On The Natural Faculties
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, 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 also, when in his book "On the Nature of Man" he gives the name "phlegm" 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. Thus, the white-coloured substance which everyone else calls phlegm, and which Prodicus calls blenna [mucus], is the well-known cold, moist humour 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 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' writings, that he so carelessly passes over the consideration of the humours? Or, does the 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 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 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; 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 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 or 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 humour. 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. 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, 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, 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 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 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. 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 the from 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; 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, 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.