On The Natural Faculties
*Cirrhosis of the liver.
The learned Erasistratus, however, overlooks- nay, despises- what neither Hippocrates, Diocles, Praxagoras, 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. 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.
Now, Erasistratus is thoroughly small-minded and petty to the last degree in all his disputations- when, for instance, in his treatise "On Digestion," he argues jealously with those who consider that this is a process of putrefaction of the food; and, in his work "On Anadosis," 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, 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 chylification 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? 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 something 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.
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 kind* 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 purified 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? 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 in every person who took it. The facts, however, are not so. 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 poi 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 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. 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.