Hippocrates and Aristotle

All these points that would have helped in the diagnosis and the cure of disease were entirely passed over by Erasistratus.

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 the causes by which everything throughout nature is governed the 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.288

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.

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 undergoing alteration through the agency of its contained heat.289 Imagine 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 the flower and the other the lees.

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 becomes vitelline,290 being 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 in its normal condition,291 but no particular name has been given to [such a condition of] the humour, except that some people have called it corrosive or acetose, 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.

Most of the ancient physicians give the name black humour and not black bile to the normal portion of this humour, which is discharged from the bowel and which also frequently rises to the top [of the stomach-contents].

They call black bile that 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 nutriment292 which belongs naturally to the thick and earth-like part of the food,292 and 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), becomes yellow bile, and is cleared away through the so-called biliary293 vessels; now, this is thin, moist, and fluid, not like what it is when, having been roasted to an excessive degree, it becomes yellow, fiery, and thick, like the yolk of eggs; 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.294 In 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-called potter’s earth and 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 of serum. 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 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 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 the fibres which it contains. And the use of these has been discussed by Plato,296 and 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 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,297 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. 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 treatise298 I have written on the humours according to Praxagoras, son of Nicarchus; although this authority makes as many as ten humours, not including 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.

167 cf. p. 89.

168 This term is nowadays limited to the drawing action of a blister, cf. p. 223.

169 The radicles of the hepatic ducts in the liver were supposed to be the active agents in extracting bile from the blood. cf. pp. 145-149.

170 Anadosis; cf. p. 13, note 5.

171 The term κοιλία is used both specifically for the stomach proper and also (as probably here) in a somewhat wider sense for the stomach region, including the adjacent part of the small intestine; this was the part of the alimentary canal from which nutriment was believed to be absorbed by the mesenteric veins; cf. p. 309, note 2.

172 cf. p. 100, note 2; p. 167, note 2.

173 A characteristic “lesion” in Erasistratus’s pathology.

174 A certain subordinate place allowed to the horror vacui.

175 i.e. the parts to which the veins convey blood after it leaves the liver—second stage of anadosis; cf. p. 91, note 2; p. 13, note 5.

176 What we now call the pulmonary artery. Galen believed that the right ventricle existed for the purpose of sending nutrient blood to the lungs.

177 Lit. owing to the ongrowth (epiphysis) of membranes; he means the tricuspid valve; cf. p. 314, note 2; p. 321, note 4.

178 Horror vacui.

179 But Erasistratus had never upheld this in the case of urinary secretion, cf. p. 99.

180 This was the characteristically “anatomical” explanation of bile-secretion made by Erasistratus. cf. p. 170, note 2. Why, then, says Galen, does not urine, rather than bile, enter the bile-ducts?

181 Urine, or, more exactly, blood-serum.

182 Or ducts, canals, conduits, i.e. morphological factors.

183 Or artistic skill, “artistry.” cf. Book I., chap. xii.

184 “Only”; cf. Introd., p. xxviii.

185 Note how Galen, although he has not yet clearly differentiated physiological from physical processes (both are “natural”) yet separates them definitely from the psychical. cf. p. 2, footnote. A psychical function or activity is, in Latin, actio animalis (from anima = psyche).

186 The stage of organogenesis or diaplasis; cf. p. 25, note 4.

187 The spermatozoon now becomes an “organism” proper.

188 Galen attributed to the sperma or semen what we should to the fertilized ovum: to him the maternal contribution is purely passive—mere food for the sperm. The epoch-making Ovum Theory was not developed till the seventeenth century. cf. p. 19, note 3.

189 i.e. we should be talking psychology, not biology; cf. stomach, p. 307, note 3.

190 Attraction now described not merely as qualitative but also as quantitative. cf. p. 85, note 3.

191 He still tends either to biologize physics, or to physicize biology—whichever way we prefer to look at it. cf. Book I., chap. xiv.

192 Aristotelian and Stoic duality of an active and a passive principle.

193 Note that early embryonic development is described as a process of nutrition. cf. p. 130, note 2.

194 On the alterative and shaping faculties cf. p. 18, note 1.

195 pp. 27-29.

196 cf. Introduction, p. xxvi.

197 cf. p. 15.

198 For definitions of alteration and mingling (crasis, “temperament”) cf. Book I., chaps. ii. and iii.

199 i.e. are associated with oxidation? cf. p. 41, note 3.

200 “Useless” organs; cf. p. 56, note 2. For fallacy of Erasistratus’s view on the spleen v. p. 205.

201 The Stoics.

202 The Peripatetics (Aristotelians).

203 Aristotle regarded the qualitative differences apprehended by our senses (the cold, the warm, the moist, and the dry) as fundamental, while the Stoics held the four corporeal elements (earth, air, fire, and water) to be still more fundamental. cf. p. 8, note 3.

204 Lit. bile-receiving (choledochous).

205 Jecoris portae, the transverse fissure, by which the portal vein enters the liver.

206 Lit. “anastomosing.”

207 More literally, “synapse.”

208 The portal vein.

209 The hepatic vein or veins.

210 The portal vein.

211 cf. p. 120, note 1.

212 cf. p. 272, note 1.

213 i.e. one might assume an attraction.

214 i.e. visible to the mind’s eye as distinguished from the bodily eye. cf. p. 21, note 4. Theoreton without qualification means merely visible, not theoretic. cf. p. 205, note 1.

215 According to the Pneumatist school, certain of whose ideas were accepted by Erasistratus, the air, breath, pneuma, or spirit was brought by inspiration into the left side of the heart, where it was converted into natural, vital, and psychic pneuma; the latter then went to the brain, whence it was distributed through the nervous system; practically this teaching involved the idea of a psyche, or conscious vital principle. “Psychic pneuma” is in Latin spiritus animalis (anima = psyche); cf. p. 126, note 4. Introduction, p. xxxiv.

216 Observe that Erasistratus’s “simple nerve” may be almost looked on as an anticipation of the cell. The question Galen now asks is whether this vessel is a “unit mass of living matter,” or merely an agglomeration of atoms subject to mechanical law. cf. Galen’s “fibres,” p. 329.

217 cf. Book I., chap. xii.

218 i.e. in biology we must begin with living substance—with something which is specifically alive—here with the “unit mass of living matter.” cf. p. 73, note 3.

219 “Ad elementa quae nec coalescere possunt nec in partes dividi” (Linacre). On the two contrasted schools cf. p. 45.

220 cf. loc. cit.

221 “Auxetic.” cf. p. 26, note 1.

222 “At corporum quae nec una committi nec dividi possunt nullum in se formatricem, auctricem, nutricem, aut in summa artificem facultatem habet; quippe quod impatibile esse immutibileque praesumitur” (Linacre).

223 Book I., chaps. v.-xi.

224 cf. p. 153.

225 On account of his idea of a simple tissue not susceptible of further analysis.

226 Or “cell”; cf. p. 153, note 2.

227 The horror vacui.

228 Prosthesis of nutriment; cf. p. 39, note 6.

229 Anadosis, “absorption”; cf. p. 13, note 5.

230 Lit. diadosis.

231 i.e. let him explain the diadosis.

232 “Spiritus animalis”; cf. p. 152, note 1. The nutriment was for the walls of the vessels, not for their cavities. cf. p. 319, note 3.

233 Specific attraction; cf. Book I., chap. xiv.

234 cf. p. 100, note 2.

235 In Book II., chap. i.

236 Prevention better than cure.

237 e.g. Anaxagoras; cf. p. 7, note 5; p. 20, note 3.

238 Lit. haematosis.

239 cf. p. 174, note 4.

240 Erasistratus held the spleen to be useless, cf. p. 143.

241 Induration: Gk. skirros, Lat. scirrhus. The condition is now commonly known by Laënnec’s term cirrhosis, from Gk. kirros, meaning yellow or tawny. Here again we have an example of Erasistratus’s bias towards anatomical or structural rather than functional explanations of disease, cf. p. 124, note 1.

242 On the risks which were supposed to attend the checking of habitual bleeding from piles cf. Celsus (De Re Med. VI. xviii. 9), “Atque in quibusdam parum tuto supprimitur, qui sanguinis profluvio imbecilliores non fiunt; habent enim purgationem hanc, non morbum.” (i.e. the habit was to be looked on as a periodical cleansing, not as a disease.)

243 Lit. catharsis.

244 Apparently some form of anaemia.

245 Philistion of Locri, a contemporary of Plato, was one of the chief representatives of the Sicilian school of medicine. For Diocles and Praxagoras see p. 51, note 1.

246 cf. Book I., chap. iii.

247 Gk. pepsis; otherwise rendered coction.

248 cf. p. 13, note 5.

249 e.g. Asclepiades.

250 Lit. chylosis; cf. p. 238, note 2.

251 That is to say, the haematopoietic function deserves consideration as much as the digestive processes which precede it.

252 i.e. Erasistratus could obviously say nothing about any of the humours or their origins, since he had not postulated the four qualities (particularly the Warm—that is, innate heat).

253 i.e. bile.

254 i.e. deprived of its bile.

255 Here it is rather the living organism we consider than the particular food that is put into it.

256 Supreme importance of the “soil.” cf. Introduction, pp. xii. and xxxi.

257 Aristotle, Hist. Animal., iii. xix.; Plato, Timaeus, 80 E.

258 Philotimus succeeded Diocles and Praxagoras, who were successive leaders of the Hippocratic school. cf. p. 51, note 1.

259 Lit. phenomena.

260 i.e. living organisms; cf. p. 47, note 1.

261 Erasistratus rejected the idea of innate heat; he held that the heat of the body was introduced from outside.

262 As a bubo is a swelling in the groin, we must suppose that the wound referred to would be in the leg or lower abdomen.

263 i.e. fever as a cause of disease.

264 As we should say, “circulatory” changes.

265 This is the “vital spirit” or pneuma which, according to Erasistratus and the Pneumatist school, was elaborated in the left ventricle, and thereafter carried by the arteries all over the body, there to subserve circulatory processes. It has some analogy with oxygen, but this is also the case with the “natural spirit” or pneuma, whose seat was the liver and which was distributed by the veins through the body; it presided over the more vegetative processes. cf. p. 152, note 1; Introduction, p. xxxiv.

266 Even leaving the pneuma out of account, Galen claims that he can still prove his thesis.

267 In other words: if dyscrasia is a first principle in pathology, then eucrasia must be a first principle in physiology.

268 The above is a good instance of Galen’s “logical” method as applied to medical questions; an appeal to those who are capable of following “logical sequence.” cf. p. 209, note 1.

269 The aim of dietetics always being the production of moderate heat—i.e. blood.

270 Note contrasted methods of Rationalists and Empiricists.

271 Lit. anaesthesia. Linacre renders it indocilitas.

272 p. 15.

273 Iatros: lit. “healer.”

274 Lit. “physicist” or “physiologist,” the student of the physis. cf. p. 70, note 2.

275 That is, a blending of the four principles in their natural proportion; Lat. temperies. Dyscrasia = intemperies, “distemper.”

276 This is the orthodox Hippocratic treatment, that of opposites by opposites. Contrast the homoeopathic principle which is the basis of our modern methods of immunisation (similia similibus curentur, Hahnemann).

277 Lit. aseptic.

278 Prodicus of Ceos, a Sophist, contemporary of Socrates.

279 Plato, Timaeus, 83-86, passim.

280 cf. the term blennorrhoea, which is still used.

281 cf. the Scotch term “colded” for “affected with a cold”; Germ. erkältet.

282 The word theôria used here is not the same as our theory. It is rather a “contemplation,” the process by which a theory is arrived at. cf. p. 226, note 2.

283 Erasistratus on the uselessness of the spleen. cf. p. 143.

284 The Empirical school, cf. p. 193.

285 Enlargement and suppuration (?) of spleen associated with toxaemia or “cacochymy.”

286 Lit. “melancholic.”

287 i.e. the combination of sensible qualities which we call black bile. cf. p. 8, note 3.

288 Thus Galen has demonstrated the functions of the spleen both deductively and inductively. For another example of the combined method cf. Book III., chaps, i. and ii.; cf. also Introd. p. xxxii.

289 i.e. its innate heat.

290 Lit. lecithoid.

291 Note that there can be “normal” black bile.

292 The term food here means the food as introduced into the stomach; the term nutriment (trophé) means the same food in the digested condition, as it is conveyed to the tissues. cf. pp. 41-43. Note idea of imperfectly oxidized material being absorbed by the spleen. cf. p. 214, note 1.

293 Lit. choledochous, bile-receiving.

294 Thus over-roasting—shall we say excessive oxidation?—produces the abnormal forms of both black and yellow bile.

295 cf. p. 277, note 2.

296 Timaeus, 82 C-D.

297 cf. p. 90, note 1. The term “catarrh” refers to this “running down,” which was supposed to take place through the pores of the cribriform plate of the ethmoid into the nose.

298 Now lost.

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