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On The Natural Faculties   

To imagine that matter of different kinds is carried in one direction only would characterise a man who was entirely ignorant of all the natural faculties, and particularly of the eliminative faculty, which is the opposite of the attractive. For opposite movements of matter, active and passive, must necessarily follow opposite faculties; that is to say, every part, after it has attracted its special nutrient juice and has retained and taken the benefit of it hastens to get rid of all the surplusage as quickly and effectively as possible, and this it does in accordance with the mechanical tendency of this surplus matter.

Hence the stomach clears away by vomiting those superfluities which come to the surface of its contents, whilst the sediment it clears away by diarrhoea. And when the animal becomes sick, this means that the stomach is striving to be evacuated by vomiting. And the expulsive faculty has in it so violent and forcible an element that in cases of ileus [volvulus], when the lower exit is completely closed, vomiting of faeces occurs; yet such surplus matter could not be emitted from the mouth without having first traversed the whole of the small intestine, the jejunum, the pylorus, the stomach, and the oesophagus. What is there to wonder at, then, if something should also be transferred from the extreme skin-surface and so reach the intestines and stomach? This also was pointed out to us by Hippocrates, who maintained that not merely pneuma or excess-matter, but actual nutriment is brought down from the outer surface to the original place from which it was taken up. For the slightest mechanical movements determine this expulsive faculty, which apparently acts through the transverse fibres, and which is very rapidly transmitted from the source of motion to the opposite extremities. It is, therefore, neither unlikely nor impossible that, when the part adjoining the skin becomes suddenly oppressed by an unwonted cold, it should at once be weakened and should find that the liquid previously deposited beside it without discomfort had now become more of a burden than a source of nutrition, and should therefore strive to put it away. Finally, seeing that the passage outwards was shut off by the condensation [of tissue], it would turn to the remaining exit and would thus forcibly expel all the waste-matter at once into the adjacent part; this would do the same to the part following it; and the process would not cease until the transference finally terminated at the inner of the veins.

Now, movements like these come to an end fairly soon, but those resulting from internal irritants (e.g., in the administration of purgative drugs or in cholera) become much stronger and more lasting; they persist as long as the condition of things about the mouths of the veins continues, that is, so long as these continue to attract what is adjacent. For this condition causes evacuation of the contiguous part, and that again of the part next to it, and this never stops until the extreme surface is reached; thus, as each part keeps passing on matter to its neighbour, the original affection very quickly arrives at the extreme termination. Now this is also the case in ileus; the inflamed intestine is unable to support either the weight or the acridity of the waste substances and so does its best to excrete them, in fact to drive them as far away as possible. And, being prevented from effecting an expulsion downwards when the severest part of the inflammation is there, it expels the matter into the adjoining part of the intestines situated above. Thus the tendency of the eliminative faculty is step by step upwards, until the superfluities reach the mouth.

Now this will be also spoken of at greater length in my treatise on disease. For the present, however, I think I have shown clearly that there is a universal conveyance or transference from one thing into another, and that, as Hippocrates used to say, there exists in everything a consensus in the movement of air and fluids. And I do not think that anyone, however slow his intellect, will now be at a loss to understand any of these points,- how, for instance, the stomach or intestines get nourished, or in what manner anything makes its way inwards from the outer surface of the body. Seeing that all parts have the faculty of attracting what is suitable or well-disposed and of eliminating what is troublesome or irritating, it is not surprising that opposite movements should occur in them consecutively- as may be clearly seen in the case of the heart, in the various arteries, in the thorax, and lungs. In all these the active movements of the organs and therewith the passive movements of [their contained] matters may be seen taking place almost every second in opposite directions. Now, you are not astonished when the trachea-artery alternately draws air into the lungs and gives it out, and when the nostrils and the whole mouth act similarly; nor do you think it strange or paradoxical that the air is dismissed through the very channel by which it was admitted just before. Do you, then, feel a difficulty in the case of the veins which pass down from the liver into the stomach and intestines, and do you think it strange that nutriment should at once be yielded up to the liver and drawn back from it into the stomach by the same veins? You must define what you mean by this expression "at once." If you mean "at the same time" this is not what we ourselves say; for just as we take in a breath at one moment and give it out again at another, so at one time the liver draws nutriment from the stomach, and at another the stomach from the liver. But if your expression "at once" means that in one and the same animal a single organ subserves the transport of matter in opposite directions, and if it is this which disturbs you, consider inspiration and expiration. For of course these also take place through the same organs, albeit they differ in their manner of movement, and in the way in which the matter is conveyed through them.

Now the lungs, the thorax, the arteries rough and smooth, the heart, the mouth, and the nostrils reverse their movements at very short intervals and change the direction of the matters they contain. On the other hand, the veins which pass down the from the liver to the intestines and stomach reverse the direction not at such short intervals, but sometimes once in many days.

The whole matter, in fact, is as follows:- Each of the organs draws into itself the nutriment alongside it, and devours all the useful fluid in it, until it is thoroughly satisfied; this nutriment, as I have already shown, it stores up in itself, afterwards making it adhere and then assimilating it- that is, it becomes nourished by it. For it has been demonstrated with sufficient clearness already that there is something which necessarily precedes actual nutrition, namely adhesion, and that before this again comes presentation. Thus as in the case of the animals themselves the end of eating is that the stomach should be filled, similarly in the case of each of the parts, the end of presentation is the filling of this part with its appropriate liquid. Since, therefore, every part has, like the stomach, a craving to be nourished, it too envelops its nutriment and clasps it all round as the stomach does. And this [action of the stomach], as has been already said, is necessarily followed by the digestion of the food, although it is not to make it suitable for the other parts that the stomach contracts upon it; if it did so, it would no longer be a physiological organ, but an animal possessing reason and intelligence, with the power of choosing the better [of two alternatives].

But while the stomach contracts for the reason that the whole body possesses a power of attracting and of utilising appropriate qualities, as has already been explained, it also happens that, in this process, the food undergoes alteration; further, when filled and saturated with the fluid pabulum from the food, it thereafter looks on the food as a burden; thus it at once gets of the excess- that is to say, drives it gets downwards- itself turning to another task, namely that of causing adhesion. And during this time, while the nutriment is passing along the whole length of the intestine, it is caught up by the vessels which pass into the intestine; as we shall shortly demonstrate, most of it is seized by the veins, but a little also by the arteries; at this stage also it becomes presented to the coats of the intestines.

Now imagine the whole economy of nutrition divided into three periods. Suppose that in the first period the nutriment remains in the stomach and is digested and presented to the stomach until satiety is reached, also that some of it is taken up from the stomach to the liver.

During the second period it passes along the intestines and becomes presented both to them and to the liver- again until the stage of satiety- while a small part of it is carried all over the body. During this period, also imagine that what was presented to the stomach in the first period becomes now adherent to it.

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