Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
 Instructor:    Dr. Barbara J. Becker

Week 2.  Calamities

excerpts from
On the Natural Faculties  (c.170)
by Galen (c.130-200)

Book I

13. ... [On the bladder.]  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 skill -- 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! 

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 ducts 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 vene-section; 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.

*Asclepiades (fl.100 BCE) was considered the founder of the empiric school of medicine.  Galen ardently opposed the Empirics.  They viewed the good physician as a vigilant practitioner who, because of Nature's indifference to the welfare of living beings, had to intervene continuously and actively to neutralize the harm that could, at any time, by chance arise.  In contrast, Galen adhered to the view that Nature and living bodies know what is best and always strive to maintain a healthful balance.  Should something disrupt this balance, the physician will know how to facilitate and expedite its natural restoration.

14. ... Now people of the present day do not begin by getting a clear comprehension of these sects, as well as of the better ones, thereafter devoting a long time to judging and testing the true and false in each of them; despite their ignorance, they style themselves, some "physicians" and others "philosophers."  No wonder, then, that they honor the false equally with the true.  For everyone becomes like the first teacher that he comes across, without waiting to learn anything from anybody else.  And there are some of them, who, even if they meet with more than one teacher, are yet so unintelligent and slow-witted that even by the time they have reached old age they are still incapable of understanding the steps of an argument....  In the old days such people used to be set to menial tasks....  What will be the end of it God knows!

Book II

9.  [On the Humors.]  ... [T]he things that we have said are not to be looked upon as proofs but rather as indications of the dullness of those who think differently, and who do not even recognize what is agreed on by everyone and is a matter of daily observation. 

As for the scientific proofs of all this, they are to be drawn from these principles of which I have already spoken -- namely, that bodies act upon and are acted upon by each other in virtue of the Warm, Cold, Moist and Dry.  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 upon 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. 

*Erasistratus (c.300-225 BCE) held it was useless to develop a treatment for an individual illness based on reasoning from general principles.  Instead, he advocated treating each disease based on how its symptoms compare with those observed in previous cases because like symptoms will respond favorably to like treatments.

There is no use in recognizing the mere fact of contraction, without also knowing the cause; if we know this, we shall also be able to rectify the failures of function.  "This is no concern of ours," they say; "we do not occupy ourselves with such causes as these; they are outside the sphere of the practitioner, and belong to that of the scientific investigator." 

Are you, then, going to oppose those who maintain that the cause of the function of every organ is a natural eucrasia [balance], that the dyscrasia [imbalance] is itself known as a disease, and that it is certainly by this that the activity becomes impaired?  Or, on the other hand, will you be convinced by the proofs which the ancient writers furnished?  Or will you take a midway course between these two, neither perforce accepting these arguments as true nor contradicting them as false, but suddenly becoming skeptics -- Pyrrhonists*, in fact? 

*Pyrrho (c. 360-270 BCE) was a Greek philosopher who maintained that all knowledge is uncertain, even that derived from the senses.

But if you do this you will have to shelter yourselves behind the Empiricist teaching.  For how are you going to be successful in treatment, if you do not understand the real essence of each disease?  Why, then, did you not call yourselves Empiricists from the beginning?  Why do you confuse us by announcing that you are investigating natural activities with a view to treatment? 

If the stomach is, in a particular case, unable to exercise its peristaltic and grinding functions, how are we going to bring it back to the normal if we do not know the cause of its disability? 

What I say is that we must cool the over-heated stomach and warm the chilled one; so also we must moisten the one which has become dried up, and conversely; so, too, in combinations of these conditions; if the stomach becomes at the same time warmer and drier than normally, the first principle of treatment is at once to chill and moisten it; and if it become colder and moister, it must be warmed and dried; so also in other cases. 

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 inquiry into activities is that by knowing the causes of the dyscrasiae 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. 

Now, it seems to me that Erasistratus is unaware of this fact also, that the actual disease is that condition of the body which, not accidentally, but primarily and of itself, impairs the normal function.  How, then, is he going to diagnose or cure diseases if he is entirely ignorant of what they are, and of what kind and number?  As regards the stomach, certainly, Erasistratus held that one should at least investigate how it digests the food.  But why was not investigation also made as to the primary originative cause of this?  And, as regards the veins and the blood, he omitted even to ask the question "how?"

Yet neither Hippocrates nor any of the other physicians or philosophers whom I mentioned a short while ago thought it right to omit this; they say that when the heat which exists naturally in every animal is well blended and moderately moist it generates blood; for this reason they also say that the blood is a virtually warm and moist humor, and similarly also that yellow bile is warm and dry, even though for the most part it appears moist.  (For in them the apparently dry would seem to differ from the virtually dry.) 

Who does not know that brine and sea-water preserve meat and keep it uncorrupted, whilst all other water -- the drinkable kind -- readily spoils and rots it?  And who does not know that when yellow bile is contained in large quantity in the stomach, we are troubled with an unquenchable thirst, and that when we vomit this up, we at once become much freer from thirst than if we had drunk very large quantities of fluid?  Therefore this humor has been very properly termed warm, and also virtually dry.  And, similarly, phlegm has been called cold and moist; for about this also clear proofs have been given by Hippocrates and the other Ancients. 

Prodicus also, when in his book "On the Nature of Man" he gives the name "phlegm" to that element in the humors which has been burned or, as it were, over-roasted, while using a different terminology, still keeps to the fact just as the others do; this man's innovations in nomenclature have also been amply done justice to by Plato.  Thus, the white-colored substance which everyone else calls phlegm, and which Prodicus calls blenna [mucus], is the well-known cold, moist humor which collects mostly in old people and in those who have been chilled in some way, and not even a lunatic could say that this was anything else than cold and moist. 

If, then, there is a warm and moist humor, and another which is warm and dry, and yet another which is moist and cold, is there none which is virtually cold and dry?  Is the fourth combination of temperaments, which exists in all other things, non-existent in the humors alone?  No; the black bile is such a humor.  This, according to intelligent physicians and philosophers, tends to be in excess, as regards seasons, mainly in the fall of the year, and, as regards ages, mainly after the prime of life.  And, similarly, also they say that there are cold and dry modes of life, regions, constitutions, and diseases.  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 humor 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 humor which is more pernicious than these wander about persistently in the veins mingled with the blood? 

Yet Hippocrates says, "Dysentery is a fatal condition if it proceeds from black bile"; while that proceeding from yellow bile is by no means deadly, and most people recover from it; this proves how much more pernicious and acrid in its potentialities is black than yellow bile.  Has Erasistratus, then, not read the book, "On the Nature of Man," any more than any of the rest of Hippocrates' writings, that he so carelessly passes over the consideration of the humors?  Or, does he know it, and yet voluntarily neglect one of the finest studies in medicine? 

Thus he ought not to have said anything about the spleen, nor have stultified himself by holding that an artistic Nature would have prepared so large an organ for no purpose.  As a matter of fact, not only Hippocrates and Plato -- who are no less authorities on Nature than is Erasistratus -- say that this viscus [singular of viscera; an inner part of the body] 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. 

Now, all of these the high and mighty Erasistratus affected to despise, and he neither contradicted them nor even so much as mentioned their opinion.  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 humors; 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 color, and the cicatrices [scars] of ulcers are dark.  For, generally speaking, when the spleen is drawing the atrabiliary humor [black bile] into itself to a less degree than is proper, the blood is unpurified, and the whole body takes on a bad color. 

And when does it draw this in to a less degree than proper?  Obviously, when it [the spleen] is in a bad condition.  Thus, just as the kidneys, whose function it is to attract the urine, do this badly when they are out of order, so also the spleen, which has in itself a native power of attracting an atrabiliary quality, if it ever happens to be weak, must necessarily exercise this attraction badly, with the result that the blood becomes thicker and darker. 

Now all these points, affording as they do the greatest help in the diagnosis and in the cure of disease were entirely passed over by Erasistratus, and 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 (by 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 humor.  And having in the next place drawn attention to the fact that this humor is black bile 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, I shall now proceed to what remains of the subject in hand. 

What else, then, remains but to explain clearly what it is that happens in the generation of the humors, 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.  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 humors 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 [yellow like an egg yolk], being so termed because it becomes like the yolk of an egg, both in color and density; and again, even the black bile itself becomes much more malignant than when in its normal condition, but no particular name has been given to [such a condition of] the humor, 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 humor. 

It seems to me also that most of the ancient physicians give the name black humor and not black bile to the normal portion of this humor, which is discharged from the bowel and which also frequently rises to the top [of the stomach-contents]; and 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 realize the facts, which are as follow:--

In the genesis of blood, everything in the nutriment which belongs naturally to the thick and earth-like part of the food, 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 biliary 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 humor: 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.  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 the 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 humors are waste substances, and the animal body needs to be purified from them. 

There is, however, a natural use for the humors 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 humors 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.  For the blood in many parts of the body has need of a certain amount of thickening, as also, I take it, of the fibers which it contains.  And the use of these has been discussed by Plato, 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 humor, 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, but one should call it mucus or coryza [catarrh] -- 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 recognize 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 humor 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 humors 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 humors 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 treatise I have written on the humors according to Praxagoras, son of Nicarchus; although this authority makes as many as ten humors, 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 humors 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 humors, 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.

Book III

13. [On the Heart]  ... In the case of the arteries this is clear enough, as also in the case of heart, thorax, and lungs; for, since all of these dilate and contract alternately, it must needs be that matter is subsequently discharged back into the parts from which it was previously drawn.  Now Nature foresaw this necessity, and provided the cardiac openings of the vessels with membranous attachments, to prevent their contents from being carried backwards.  How and in what manner this takes place will be stated in my work "On the Use of Parts," where among other things I show that it is impossible for the openings of the vessels to be closed so accurately that nothing at all can run back.  Thus it is inevitable that the reflux into the venous artery (as will also be made clear in the work mentioned) should be much greater than through the other openings.  But what it is important for our present purpose to recognize is that every thing possessing a large and appreciable cavity must, when it dilates, abstract matter from all its neighbors, and, when it contracts, must squeeze matter back into them.  This should all be clear from what has already been said in this treatise and from what Erasistratus and I myself have demonstrated elsewhere respecting the tendency of a vacuum to become refilled.  

14.  And further, it has been shown in other treatises that all the arteries possess a power which derives from the heart, and by virtue of which they dilate and contract.  

Put together, therefore, the two facts -- that the arteries have this motion, and that everything, when it dilates, draws neighboring matter into itself -- and you will find nothing strange in the fact that those arteries which reach the skin draw in the outer air when they dilate, while those which anastomose [interconnect] at any point with the veins attract the thinnest and most vaporous part of the blood which these contain, and as for those arteries which are near the heart, it is on the heart itself that they exert their traction.  For, by virtue of the tendency by which a vacuum becomes refilled, the lightest and thinnest part obeys the tendency before that which is heavier and thicker.  Now the lightest and thinnest of anything in the body is firstly pneuma, secondly vapor, and in the third place that part of the blood which has been accurately elaborated and refined.  

These, then, are what the arteries draw into themselves on every side; those arteries which reach the skin draw in the outer air (this being near them and one of the lightest of things); as to the other arteries, those which pass up from the heart into the neck, and that which lies along the spine, as also such arteries as are near these -- draw mostly from the heart itself; and those which are farther from the heart and skin necessarily draw the lightest part of the blood out of the veins. 

So also the traction exercised by the diastole [expansion] of the arteries which go to the stomach and intestines takes place at the expense of the heart itself and the numerous veins in its neighborhood; for these arteries cannot get anything worth speaking of from the thick heavy nutriment contained in the intestines and stomach, since they first become filled with lighter elements.  For if you let down a tube into a vessel full of water and sand, and suck the air out of the tube with your mouth, the sand cannot come up to you before the water, for in accordance with the principle of the refilling of a vacuum the lighter matter is always the first to succeed to the evacuation.  

15.  It is not to be wondered at, therefore, that only a very little [nutrient matter] such, namely, as has been accurately elaborated -- gets from the stomach into the arteries, since these first become filled with lighter matter.  We must understand that there are two kinds of attraction, that by which a vacuum becomes refilled and that caused by appropriateness of quality; air is drawn into bellows in one way, and iron by the lodestone in another.  And we must also understand that the traction which results from evacuation acts primarily on what is light, whilst that from appropriateness of quality acts frequently, it may be, on what is heavier (if this should be naturally more nearly related).  Therefore, in the case of the heart and the arteries, it is in so far as they are hollow organs, capable of diastole, that they always attract the lighter matter first, while, in so far as they require nourishment, it is actually into their coats (which are the real bodies of these organs) that the appropriate matter is drawn.  Of the blood, then, which is taken into their cavities when they dilate, that part which is most proper to them and most able to afford nourishment is attracted by their actual coats.  

Now, apart from what has been said, the following is sufficient proof that something is taken over from the veins into the arteries.  If you will kill an animal by cutting through a number of its large arteries, you will find the veins becoming empty along with the arteries:  now, this could never occur if there were not anastomoses between them.  Similarly, also, in the heart itself, the thinnest portion of the blood is drawn from the right ventricle into the left, owing to there being perforations in the septum between them: these can be seen for a great part [of their length]; they are like a kind of fossae [pits] with wide mouths, and they get constantly narrower; it is not possible, however, actually to observe their extreme terminations, owing both to the smallness of these and to the fact that when the animal is dead all the parts are chilled and shrunken.  Here, too, however, our argument, starting from the principle that nothing is done by Nature in vain, discovers these anastomoses between the ventricles of the heart; for it could not be at random and by chance that there occurred fossae ending thus in narrow terminations.

The source and purpose of blood, according to Galen:
  • stomach converts food to chyle
  • chyle flows to liver (1) where it is converted to blood
  • blood flows to heart via vena cava (2)
  • blood goes to right chamber of heart (3), is pushed through tiny pores in the heart's septum into left chamber (4) where it receives "vital spirit"
  • blood flows to periphery of body and is converted into flesh

And secondly [the presence of these anastomoses has been assumed] from the fact that, of the two orifices in the right ventricle, the one conducting blood in and the other out, the former [the tricuspid orifice] is much the larger.  For, the fact that the insertion of the vena cava into the heart is larger than the vein which is inserted into the lungs suggests that not all the blood which the vena cava gives to the heart is driven away again from the heart to the lungs.  Nor can it be said that any of the blood is expended in the nourishment of the actual body of the heart, since there is another vein [the coronary vein] which breaks up in it and which does not take its origin nor get its share of blood from the heart itself.  And even if a certain amount is so expended, still the vein leading to the lungs is not to such a slight extent smaller than that inserted into the heart as to make it likely that the blood is used as nutriment for the heart:  the disparity is much too great for such an explanation.  It is, therefore, clear that something is taken over into the left ventricle.  

Moreover, of the two vessels connected with it, that which brings pneuma into it from the lungs is much smaller than the great outgrowing artery from which the arteries all over the body originate; this would suggest that it not merely gets pneuma from the lungs, but that it also gets blood from the right ventricle through the anastomoses mentioned.  

Now it belongs to the treatise "On the Use of Parts" to show that it was best that some parts of the body should be nourished by pure, thin, and vaporous blood, and others by thick, turbid blood, and that in this matter also Nature has overlooked nothing.  Thus it is not desirable that these matters should be further discussed.  Having mentioned, however, that there are two kinds of attraction, certain bodies exerting attraction along wide channels during diastole (by virtue of the principle by which a vacuum becomes refilled) and others exerting it by virtue of their appropriateness of quality, we must next remark that the former bodies can attract even from a distance, while the latter can only do so from among things which are quite close to them; the very longest tube let down into water can easily draw up the liquid into the mouth, but if you withdraw iron to a distance from the lodestone or corn from the jar (an instance of this kind has in fact been already given) no further attraction can take place.

This you can observe most clearly in connection with garden conduits.  For a certain amount of moisture is distributed from these into every part lying close at hand but it cannot reach those lying farther off: therefore one has to arrange the flow of water into all parts of the garden by cutting a number of small channels leading from the large one.  The intervening spaces between these small channels are made of such a size as will, presumably, best allow them [the spaces] to satisfy their needs by drawing from the liquid which flows to them from every side. 

So also is it in the bodies of animals.  Numerous conduits distributed through the various limbs bring them pure blood, much like the garden water-supply, and, further, the intervals between these conduits have been wonderfully arranged by Nature from the outset so that the intervening parts should be plentifully provided for when absorbing blood, and that they should never be deluged by a quantity of superfluous fluid running in at unsuitable times.

For the way in which they obtain nourishment is somewhat as follows.  In the body which is continuous throughout, such as Erasistratus supposes his simple vessel to be, it is the superficial parts which are the first to make use of the nutriment with which they are brought into contact; then the parts coming next draw their share from these by virtue of their contiguity; and again others from these; and this does not stop until the quality of the nutrient substance has been distributed among all parts of the corpuscle in question. 

And for such parts as need the humor which is destined to nourish them to be altered still further, Nature has provided a kind of storehouse, either in the form of a central cavity or else as separate caverns, or something analogous to caverns.  Thus the flesh of the viscera and of the muscles is nourished from the blood directly, this having undergone merely a slight alteration; the bones, however, in order to be nourished, very great change, and what blood is to flesh, marrow is to bone; in the case of the small bones, which do not possess central cavities, this marrow is distributed in their caverns, whereas in the larger bones which do contain central cavities the marrow is all concentrated in these.

For, as was pointed out in the first book, things having a similar substance can easily change into one another, whereas it is impossible for those which are very different to be assimilated to one another without intermediate stages.  Such a one in respect to cartilage is the myxoid [mucus-like] substance which surrounds it, and in respect to ligaments, membranes, and nerves the viscous liquid dispersed inside them; for each of these consists of numerous fibers, which are homogeneous--in fact, actual sensible elements; and in the intervals between these fibers is dispersed the humor most suited for nutrition; this they drawn from the blood in the veins, choosing the most appropriate possible, and now they are assimilating it step by step and changing it into their own substance.

All these considerations, then, agree with one another, and bear sufficient witness to the truth of what has been already demonstrated; there is thus no need to prolong the discussion further.  For, from what has been said, anyone can readily discover in what way all the particular [vital activities] come about.  For instance, we could in this way ascertain why it is that in the case of many people who are partaking freely of wine, the fluid which they have drunk is rapidly absorbed through the body and almost the whole of it is passed by the kidneys within a very short time.  For here, too, the rapidity with which the fluid is absorbed depends on appropriateness of quality, on the thinness of the fluid, on the width of the vessels and their mouths, and on the efficiency of the attractive faculty. 

The parts situated near the alimentary canal, by virtue of their appropriateness of quality, draw in the imbibed food for their own purposes, then the parts next to them in their turn snatch it away, then those next again take it from these, until it reaches the vena cava, whence finally the kidneys attract that part of it which is proper to them.  Thus it is in no way surprising that wine is taken up more rapidly than water, owing to its appropriateness of quality, and, further, that the white clear kind of wine is absorbed more rapidly owing to its thinness, while black turbid wine is checked on the way and retarded because of its thickness.  

These facts, also, will afford abundant proof of what has already been said about the arteries; everywhere, in fact, such blood as is both specifically appropriate and at the same time thin in consistency answers more readily to their traction than does blood which is not so; this is why the arteries which, in their diastole, absorb vapor, pneuma, and thin blood attract either none at all or very little of the juices contained in the stomach and intestines.  


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  • The Pardoner's Tale, from The Canterbury Tales (c. 1390) by Geoffrey Chaucer (c.1340 - 1400)
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