Chapter XXV: Book II: B (3)

Kai mên ouk endechetai tauton edesma tois men cholên
gennan, tois d' haima mê ouk en tô sômati tês geneseôs
autôn epiteloumenês. ei gar dê oikothen ge kai par'
heautou tôn edesmatôn hekaston echon kai ouk en tois tôn
zôôn sômasi || metaballomenon egenna tên cholên, en 125
hapasin an homoiôs autên tois sômasin egenna kai to men
pikron exô geuomenois ên an oimai cholês poiêtikon, ei
de ti glyky kai chrêston, ouk an oude to brachytaton ex
autou cholês egennato. kai mên ou to meli monon, alla
kai tôn allôn hekaston tôn glykeôn tois proeirêmenois
sômasi tois di' hotioun tôn eirêmenôn thermois ousin eis
cholên hetoimôs existatai.

Kaitoi taut' ouk oid' hopôs exênechthên eipein ou
proelomenos all' hyp' autês tou logou tês akolouthias
anankastheis. eirêtai d' epi pleiston hyper autôn
Aristotelei te kai Praxagora tên Hippokratous kai
Platônos gnômên orthôs exêgêsamenois.

IX

For this reason the things that we have said are not to be looked upon as proofs but rather as indications of the dulness[271] of those who think differently, and who do not even recognise 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[272]--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. 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_,[273] and belong to that of the _scientific investigator_."[274] Are you, then, going to oppose those who maintain that the cause of the function of every organ is a natural eucrasia,[275] that the dyscrasia 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 sceptics--Pyrrhonists, in fact? 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[276] 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 enquiry 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 humour, 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,[277] 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 humour 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[278] also, when in his book "On the Nature of Man" he gives the name "phlegm" (from the verb [Greek: pephlechthai]) to that element in the humours 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.[279] Thus, the white-coloured substance which everyone else calls _phlegm_, and which Prodicus calls _blenna_ [mucus],[280] is the well-known cold, moist humour which collects mostly in old people and in those who have been chilled[281] 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 humour, 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 humours alone? No; the _black bile_ is such a humour. 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 humour 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 humour 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's writings, that he so carelessly passes over the consideration of the humours? Or, does he know it, and yet voluntarily neglect one of the finest studies[282] in medicine? Thus he ought not to have said anything about the _spleen_,[283] 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 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[284] 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 humours;[285] 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 colour, and the cicatrices of ulcers are dark. For, generally speaking, when the spleen is drawing the atrabiliary[286] humour into itself to a less degree than is proper, the blood is unpurified, and the whole body takes on a bad colour. 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,[287] 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 humour.[288] And 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, 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 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. It seems to me also that 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]; 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 realise the facts, which are as follow:--

In the genesis of blood, everything in the nutriment[292] 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 biliary[293] 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 itself[295]; 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 treatise[298] 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.

IX

Mê toinyn hôs apodeixeis hyph' hêmôn eirêsthai nomizein
ta toiauta mallon ê peri tês tôn allôs gignôskontôn
anaisthêsias endeixeis, hoi mêde ta pros hapantôn
homologoumena kai kath' hekastên hêmeran phainomena
gignôskousin; tas d' apodeixeis autôn tas kat' epistêmên
ex ekeinôn chrê lambanein tôn archôn, hôn êdê kai
prosthen || eipomen, hôs to dran kai paschein eis allêla 126
tois sômasin hyparchei kata to thermon kai psychron kai
xêron kai hygron. kai eite phlebas eith' hêpar eit'
artêrias eite kardian eite koilian eit' allo ti morion
energein tis phêseien hêntinoun energeian, aphyktois
anankais anankasthêsetai dia tên ek tôn tettarôn poian
krasin homologêsai tên energeian hyparchein autô. dia ti
gar hê gastêr peristelletai tois sitiois, dia ti d' hai
phlebes haima gennôsi, para tôn Erasistrateiôn edeomên
akousai. to gar hoti peristelletai monon auto kath'
heauto gignôskein oudepô chrêston, ei mê kai tên aitian
eideiêmen; houtô gar an oimai kai ta sphalmata
therapeusaimen. ou melei, phasin, hêmin oude
polypragmonoumen eti tas toiautas aitias; hyper iatron
gar eisi kai tô physikô prosêkousi. poteron oun oud'
antereite tô phaskonti tên men eukrasian tên kata physin
aitian einai tês energeias hekastô tôn organôn, tên d'
au dyskrasian noson t êdê kaleisthai kai pantôs hyp'
au||tês blaptesthai tên energeian? ê peisthêsesthe tais 127
tôn palaiôn apodeixesin? ê triton ti kai meson hekaterou
toutôn praxete mêth' hôs alêthesi tois logois ex anankês
peithomenoi mêt' antilegontes hôs pseudesin, all'
aporêtikoi tines exaiphnês kai Pyrrhôneioi genêsesthe?
kai mên ei touto drasete, tên empeirian anankaion hymin
prostêsasthai. tô gar an eti tropô kai tôn iamatôn
euporoiête tên ousian hekastou tôn nosêmatôn agnoountes?
ti oun ouk ex archês empeirikous hymas autous ekalesate?
ti de pragmath' hêmin parechete physikas energeias
epangellomenoi zêtein iaseôs heneken? ei gar adynatos hê
gastêr esti tini peristellesthai kai tribein, pôs autên
eis to kata physin epanaxomen agnoountes tên aitian tês
adynamias? egô men phêmi tên men hypertethermasmenên
empsykteon hêmin einai, tên d' epsygmenên thermanteon;
houtô de kai tên exêrasmenên hygranteon, tên d'
hygrasmenên xêranteon. alla kai || kata syzygian, ei 128
thermotera tou kata physin hama kai xêrotera tychoi
gegenêmenê, kephalaion einai tês iaseôs empsychein th'
hama kai hygrainein; ei d' au psychrotera te kai
hygrotera, thermainein te kai xêrainein kapi tôn allôn
hôsautôs; hoi d' ap' Erasistratou ti pote kai praxousin
oud' holôs zêtein tôn energeiôn tas aitias
homologountes? ho gar toi karpos tês peri tôn energeiôn
zêtêseôs houtos esti, to tas aitias tôn dyskrasiôn
eidota eis to kata physin epanagein autas, hôs auto ge
monon to gnônai tên hekastou tôn organôn energeian hêtis
estin oupô chrêston eis tas iaseis.

Erasistratos de moi dokei kai auto tout' agnoein, hôs,
hêtis an en tô sômati diathesis blaptê tên energeian mê
kata ti symbebêkos alla prôtôs te kai kath' heautên,
hautê to nosêma estin auto. pôs oun eti diagnôstikos te
kai iatikos estai tôn nosêmatôn agnoôn holôs auta tina
t' esti kai posa kai poia? kata men dê tên gastera to ge
tosouton Erasistratos êxiôse zêteisthai to pôs pettetai
ta sitia; || to d' hêtis prôtê te kai archêgos aitia 129
toutou, pôs ouk epeskepsato? kata de tas phlebas kai to
haima kai auto to pôs parelipen.

All' outh' Hippokratês out' allos tis hôn oligô prosthen
emnêmoneusa philosophôn ê iatrôn axion ôet' einai
paralipein; alla tên kata physin en hekastô zôô
thermasian eukraton te kai metriôs hygran ousan haimatos
einai phasi gennêtikên kai di' auto ge touto kai to
haima thermon kai hygron einai phasi tê dynamei chymon,
hôsper tên xanthên cholên thermên kai xêran einai, ei
kai hoti malisth' hygra phainetai. diapherein gar autois
dokei to kata phantasian hygron tou kata dynamin. ê tis
ouk oiden, hôs halmê men kai thalatta taricheuei ta krea
kai asêpta diaphylattei, to d' allo pan hydôr to potimon
hetoimôs diaphtheirei te kai sêpei? tis d' ouk oiden,
hôs xanthês cholês en tê gastri periechomenês pollês
apaustô dipsei synechometha kai hôs emesantes autên
euthys adipsoi gignometha mallon ê ei pampoly poton
prosêrametha? || thermos oun eulogôs ho chymos houtos 130
eirêtai kai xêros kata dynamin, hôsper ge kai to phlegma
psychron kai hygron. enargeis gar kai peri toutou
pisteis Hippokratei te kai tois allois eirêntai
palaiois.

Prodikos d' en tô peri physeôs anthrôpou grammati to
synkekaumenon kai hoion hyperôptêmenon en tois chymois
onomazôn phlegma para to pephlechthai tê lexei men
heterôs chrêtai, phylattei mentoi to pragma kata tauto
tois allois. tên d' en tois onomasi tandros toutou
kainotomian hikanôs endeiknytai kai Platôn. alla touto
ge to pros hapantôn anthrôpôn onomazomenon phlegma to
leukon tên chroan, ho blennan onomazei Prodikos, ho
psychros kai hygros chymos estin houtos kai pleistos
tois te gerousi kai tois hopôsdêpote psygeisin
athroizetai kai oudeis oude mainomenos an allo ti ê
psychron kai hygron eipoi an auton.

Ar' oun thermos men tis esti kai hygros chymos kai
thermos kai xêros heteros kai hygros kai psychros allos,
oudeis d' esti psychros kai xêros tên dynamin, all' hê
tetartê syzygia tôn kraseôn || en hapasi tois allois 131
hyparchousa monois tois chymois ouch hyparchei? kai mên
hê ge melaina cholê toioutos esti chymos, hon hoi
sôphronountes iatroi kai philosophoi pleonektein ephasan
tôn men hôrôn tou etous en phthinopôrô malista, tôn d'
hêlikiôn en tais meta tên akmên. houtô de kai diaitêmata
kai chôria kai katastaseis kai nosous tinas psychras kai
xêras einai phasin; ou gar dê chôlên en tautê monê tê
syzygia tên physin einai nomizousin all' hôsper tas
allas treis houtô kai tênde dia pantôn ektetasthai.

Êuxamên oun kantauth' erôtêsai dynasthai ton
Erasistraton, ei mêden organon hê technikê physis
edêmiourgêse kathartikon tou toioutou chymou, alla tôn
men ourôn ara tês diakriseôs estin organa dyo kai tês
xanthês cholês heteron ou smikron, ho de toutôn
kakoêthesteros chymos alatai dia pantos en tais phlepsin
anamemigmenos tô haimati. kaitoi "Dysenteriê," phêsi pou
Hippokratês, "ên apo cholês melainês arxêtai,
thanasimon," ou mên hê g' apo tês xan||thês cholês 132
archomenê pantôs olethrios, all' hoi pleious ex autês
diasôzontai. tosoutô kakoêthestera te kai drimytera tên
dynamin hê melaina cholê tês xanthês estin. ar' oun oute
tôn allôn anegnô ti tôn tou Hippokratous grammatôn ho
Erasistratos ouden oute to peri physeôs anthrôpou
biblion, hin' houtôs argôs parelthoi tên peri tôn chymôn
episkepsin, ê gignôskei men, hekôn de paraleipei
kallistên tês technês theôrian? echrên oun auton mêde
peri tou splênos eirêkenai ti mêd' aschêmonein hypo tês
technikês physeôs organon têlikouton matên hêgoumenon
kateskeuasthai. kai mên ouch Hippokratês monon ê Platôn,
ouden ti cheirous Erasistratou peri physin andres, hen
ti tôn kathairontôn to haima kai tout' einai phasi to
splanchnon, alla kai myrioi syn autois alloi tôn palaiôn
iatrôn te kai philosophôn, hôn hapantôn prospoiêsamenos
hyperphronein ho gennaios Erasistratos out' anteipen
outh' holôs tês doxês autôn emnêmoneuse. kai mên hosois
ge to sôma thallei, toutois ho splên phthinei, phêsin
Hippokratês, kai hoi apo tês || empeirias hormômenoi 133
pantes homologousin iatroi. kai hosois g' au megas kai
hypoulos auxanetai, toutois kataphtheirei te kai
kakochyma ta sômata tithêsin, hôs kai touto palin ouch
Hippokratês monon alla kai Platôn alloi te polloi kai
hoi apo tês empeirias homologousin iatroi. kai hoi apo
splênos de kakopragountos ikteroi melanteroi kai tôn
helkôn hai oulai melainai. katholou gar, hotan
endeesteron ê prosêken eis heauton helkê ton
melancholikon chymon, akatharton men to haima,
kakochroun de to pan gignetai sôma. pote d' endeesteron
helkei? ê dêlon hoti kakôs diakeimenos? hôsper oun tois
nephrois energeias ousês helkein ta oura kakôs helkein
hyparchei kakopragousin, houtô kai tô splêni poiotêtos
melancholikês helktikên en heautô dynamin echonti
symphyton arrhôstêsanti pote tautên anankaion helkein
kakôs kan tôde pachyteron êdê kai melanteron gignesthai
to haima.

Taut' oun hapanta pros te tas diagnôseis tôn nosêmatôn
kai tas iaseis megistên parechomena chreian || 134
hyperepêdêse teleôs ho Erasistratos kai kataphronein
prosepoiêsato têlikoutôn andrôn ho mêde tôn tychontôn
kataphronôn all' aei philotimôs antilegôn tais
êlithiôtatais doxais. hô kai dêlon, hôs ouden echôn out'
anteipein tois presbyterois hyper hôn apephênanto peri
splênos energeias te kai chreias out' autos exeuriskôn
ti kainon eis to mêden holôs eipein aphiketo. all'
hêmeis ge prôton men ek tôn aitiôn, hois hapanta
dioikeitai ta kata tas physeis, tou thermou legô kai
psychrou kai xêrou kai hygrou, deuteron d' ex autôn tôn
enargôs phainomenôn kata to sôma psychron kai xêron
einai tina chrênai chymon apedeixamen. hexês d', hoti
kai melancholikos houtos hyparchei kai to kathairon
auton splanchnon ho splên estin, dia bracheôn hôs eni
malista tôn tois palaiois apodedeigmenôn anamnêsantes
epi to leipon eti tois parousi logois aphixometha.

Ti d' an eiê leipon allo g' ê exêgêsasthai saphôs, hoion
ti boulontai te || kai apodeiknyousi peri tên tôn chymôn 135
genesin hoi palaioi symbainein. enargesteron d' an
gnôstheiê dia paradeigmatos. oinon dê moi noei gleukinon
ou pro pollou tôn staphylôn ektethlimmenon zeonta te kai
alloioumenon hypo tês en autô thermasias; epeita kata
tên autou metabolên dyo gennômena perittômata to men
kouphoteron te kai aerôdesteron, to de baryteron te kai
geôdesteron, hôn to men anthos, oimai, to de tryga
kalousi. toutôn tô men heterô tên xanthên cholên, tô d'
heterô tên melainan eikazôn ouk an hamartois, ou tên
autên echontôn idean tôn chymôn toutôn en tô kata physin
dioikeisthai to zôon, hoian kai para physin echontos
epiphainontai pollakis. hê men gar xanthê lekithôdês
gignetai; kai gar onomazousin houtôs autên, hoti tais
tôn ôôn lekithois homoioutai kata te chroan kai pachos.
hê d' au melaina kakoêthestera men poly kai hautê tês
kata physin; onoma d' ouden idion keitai tô toioutô
chymô, plên ei pou tines ê xystikon ê oxôdê keklêkasin
auton, hoti kai drimys homoiôs oxei gignetai kai || xyei 136
ge to sôma tou zôou kai tên gên, ei kat' autês
ekchytheiê, kai tina meta pompholygôn hoion zymôsin te
kai zesin ergazetai, sêpedonos epiktêtou proselthousês
ekeinô tô kata physin echonti chymô tô melani. kai moi
dokousin hoi pleistoi tôn palaiôn iatrôn auto men to
kata physin echon tou toioutou chymou kai diachôroun
katô kai pollakis epipolazon anô melana kalein chymon,
ou melainan cholên, to d' ek synkauseôs tinos kai
sêpedonos eis tên oxeian methistamenon poiotêta melainan
onomazein cholên. alla peri men tôn onomatôn ou chrê
diapheresthai, to d' alêthes hôd' echon eidenai.

Kata tên tou haimatos genesin hoson an hikanôs pachy kai
geôdes ek tês tôn sitiôn physeôs empheromenon tê trophê
mê dexêtai kalôs tên ek tês emphytou thermasias
alloiôsin, ho splên eis heauton helkei touto. to d'
optêthen, hôs an tis eipoi, kai synkauthen tês trophês,
eiê d' an touto to thermotaton en autê kai glykytaton,
hoion to te meli kai hê pimelê, xanthê genomenon cholê
dia tôn cholêdochôn onomazomenôn angeiôn ekkathairetai.
|| lepton d' esti touto kai hygron kai rhyton ouch 137
hôsper hotan optêthen eschatôs xanthon kai pyrôdes kai
pachy genêtai tais tôn ôôn homoion lekithois. touto men
gar êdê para physin; thateron de to proteron eirêmenon
kata physin estin; hôsper ge kai tou melanos chymou to
men mêpô tên hoion zesin te kai zymôsin tês gês
ergazomenon kata physin esti, to d' eis toiautên
methistamenon idean te kai dynamin êdê para physin, hôs
an tên ek tês synkauseôs tou para physin thermou
proseilêphos drimytêta kai hoion tephra tis êdê gegonos.
hôde pôs kai hê kekaumenê tryx tês akaustou diênenke.
thermon gar ti chrêma hautê g' hikanôs estin, hôste
kaiein te kai têkein kai diaphtheirein tên sarka. tê d'
hetera tê mêpô kekaumenê tous iatrous estin heurein
chrômenous eis hosaper kai tê gê tê kaloumenê keramitidi
kai tois allois, hosa xêrainein th' hama kai psychein
pephyken.

Eis tên tês houtô synkautheisês melainês cholês idean
kai hê lekithôdês ekeinê methistatai pollakis, hotan kai
autê poth' hoion optêtheisa tychê pyrôdei thermasia. ta
d' alla || tôn cholôn eidê sympanta ta men ek tês tôn 138
eirêmenôn kraseôs gignetai, ta d' hoion hodoi tines eisi
tês toutôn geneseôs te kai eis allêla metabolês.
diapherousi de tô tas men akratous einai kai monas, ta
d' hoion orrhois tisin exygrasmenas. all' hoi men orrhoi
tôn chymôn hapantes perittômata kai katharon autôn einai
deitai tou zôou to sôma. tôn d' eirêmenôn chymôn esti
tis chreia tê physei kai tou pacheos kai tou leptou kai
kathairetai pros te tou splênos kai tês epi tô hêpati
kysteôs to haima kai apotithetai tosouton te kai
toiouton hekaterou meros, hoson kai hoion, eiper eis
holon ênechthê tou zôou to sôma, blabên an tin'
eirgasato. to gar hikanôs pachy kai geôdes kai teleôs
diapepheugos tên en tô hêpati metabolên ho splên eis
heauton helkei; to d' allo to metriôs pachy syn tô
kateirgasthai pantê pheretai. deitai gar en pollois tou
zôou moriois pachytêtos tinos to haima kathaper oimai
kai tôn || empheromenôn inôn. kai eirêtai men kai 139
Platôni peri tês chreias autôn, eirêsetai de kai hêmin
en ekeinois tois grammasin, en hois an tas chreias tôn
moriôn dierchômetha; deitai d' ouch hêkista kai tou
xanthou chymou tou mêpô pyrôdous eschatôs gegenêmenou to
haima kai tis autô kai hê para toude chreia, di' ekeinôn
eirêsetai.

Phlegmatos d' ouden epoiêsen hê physis organon
kathartikon, hoti psychron kai hygron esti kai hoion
hêmipeptos tis trophê. deitai toinyn ou kenousthai to
toiouton all' en tô sômati menon alloiousthai. to d' ex
enkephalou katarrheon perittôma tacha men an oude
phlegma tis orthôs alla blennan te kai koryzan, hôsper
oun kai onomazetai, kaloiê. ei de mê, all' hoti ge tês
toutou kenôseôs orthôs hê physis prounoêsato, kai tout'
en tois peri chreias moriôn eirêsetai. kai gar oun kai
to kata te tên gastera kai ta entera synistamenon
phlegma hopôs an ekkenôthê kai auto tachista te kai
kallista, to pareskeuasmenon tê physei mêchanêma di'
ekeinôn eirêsetai kai auto tôn hypomnê||matôn. hoson oun 140
empheretai tais phlepsi phlegma chrêsimon hyparchon tois
zôois, oudemias deitai kenôseôs. prosechein de chrê
kantautha ton noun kai gignôskein, hôsper tôn cholôn
hekateras to men ti chrêsimon esti kai kata physin tois
zôois, to d' achrêston te kai para physin, houtô kai tou
phlegmatos, hoson men an ê glyky, chrêston einai touto
tô zôô kai kata physin, hoson d' oxy kai halmyron
egeneto, to men oxy teleôs êpeptêsthai, to d' halmyron
diasesêphthai. teleian d' apepsian phlegmatos akouein
chrê tên tês deuteras pepseôs dêlonoti tês en phlepsin;
ou gar dê tês ge prôtês tês kata tên koilian; ê oud' an
egegenêto tên archên chymos, ei kai tautên diepepheugei.

Taut' arkein moi dokei peri geneseôs te kai diaphthoras
chymôn hypomnêmat' einai tôn Hippokratei te kai Platôni
kai Aristotelei kai Praxagora kai Dioklei kai pollois
allois tôn palaiôn eirêmenôn; ou gar edikaiôsa panta
metapherein eis tonde ton logon ta teleôs ekeinois
gegrammena. tosouton de monon hyper hekastou eipon,
hoson exormêsei te tous || entynchanontas, ei mê 141
pantapasin eien skaioi, tois tôn palaiôn homilêsai
grammasi kai tên eis to rhaon autois syneinai boêtheian
parexei. gegraptai de pou kai di' heterou logou peri tôn
kata Praxagoran ton Nikarchou chymôn. ei gar kai hoti
malista deka poiei chôris tou haimatos, hendekatos gar
an eiê chymos auto to haima, tês Hippokratous ouk
apochôrei didaskalias. all' eis eidê tina kai diaphoras
temnei tous hyp' ekeinou prôtou pantôn hama tais
oikeiais apodeixesin eirêmenous chymous.

Epainein men oun chrê tous t' exêgêsamenous ta kalôs
eirêmena kai tous ei ti paraleleiptai prostithentas; ou
gar hoion te ton auton arxasthai te kai teleiôsai;
memphesthai de tous houtôs atalaipôrous, hôs mêden
hypomenein mathein tôn orthôs eirêmenôn, kai tous eis
tosouton philotimous, hôst' epithymia neôterôn dogmatôn
aei panourgein ti kai sophizesthai, ta men hekontas
paralipontas, hôsper Erasistratos epi tôn chymôn
epoiêse, ta de pa||nourgôs antilegontas, hôsper autos 142
th' houtos kai alloi polloi tôn neôterôn.

All' houtos men ho logos entauthoi teleutatô, to d'
hypoloipon hapan en tô tritô prosthêsô.

[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 (26).

[171] The term [Greek: koilia] 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 (382).

[172] _cf._ p. 100, note 2 (152); p. 167, note 2 (234).

[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 (138); p. 13, note 5 (26).

[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 (387); p. 321, note 4 (398).

[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 (241). 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 (5). 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 (49).

[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 (34).

[189] _i.e._ we should be talking psychology, not
biology; _cf._ stomach, p. 307, note 3 (380).

[190] Attraction now described not merely as
_qualitative_ but also as _quantitative_. _cf._ p. 85,
note 3 (130).

[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 (188).

[194] On the _alterative_ and _shaping_ faculties _cf._
p. 18, note 1 (32).

[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 (70).

[200] "Useless" organs; _cf._ p. 56, note 2 (91). 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
(17).

[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 (174).

[212] _cf._ p. 272, note 1 (350).

[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 (39).
_Theoreton_ without qualification means merely
_visible_, not _theoretic_. _cf._ p. 205, note 1 (282).

[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 (185).
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 (119).

[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 (50).

[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 (216).

[227] The _horror vacui_.

[228] _Prosthesis_ of nutriment; _cf._ p. 39, note 6
(67).

[229] _Anadosis_, "absorption"; _cf._ p. 13, note 5
(26).

[230] Lit. _diadosis_.

[231] _i.e._ let him explain the _diadosis_.

[232] "Spiritus animalis"; _cf._ p. 152, note 1 (215).
The nutriment was for the _walls_ of the vessels, not
for their cavities. _cf._ p. 319, note 3 (394).

[233] Specific attraction; _cf._ Book I., chap. xiv.

[234] _cf._ p. 100, note 2 (152).

[235] In Book II., chap. i.

[236] Prevention better than cure.

[237] _e.g._ Anaxagoras; _cf._ p. 7, note 5 (14); p. 20,
note 3 (38).

[238] Lit. _haematosis_.

[239] _cf._ p. 174, note 4 (250).

[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 (180).

[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 (83).

[246] _cf._ Book I., chap. iii.

[247] Gk. _pepsis_; otherwise rendered _coction_.

[248] _cf._ p. 13, note 5 (26).

[249] _e.g._ Asclepiades.

[250] Lit. _chylosis_; _cf._ p. 238, note 2 (312).

[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 (83).

[259] Lit. _phenomena_.

[260] _i.e._ living organisms; _cf._ p. 47, note 1 (75).

[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 (215); 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 (288).

[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 (114).

[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 (305).

[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 (17).

[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 (295).

[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 (353).

[296] _Timaeus_, 82 C-D.

[297] _cf._ p. 90, note 1 (137). 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.