. On the relation of right auricle to vena cava and right ventricle, cf. p. 321, notes 4 and 5.

139 We arrive at our belief by excluding other possibilities.

140 i.e. the mechanistic physicists. cf. pp. 45-47.

141 cf. p. 85, note 3.

142 The subject of anadosis is taken up in the next chapter. cf. also p. 62, note 1.

143 On Erasistratus v. Introd. p. xii. His view that the stomach exerts no holké, or attraction, is dealt with more fully in Book III., chap. viii.

144 i.e. the tissues.

145 cf. p. 291.

146 Peristalsis may be used here to translate Gk. peristolé, meaning the contraction and dilation of muscle-fibres circularly round a lumen, cf. p. 263, note 2.

147 For a demonstration that this phenomenon is a conclusive proof neither of peristolé nor of real vital attraction, but is found even in dead bodies v. p. 267.

148 This was Erasistratus’s favourite principle, known in Latin as the “horror vacui” and in English as “Nature’s abhorrence of a vacuum,” although these terms are not an exact translation of the Greek. τὸ κενούμενον probably means the vacuum, not the matter evacuated, although Galen elsewhere uses κενόω in the latter (non-classical) sense, e.g. pp. 67, 215. Akolouthia is a following-up, a sequence, almost a consequence.

149 v. p. 123.

150 cf. Book II., chap. i.

151 Vital factor necessary over and above the mechanical.

152 cf. p. 119, note 2.

153 pp. 91, 93.

154 i.e. the part below the liver; cf. p. 91, note 2.

155 Renal veins.

156 cf. p. 87, note 3.

157 κοίλην: the usual reading is κοιλίαν, which would make it “from the region of the alimentary canal.” cf. p. 118, note 1.

158 Not at an earlier stage, when it is still on its way from the alimentary canal to the liver.

159 i.e. a renal vein.

160 In a toast, the third cup was drunk to Zeus Sôtêr (the Saviour).

161 An anatomist of the Alexandrian school.

162 cf. nasal mucus, p. 90, note 1.

163 “Sur l’Ensemble des Choses” (Daremberg).

164 About twelve quarts. This is about five times as much as the average daily excretion, and could only be passed if a very large amount of wine were drunk.

165 cf. p. 51.

166 Horror vacui. Note analogical reasoning; cf. p. 289, note 1.

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