Galen, On the Natural Faculties.
A.J. Brock, Ed.

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PART 8

Now Erasistratus ought not to have been ignorant of this if he had ever had anything to do with the Peripatetics- even in a dream. Nor, similarly, should he have been unacquainted with the genesis of the humours, about which, not having even anything moderately plausible to say, he thinks to deceive us by the excuse that the consideration of such matters is not the least useful. Then, in Heaven's name, is it useful to know how food is digested in the stomach, but unnecessary to know how bile comes into existence [p. 169]in the veins? Are we to pay attention merely to the evacuation of this humour, and not to its genesis? As though it were not far better to prevent its excessive development from the beginning than to give ourselves all the trouble of expelling it! ¹ And it is a strange thing to be entirely unaware as to whether its genesis is to be looked on as taking place in the body, or whether it comes from without and is contained in the food. For, if it was right to raise this problem, why should we not make investigations concerning the blood as well- whether it takes its origin in the body, or is distributed through the food as is maintained by those who postulate homoeomeries?² Assuredly it would be much more useful to investigate what kinds of food are suited, and what kinds unsuited, to the process of blood-production³ rather than to enquire into what articles of diet are easily mastered by the activity of the stomach, and what resist and contend with it. For the choice of the latter bears reference merely to digestion, while that of the former is of importance in regard to the generation of useful blood. For it is not equally important whether the aliment be imperfectly chylified⁴ in the stomach or whether it fail to be turned into useful blood. Why is Erasistratus not ashamed to distinguish all the various kinds of digestive failure and all the occasions which give rise to them, whilst in reference to the errors of blood-production he does not utter a single word- nay, not a syllable? Now, there is certainly to be found in the veins both thick and thin blood; in some people it is redder, in others yellower, in some blacker, in others more of the nature of phlegm. And one who realizes that it[p. 171] may smell offensively not in one way only, but in a great many different respects (which cannot be put into words, although perfectly appreciable to the senses), would, I imagine, condemn in no measured terms the carelessness of Erasistratus in omitting a consideration so essential to the practice of our art.

Thus it is clear what errors in regard to the subject of dropsies logically follow this carelessness. 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 spleen⁵ or any other part, but always by induration of the liver,⁶ 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, not merely once or twice, but frequently, we have observed dropsy produced by chronic haemorrhoids which have been suppressed,⁷ or which, through immoderate bleeding, have given the patient a severe chill; similarly, in women, the complete disappearance of the monthly discharge,⁸or an undue evacuation such as is caused by violent bleeding from the womb, often provoke dropsy; and in some of them the so-called female flux ends in this disorder. I leave out of account [p. 173]the dropsy which begins in the flanks or in any other susceptible part; this clearly confutes Erasistratus' assumption, although not so obviously as does that kind of dropsy which is brought about by an excessive chilling of the whole constitution; this, which is the primary reason for the occurrence of dropsy, results from a failure of blood-production,⁹ very much like the diarrhoea which follows imperfect digestion of food; certainly in this kind of dropsy neither the liver nor any other viscus becomes indurated.

The learned Erasistratus, however, overlooks- nay, despises- what neither Hippocrates, Diocles, Praxagoras, nor Philistion¹⁰ despised, nor indeed any of the best philosophers, whether Plato, Aristotle, or Theophrastus; he passes by whole functions as though it were but a trifling and casual department of medicine which he was neglecting, without deigning to argue whether or not these authorities are right in saying that the bodily parts of all animals are governed by the Warm, the Cold, the Dry and the Moist, the one pair being active the other passive, and that among these the Warm has most power in connection with all functions, but especially with the genesis of the humours.¹¹ 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.

[p. 175]Now, Erasistratus is thoroughly small-minded and petty to the last degree in all his disputations- when, for instance, in his treatise "On Digestion,"¹² he argues jealously with those who consider that this is a process of putrefaction of the food; and, in his work "On Anadosis,"¹³ with those who think that the anadosis of blood through the veins results from the contiguity of the arteries; also, in his work "On Respiration," with those who maintain that the air is forced along by contraction. Nay, he did not even hesitate to contradict those who maintain that the urine passes into the bladder in a vaporous state,¹⁴ as also those who say that imbibed fluids are carried into the lung. Thus he delights to choose always the most valueless doctrines, and to spend his time more and more in contradicting these; whereas on the subject of the origin of blood (which is in no way less important than the chylification¹⁵ of food in the stomach) he did not deign to dispute with any of the ancients, nor did he himself venture to bring forward any other opinion, despite the fact that at the beginning of his treatise on "General Principles" he undertook to say how all the various natural functions take place, and through what parts of the animal! Now, is it possible that, when the faculty which naturally digests food is weak, the animal's digestion fails, whereas the faculty which turns the digested food into blood cannot suffer any kind of impairment?¹⁶ Are we to suppose this latter faculty alone to be as tough as steel and unaffected by circumstances? Or is it that weakness of this faculty will result in some-[p. 177]thing else than dropsy? The fact, therefore, that Erasistratus, in regard to other matters, did not hesitate to attack even the most trivial views, whilst in this he neither dared to contradict his predecessors nor to advance any new view of his own, proves plainly that he recognized the fallacy of his own way of thinking.¹⁷

For what could a man possibly say about blood who had no use for innate heat? What could he say about yellow or black bile, or phlegm? Well, of course, he might say that the bile could come directly from without, mingled with the food! Thus Erasistratus practically says so in the following words: "It is of no value in practical medicine to find out whether fluid of this kind¹⁸ arises from the elaboration of food in the stomach-region, or whether it reaches the body because it is mixed with the food taken in from outside." But my very good Sir, you most certainly maintain also that this humour has to be evacuated from the animal, and that it causes great pain if it be not evacuated. How, then, if you suppose that no good comes from the bile, do you venture to say that an investigation into its origin is of no value in medicine?

Well, let us suppose that it is contained in the food, and not specifically secreted in the liver (for you hold these two things possible). In this case, it will certainly make a considerable difference whether the ingested food contains a minimum or a maximum of bile; for the one kind is harmless, whereas that containing a large quantity of bile, owing to the fact that it cannot be properly purified¹⁹ [p. 179]in the liver, will result in the various affections- particularly jaundice- which Erasistratus himself states to occur where there is much bile. Surely, then, it is most essential for the physician to know in the first place, that the bile is contained in the food itself from outside, and, secondly, that for example, beet contains a great deal of bile, and bread very little, while olive oil contains most, and wine least of all, and all the other articles of diet different quantities. Would it not be absurd for any one to choose voluntarily those articles which contain more bile, rather than those containing less?

What, however, if the bile is not contained in the food, but comes into existence in the animal's body? Will it not also be useful to know what state of the body is followed by a greater, and what by a smaller occurrence of bile?²⁰ For obviously it is in our power to alter and transmute morbid states of the body- in fact, to give them a turn for the better. But if we did not know in what respect they were morbid or in what way they diverged from the normal, how should we be able to ameliorate them?

Therefore it is not useless in treatment, as Erasistratus says, to know the actual truth about the genesis of bile. Certainly it is not impossible, or even difficult to discover that the reason why honey produces yellow bile is not that it contains a large quantity of this within itself, but because it [the honey] undergoes change, becoming altered and transmuted into bile. For it would be bitter to the taste if it contained bile from the outset, and it would produce an equal quantity of bile [p. 181]in every person who took it. The facts, however, are not so.²¹ 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. 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.

Having come to this point in the argument, I should like to ask those who declare that Erasistratus was very familiar with the Peripatetics, whether they know what Aristotle stated and demonstrated with regard to our bodies being compounded out of the Warm, the Cold, the Dry and the Moist, and how he says that among these the Warm is the most active, and that those animals which are by nature warmest have abundance of blood, whilst those that are colder are entirely lacking in blood, and consequently in winter lie idle and motionless, lurking [p. 183]in holes like corpses. Further, the question of the colour of the blood has been dealt with not only by Aristotle but also by Plato.²² Now I, for my part, as I have already said, did not set before myself the task of stating what has been so well demonstrated by the Ancients, since I cannot surpass these men either in my views or in my method of giving them expression. Doctrines, however, which they either stated without demonstration, as being self-evident (since they never suspected that there could be sophists so degraded as to contemn the truth in these matters), or else which they actually omitted to mention at all- these I propose to discover and prove.

Now in reference to the genesis of the humours, I do not know that any one could add anything wiser than what has been said by Hippocrates, Aristotle, Praxagoras, Philotimus²³ and many other among the Ancients. These men demonstrated that when the nutriment becomes altered in the veins by the innate heat, blood is produced when it is in moderation, and the other humours when it is not in proper proportion. And all the observed facts²⁴ agree with this argument. Thus, those articles of food, which are by nature warmer are more productive of bile, while those which are colder produce more phlegm. Similarly of the periods of life, those which are naturally warmer tend more to bile, and the colder more to phlegm. Of occupations also, localities and seasons, and, above all, of natures²⁵ themselves, the colder are more phlegmatic, and the warmer more [p. 185]bilious. Also cold diseases result from and warmer ones from yellow bile. There is not a single thing to be found which does not bear witness to the truth of this account. How could it be otherwise? For, seeing that every part functions in its own special way because of the manner in which the four qualities are compounded, it is absolutely necessary that the function [activity] should be either completely destroyed, or, at least hampered, by any damage to the qualities, and that thus the animal should fall ill, either as a whole, or in certain of its parts.

Also the diseases which are primary and most generic are four in number, and differ from each other in warmth, cold, dryness and moisture. Now, Erasistratus himself confesses this, albeit unintentionally;²⁶ for when he says that the digestion of food becomes worse in fever, not because the innate heat has ceased to be in due proportion, as people previously supposed, but because the stomach, with its activity impaired, cannot contract and triturate as before- then, I say, one may justly ask him what it is that has impaired the activity of the stomach.

Thus, for example, when a bubo develops following an accidental wound²⁷ gastric digestion does not become impaired until the patient has become fevered; neither the bubo nor the sore of itself impedes in any way or damages the activity of the stomach. But if fever occurs, the digestion at once deteriorates, and we are also right in saying that the activity of the stomach at once becomes impaired. We must add, however, by what [p. 187]it has been impaired. For the wound was not capable of impairing it, nor yet the bubo, for, if they had been, then they would have caused this damage before the fever as well. If it was not these that caused it, then it was the excess of heat²⁸ (for these two symptoms occurred besides the bubo- an alteration in the arterial and cardiac movements²⁹ and an excessive development of natural heat). Now the alteration of these movements will not merely not impair the function of the stomach in any way: it will actually prove an additional help among those animals in which, according to Erasistratus, the pneuma, which is propelled through the arteries and into the alimentary canal, is of great service in digestion³⁰; there is only left, then, the disproportionate heat to account for the damage to the gastric activity. For the pneuma is driven in more vigorously and continuously, and in greater quantity now than before; thus in this case, the animal whose digestion is promoted by pneuma will digest more, whereas the remaining factor- abnormal heat- will give them indigestion. For to say, on the one hand, that the pneuma has a certain property by virtue of which it promotes digestion, and then to say that this property disappears in cases of fever, is simply to admit the absurdity. For when they are again asked what it is that has altered the pneuma, they will only be able to reply, "the abnormal heat," and particularly if it be the pneuma in the food canal which is in [p. 189]question (since this does not come in any way near the bubo).

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?³¹ But Erasistratus himself agrees that human beings digest badly in fevers, adding as the cause that the activity of the stomach has been impaired. He cannot, however, advance any other cause of this impairment than abnormal heat. But if it is not by accident that the abnormal heat impairs this activity, but by virtue of its own essence and power, then this abnormal heat must belong to the primary diseases. But, indeed, if disproportion of heat belongs to the primary diseases, it cannot but be that a proportionate blending [eucrasia] of the qualities produces the normal activity.³² For a disproportionate blend [dyscrasia] can only become a cause of the primary diseases through derangement of the eucrasia. That is to say, it is because the [normal] activities arise from the eucrasia that the primary impairments of these activities necessarily arise the from derangement.

I think, then, it has been proved to the satisfaction of those who are capable of seeing logical consequences, that, even according to Erasistratus' own argument, the cause of the normal functions is eucrasia of the Warm.³³ Now, this being so, there is nothing further to prevent us from saying [p. 191]that, in the case of each function, eucrasia is followed by the more, and dyscrasia by the less favourable alternative. And, therefore, if this be the case, we must suppose blood to be the outcome of proportionate, and yellow bile of disproportionate heat. So we naturally find yellow bile appearing in greatest quantity in ourselves at the warm periods of life, in warm countries, at warm seasons of the year, and when we are in a warm condition; similarly in people of warm temperaments, and in connection with warm occupations, modes of life, or diseases.

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. Who, in fact, does not know that anything which is overcooked grows at first salt and afterwards bitter? And if you will boil honey itself, far the sweetest of all 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. Therefore the external heat, [p. 193]which would be useful for insufficiently warm substances, becomes in the honey a source of damage, in fact an excess; and it is for this reason that honey, when boiled, can be demonstrated to become bitter sooner than the others. 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.³⁴ Therefore Hippocrates not improperly advised those who were naturally bilious not to take honey, since they were obviously of too warm a temperament. 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,³⁵ 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. 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, if it be not that the genesis of these humours is [p. 195]accomplished in the body. For if all articles of food contained bile from the beginning and of themselves, and did not produce it by undergoing change in the animal body, then they would produce it similarly in all bodies; the food which was bitter to the taste would, I take it, be productive of bile, while that which tasted good and sweet would not generate even the smallest quantity of bile. Moreover, not only honey but all other sweet substances are readily converted into bile in the aforesaid bodies which are warm for any of the reasons mentioned.

Well, I have somehow or other been led into this discussion,- not in accordance with my plan, but compelled by the course of the argument. This subject has been treated at great length by Aristotle and Praxagoras, who have correctly expounded the view of Hippocrates and Plato.