Galen On the Natural Faculties translated by Arthur John Brock, M.D.
1. It has been made clear in the preceding discussion that nutrition occurs by an alteration or assimilation of that which nourishes to that which receives nourishment, and that there exists in every part of the animal a faculty which in view of its activity we call, in general terms, alterative, or, more specifically, assimilative and nutritive. It was also shown that a sufficient supply of the matter which the part being nourished makes into nutriment for itself is ensured by virtue of another faculty which naturally attracts its proper juice [humour] that juice is proper to each part which is adapted for assimilation, and that the faculty which attracts the juice is called, by reason of its activity, attractive or epispastic. It has also been shown that assimilation is preceded by adhesion, and this, again, by presentation, the latter stage being, as one might say, the end or goal of the activity corresponding to the attractive faculty. For the actual bringing up of nutriment from the veins into each of the parts takes place through the activation of the attractive faculty, whilst to have been finally brought up and presented to the part is the actual end for which we desired such an activity; it is attracted in order that it may be presented. After this, considerable time is needed for the nutrition of the animal; whilst a thing may be even rapidly attracted, on the other hand to become adherent, altered, and entirely assimilated to the part which is being nourished and to become a part of it, cannot take place suddenly, but requires a considerable amount of time.
But if the nutritive juice, so presented, does not remain in the part, but withdraws to another one, and keeps flowing away, and constantly changing and shifting its position, neither adhesion nor complete assimilation will take place in any of them. Here too, then, the [animal's] nature has need of some other faculty for ensuring a prolonged stay of the presented juice at the part, and this not a faculty which comes in from somewhere outside but one which is resident in the part which is to be nourished. This faculty, again, in view of its activity our predecessors were obliged to call retentive. Thus our argument has clearly shown the necessity for the genesis of such a faculty, and whoever has an appreciation of logical sequence must be firmly persuaded from what we have said that, if it be laid down and proved by previous demonstration that Nature is artistic and solicitous for the animal's welfare, it necessarily follows that she must also possess a faculty of this kind.
2. Since, however, it is not our habit to employ this kind of demonstration alone, but to add thereto cogent and compelling proofs drawn from obvious facts, we will also proceed to the latter kind in the present instance: we will demonstrate that in certain parts of the body the retentive faculty is so obvious that its operation can be actually recognised by the senses, whilst in other parts it is less obvious to the senses, but is capable even here of being detected by the argument. Let us begin our exposition, then, by first dealing systematically for a while with certain definite parts of the body, in reference to which we may accurately test and enquire what sort of thing the retentive faculty is. Now, could one begin the enquiry in any better way than with the largest and hollowest organs? Personally I do not think one could. It is to be expected that in these, owing to their size, the activities will show quite clearly, whereas with respect to the small organs, even if they possess a strong faculty of this kind, its activation will not at once be recognisable to sense.
Now those parts of the animal which are especially hollow and large are the stomach and the organ which is called the womb or uterus. What prevents us, then, from taking up these first and considering their activities, conducting the enquiry on our own persons in regard to those activities which are obvious without dissection, and, in the case of those which are more obscure, dissecting animals which are near to man; not that even animals unlike him will not show, in a general way, the faculty in question, but because in this manner we may find out at once what is common to all and what is peculiar to ourselves, and so may become more resourceful in the diagnosis and treatment of disease. Now it is impossible to speak of both organs at once, so we shall deal with each in turn, beginning with the one which is capable of demonstrating the retentive faculty most plainly. For the stomach retains the food until it has quite digested it, and the uterus retains the embryo until it brings it to completion, but the time taken for the completion of the embryo is many times more than that for the digestion of food.
3. We may expect, then, to detect the retentive faculty in the uterus more clearly in proportion to the longer duration of its activity as compared with that of the stomach. For, as we know, it takes nine months in most women for the foetus to attain maturity in the womb, this organ having its neck quite closed, and entirely surrounding the embryo together with the chorion. Further, it is the utility of the function which determines the closure of the os and the stay of the foetus in the uterus. For it is not casually nor without reason that Nature has made the uterus capable of contracting upon, and of retaining the embryo, but in order that the latter may arrive at a proper size. When, therefore, the object for which the uterus brought its retentive faculty into play has been fulfilled, it then stops this faculty and brings it back to a state of rest, and employs instead of it another faculty hitherto quiescent – the propulsive faculty. In this case again the quiescent and active states are both determined by utility; when this calls, there is activity; when it does not, there is rest. Here, then, once more, we must observe well the Art [artistic tendency] of Nature – how she has not merely placed in each organ the capabilities of useful activities, but has also fore-ordained the times both of rest and movement.
For everything connected with the pregnancy proceeds properly, the eliminative faculty remains quiescent as though it did not exist, but if anything goes wrong in connection either with the chorion or any of the other membranes or with the foetus itself, and its completion is entirely despaired of, then the uterus no longer awaits the nine-months period, but the retentive faculty forthwith ceases and allows the heretofore inoperative faculty to come into action. Now it is that something is done – in fact, useful work effected – by the eliminative or propulsive faculty (for so it, too, has been called, receiving, like the rest,its names from the corresponding activities). Further, our theory can, I think, demonstrate both together; for seeing that they succeed each other, and that the one keeps giving place to the other according as utility demands, it seems not unreasonable to accept a common demonstration also for both. Thus it is the work of the retentive faculty to make the uterus contract upon the foetus at every point, so that, naturally enough, when the midwives palpate it, the os is found to be closed, whilst the pregnant women themselves, during the first days – and particularly on that on which conception takes place – experience a sensation as if the uterus were moving and contracting upon itself.
Now, if both of these things occur – if the os closes apart from inflammation or any other disease, and if this is accompanied by a feeling of movement in the uterus – then the women believe that they have received the semen which comes from the male, and that they are retaining it. Now we are not inventing this for ourselves: one may say the statement is based on prolonged experience of those who occupy themselves with such matters. Thus Herophilus does not hesitate to state in his writings that up to the time of labour the os uteri will not admit so much as the tip of a probe, that it no longer opens to the slightest degree if pregnancy has begun – that, in fact, it dilates more widely at the times of the menstrual flow. With him are in agreement all the others who have applied themselves to this subject; and particularly Hippocrates, who was the first of all physicians and philosophers to declare that the os uteri closes during pregnancy and inflammation, albeit in pregnancy it does not depart from its own nature, whilst in inflammation it becomes hard. In the case of the opposite (the eliminative) faculty, the os opens, whilst the whole fundus approaches as near as possible to the os, expelling the embryo as it does so; and along with the fundus the contiguous parts – which form as it were a girdle round the whole organ – cooperate in the work; they squeeze upon the embryo and propel it bodily outwards. And, in many women who exercise such a faculty immoderately, violent pains cause forcible prolapse of the whole womb; here almost the same thing happens as frequently occurs in wresting –bouts and struggles, when in our eagerness to overturn and throw others we are ourselves upset along with them; for similarly when the uterus is forcing the embryo forward it sometimes becomes entirely prolapsed, and particularly when the ligaments connecting it with the spine happen to be naturally lax.
A wonderful device of Nature's also is this – that, when the foetus is alive, the os uteri is closed with perfect accuracy, but if it dies, the os at once opens up to the extent which is necessary for the foetus to make its exit. The midwife, however, does not make the parturient woman get up at once and sit down on the [obstetric] chair, but she begins by palpating the os as it gradually dilates, and the first thing she says is that it has dilated "enough to admit the little finger," then that "it is bigger now," and as we make enquiries from time to time, she answers that the size of the dilatation is increasing. And when it is sufficient to allow of the transit of the foetus, she then makes the patient get up from her bed and sit on the chair, and bids her make every effort to expel the child. Now, this additional work which the patient does of herself is no longer the work of the uterus but of the epigastric muscles, which also help us in defaecation and micturition.
4. Thus the two faculties are clearly to be seen in the case of the uterus; in the case of the stomach they appear as follows: firstly in the condition of gurgling, which physicians are persuaded, and with reason, to be a symptom of weakness of the stomach; for sometimes when the very smallest quantity of food has been ingested this does not occur, owing to the fact that the stomach is contracting accurately upon the food and constricting it at every point; sometimes when the stomach is full the gurglings yet make themselves heard as though it were empty. For if it be in a natural condition, employing its contractile faculty in the ordinary way, then, even if its contents be very small, it grasps the whole of them and does not leave any empty space. When it is weak, however, being unable to lay hold of its contents accurately, it produces a certain amount of vacant space, and amount of vacant space, and allows the liquid contents to flow about in different directions in accordance with its changes of shape, and so to produce gurglings. Thus those who are troubled with this symptom expect, with good reason, that they will also be unable to digest adequately; proper digestion cannot take place in a weak stomach. In such people also, the mass of food may be plainly seen to remain an abnormally long time in the stomach, as would be natural if their digestion were slow.
Indeed, the chief way in which these people will surprise one is in the length of time that not food alone but even fluids will remain in their stomachs. Now, the actual cause of this is not, as one would imagine, that the lower outlet of the stomach, being fairly narrow, will allow nothing to pass before being reduced to a fine state of division. There are a great many people who frequently swallow large quantities of big fruit-stones; one person who was holding a gold ring in his mouth, inadvertently swallowed it; another swallowed a coin, and various people have swallowed various hard and indigestible objects; yet all these people easily passed by the bowel what they had swallowed, without there being any subsequent symptoms. Now surely if narrowness of the gastric outlet were the cause of untriturated food remaining for an abnormally long time, none of these articles I have mentioned would ever have escaped. Furthermore, the fact that it is liquids which remain longest in these people's stomachs is sufficient to put the idea of narrowness of the outlet out of court. For, supposing a rapid descent were dependent upon emulsification, then soups, milk, and barley – emulsion would at once pass along in every case. But as a matter of fact this is not so. For in people who are extremely asthenic it is just these fluids which remain undigested, which accumulate and produce gurglings, and which oppress and overload the stomach, whereas in strong persons not merely do none of these things happen, but even a large quantity of bread or meat passes rapidly down.
And it is not only because the stomach is distended and loaded and because the fluid runs from one part of it to another accompanied by gurglings – it is not only for these reasons that one would judge that there was an unduly long continuance of the food in it, in those people who are so disposed, but also from the vomiting. Thus, there are some who vomit up every particle of what they have eaten, not after three or four hours, but actually in the middle of the night, a lengthy period having elapsed since their meal. Suppose you fill any animal whatsoever with liquid food – an experiment I have often carried out in pigs, to whom I give a sort of mess of wheaten flour and water, there after cutting them open after three or four hours; if you will do this yourself, you will find the food still in the stomach. For it is not chylification which determines the length of its stay here – since this can also be effected outside the stomach; the determining factor is digestion which is a different thing from chylification, as are blood-production and nutrition. For, just as it has been shown that these two processes depend upon a change of qualities, similarly also the digestion of food in the stomach involves a transmutation of it into the quality proper to that which is receiving nourishment. Then, when it is completely digested, the lower outlet opens and the food is quickly ejected through it, even if there should be amongst it abundance of stones, bones, grape-pips, or other things which cannot be reduced to chyle. And you may observe this yourself in an animal, if you will try to hit upon the time at which the descent of food from the stomach takes place.
But even if you should fail to discover the time, and nothing was yet passing down, and the food was still undergoing digestion in the stomach, still even then you would find dissection not without its uses. You will observe, as we have just said, that the pylorus is accurately closed, and that the whole stomach is in a state of contraction upon the food very much as the womb contracts upon the foetus. For it is never possible to find a vacant space in the uterus, the stomach, or in either of the two bladders – that is, either in that called bile –receiving or in the other; whether their contents be abundant or scanty, their cavities are seen to be replete and full, owing to the fact that their coats contract constantly upon the contents – so long, as least, as the animal is in a natural condition. Now Erasistratus for some reason declares that it is the contractions of the stomach which are the cause of everything – that is to say, of the softening of the food, the removal of waste matter, and the absorption of the food when chylified [emulsified]. Now I have personally, on countless occasions, divided the peritoneum of a still living animal and have always found all the intestines contracting peristaltically upon their contents. The condition of the stomach, however, is found less simple; as regards the substances freshly swallowed, it had grasped these accurately both above and below, in fact at every point, and was as devoid of movement as though it had grown round and become united with the food. At the same time I found the pylorus persistently closed and accurately shut, like the os uteri on the foetus. In the cases, however, where digestion had been completed the pylorus had opened, and the stomach was undergoing peristaltic movements, similar to those of the intestines.
5. Thus all these facts agree that the stomach, uterus, and bladders possess certain inborn faculties which are retentive of their own proper qualities and eliminative of those that are foreign. For it has been already shown that the bladder by the liver draws bile into itself, while it is also quite obvious that it eliminates this daily into the stomach. Now, of course, if the eliminative were to succeed the attractive faculty and there were not a retentive faculty between the two, there would be found, on every occasion that animals were dissected, an equal quantity of bile in the gall-bladder. This however, we do not find. For the bladder is sometimes observed to be very full, sometimes quite empty, while at other times you find in it various intermediate degrees of fulness, just as is the case with the other bladder – that which receives the urine; for even without resorting to anatomy we may observe that the urinary bladder continues to collect urine up to the time that it becomes uncomfortable through the increasing quantity of urine or the irritation caused by its acidity – the presumption thus being that here, too, there is a retentive faculty. Similarly, too, the stomach, when, as often happens, it is irritated by acidity, gets rid of the food, although still undigested, earlier than proper; or again, when oppressed by the quantity of its contents, or disordered from the co-existence of both conditions, it is seized with diarrhoea. Vomiting also is an affection of the upper [part of the] stomach analogous to diarrhoea, and it occurs when the stomach is overloaded or is unable to stand the quality of the food or surplus substances which it contains. Thus, when such a condition develops in the lower parts of the stomach, while the parts about the inlet are normal, it ends in diarrhoea, whereas if this condition is in the upper stomach, the lower parts being normal, it ends in vomiting.
6. This may often be clearly in those who are disinclined for food; when obliged to eat, they have not the strength to swallow, and, even if they force themselves to do so, they cannot retain the food, but at vomit it up. And those especially who have a dislike to some particular kind of food, sometimes take it under compulsion, and then promptly bring it up; or, if they force themselves to keep it down, they are nauseated and feel their stomach turned up, and endeavouring to relieve itself of its discomfort. Thus, as was said at the beginning, all the observed facts testify that there must exist in almost all parts of the animal a certain inclination towards, or, so to speak, an appetite for their own special quality, and an aversion to, or, as it were, a hatred of the foreign quality. And it is natural that when they feel an inclination they should attract, and that when they feel aversion they should expel. From these facts, then, again, both the attractive and the propulsive faculties have been demonstrated to exist in everything. But if there be an inclination or attraction, there will also be some benefit derived; for no existing thing attracts anything else for the mere sake of attracting, but in order to benefit by what is acquired by the attraction. And of course it cannot benefit by it if it cannot retain it. Herein, then, again, the retentive faculty is shown to have its necessary origin: for the stomach obviously inclines towards its own proper qualities and turns away from those that are foreign to it. [Translator's note: Galen confuses the nutrition of organs with that of the ultimate living elements or cells; the stomach does not, of course, feed itself in the way a cell does]. But if it aims at and attracts its food and benefits by it while retaining and contracting upon it, we may also expect that there will be some termination to the benefit received, and that thereafter will come the time for the exercise of the eliminative faculty.
7. But if the stomach both retains and benefits by its food, then it employs it for the end for which it [the stomach] naturally exists. And it exists to partake of that which is of a quality befitting and proper to it. Thus it attracts all the most useful parts of the food in a vaporous and finely divided condition, storing this up in its own coats, and applying it to them. And when it is sufficiently full it puts away from it, as one might something troublesome, the rest of the food, this having itself meanwhile obtained some profit from its association with the stomach. For it is impossible for two bodies which are adapted for acting and being acted upon to come together without either both acting or being acted upon, or else one acting and the other being acted upon. For if their forces are equal they will act and be acted upon equally, and if the one be much superior in strength, it will exert its activity upon its passive neighbour; thus, while producing a great and appreciable effect, it will itself be acted upon either little or not at all. But it is herein also that the main difference lies between nourishing food and a deleterious drug; the latter masters the forces of the body, whereas the former is mastered by them. There cannot, then, be food which is suited for the animal which is not also correspondingly subdued by the qualities existing in the animal. And to be subdued means to undergo alteration.
Now, some parts are stronger in power and others weaker; therefore, while all will subdue the nutriment which is proper to the animal, they will not all do so equally. Thus the stomach will subdue and alter its food, but not to the same extent as will the liver, veins, arteries, and heart. We must therefore observe to what extent it does alter it. The alteration is more than that which occurs in the mouth, but less than that in the liver and veins. For the latter alteration changes the nutriment into the substance of blood, whereas that in the mouth obviously changes it into a new form, but certainly does not completely transmute it. This you may discover in the food which is left in the intervals between the teeth, and which remains there all night; the bread is not exactly bread, nor the meat meat, for they have a smell similar to that of the animal's mouth, and have been disintegrated and dissolved, and have had the qualities of the animal's flesh impressed upon them. And you may observe the extent of the alteration which occurs to food in the mouth if you will chew some corn and then apply it to an unripe [undigested] boil: you will see it rapidly transmuting – in fact entirely digesting – the boil, though it cannot do anything of the kind if you mix it with water. And do not let this surprise you; this phlegm [saliva] in the mouth is also a cure for lichens [apparently skin-diseases in which a superficial crust (resembling the lichen on a tree-trunk) forms – e.g. psoriasis]; it even rapidly destroys scorpions; while, as regards the animals which emit venom, some it kills at once, and others after an interval; to all of them in any case it does great damage.
Now, the masticated food is all, firstly, soaked in and mixed up with this phlegm; and secondly, it is brought into contact with the actual skin of the mouth; thus it undergoes more change than the food which is wedged into the vacant spaces between the teeth. But just as masticated food is more altered than the latter kind, so is food which has been swallowed more altered than that which has been merely masticated. Indeed, there is no comparison between these two processes; we have only to consider what the stomach contains – phlegm, bile, pneuma, [innate] heat, and, indeed the whole substance of the stomach. And if one considers along with this the adjacent viscera like a lot of burning hearths around a great cauldron – to the right the liver, to the left the spleen, the heart above, and along with it the diaphragm (suspended and in a state of constant movement), and the omentum sheltering them all – you may believe what an extraordinary alteration it is which occurs in the food taken into the stomach. How could it easily become blood if it were not previously prepared by means of a change of this kind? It has already been shown that nothing is altered all at once from one quality to its opposite. How then could bread, beef, beans, or any other food turn into blood if they had not previously undergone some other alteration? And how could the faeces be generated right away in the small intestine? For what is there in this organ more potent in producing alteration than the factors in the stomach? Is it the number of the coats, or the way it is surrounded by neighbouring viscera, or the time that the food remains in it, or some kind of innate heat which it contains?
Most assuredly the intestines have the advantage of the stomach in none of these respects. For what possible reason, then, will objectors have it that bread may often remain a whole night in the stomach and still preserve its original qualities, whereas when once it is projected into the intestines, it straightway becomes ordure? For, if such a long period of time is incapable of altering it, neither will the short period be sufficient, or, if the latter is enough, surely the longer time will be much more so! Well, then, can it be that, while the nutriment does undergo an alteration in the stomach, this is a different kind of alteration and one which is not dependent on the nature of the organ which alters it? Or if it be an alteration of this latter kind, yet one perhaps which is not proper to the body of the animal? This is still more impossible. Digestion was shown to be nothing else than an alteration to the quality proper to that which is receiving nourishment. Since, then, this is what digestion means and since the nutriment has been shown to take on in the stomach a quality appropriate to the animal which is about to be nourished by it, it has been demonstrated adequately that nutriment does undergo digestion in the stomach. And Asclepiades is absurd when he states that the quality of the digested food never shows itself either in eructations or in the vomited matter, or on dissection. For of course the mere fact that the food smells of the body shows that it has undergone gastric digestion. But this man is so foolish that, when he hears the Ancients saying that the food is converted in the stomach into something "good," he thinks it proper to look out not for what is good in its possible effects, but for what is good to the taste: this is like saying that apples (for so one has to argue with him) become more apple-like [in flavour] in the stomach, or honey more honey-like! Erasistratus, however, is still more foolish and absurd, either through not perceiving in what sense the Ancients said that digestion is similar to the process of boiling, or because he purposely confused himself with sophistries. It is, he says, inconceivable that digestion, involving as it does such trifling warmth, should be related to the boiling process. This is as if we were to suppose that it was necessary to put the fires of Etna under the stomach before it could manage to alter the food; or else that, while it was capable of altering the food, it did not do this by virtue of its innate heat, which of course was moist, so that the word boil was used instead of bake.
What he ought to have done, if it was facts that he wished to dispute about, was to have tried to show, first and foremost, that the food is not transmuted or altered in quality by the stomach at all, and secondly, if he could not be confident of this, he ought to have tried to show that this alteration was not of any advantage to the animal. If, again, he were unable even to make this misrepresentation, he ought to have attempted to confute the postulate concerning the active principles- to show, in fact, that the functions taking place in the various parts do not depend on the way in which the Warm, Cold, Dry, and Moist are mixed, but on some other factor. And if he had not the audacity to misrepresent facts even so far as this, still he should have tried at least to show that the Warm is not the most active of all the principles which play a part in things governed by Nature. But if he was unable to demonstrate this any more than any of the previous propositions, then he ought not to have made himself ridiculous by quarrelling uselessly with a mere name – as though Aristotle had not clearly stated in the fourth book of his Meteorology, as well as in many other passages, in what way digestion can be said to be allied to boiling, and also that the latter expression is not used in its primitive or strict sense. But, as has been frequently said already, the one starting-point of all this is a thorough-going enquiry into the question of the Warm, Cold, Dry and Moist; this Aristotle carried out in the second of his books On Genesis and Destruction, where he shows that all the transmutations and alterations throughout the body take place as a result of these principles. Erasistratus, however, advanced nothing against these or anything else that has been said above, but occupied himself merely with the word "boiling."
8. Thus, as regards digestion, even though he neglected everything else, he did at least attempt to prove his point – namely, that digestion in animals differs from boiling carried on outside; in regard to the question of deglutition, however, he did not go even so far as this. What are his words? The stomach does not appear to exercise any traction. Now the fact is that the stomach possesses two coats, which certainly exist for some purpose; they extend as far as the mouth, the internal one remaining throughout similar to what it is in the stomach, and the other one tending to become of a more fleshy nature in the gullet. Now simple observation will testify that these coats [the mucous and the muscular coats] have their fibres inserted in contrary directions. And, although Erasistratus did not attempt to say for what reason they are like this, I am going to do so. The inner coat has its fibres straight, since it exists for the purpose of traction. The outer coat has its fibres transverse, for the purpose of peristalsis. In fact, the movements of each of the mobile organs of the body depend on the setting of the fibres.
Now please test this assertion first in the muscles themselves; in these the fibres are most distinct, and their movements visible owing to their vigour. And after the muscles, pass to the physical organs, and you will see that they all move in correspondence with their fibres. This is why the fibres throughout the intestines are circular in both coats – they only contract peristaltically, they do not exercise traction. The stomach, again, has some of its fibres longitudinal for the purpose of traction and the others transverse for the purpose of peristalsis. For just as the movements in the muscles take place when each of the fibres becomes tightened and drawn towards its origin, such also is what happens in the stomach; when the transverse fibres tighten, the breadth of the cavity contained by them becomes less; and when the longitudinal fibres contract and draw in upon themselves, the length must necessarily be curtailed. This curtailment of length, indeed, is well seen in the act of swallowing: the larynx is seen to rise upwards to exactly the same degree that the gullet is drawn downwards; while, after the process of swallowing has been completed and the gullet is released from tension, the larynx can be clearly seen to again. This is because the inner coat of the stomach, which has the longitudinal fibres and which also lines the gullet and the mouth, extends to the interior of the larynx, and it is thus impossible for it to be drawn down by the stomach without the larynx being involved in the traction.
Further, it will be found acknowledged in Erasistratus's own writings that the circular fibres (by which the stomach as well as other parts performs its contractions) do not curtail its length, but contract and lessen its breadth. For he says that the stomach contracts peristaltically round the food during the whole period of digestion. But if it contracts, without in any way being diminished in length, this is because downward traction of the gullet is not a property of the movement of circular peristalsis. For what alone happens, as Erasistratus himself said, is that when the upper parts contract the lower ones dilate. And everyone knows that this can be plainly seen happening even in a dead man, if water be poured down his throat; this symptom results from the passage of matter through a narrow channel; it would be extraordinary if the channel did not dilate when a mass was passing through it. Obviously then the dilatation of the lower parts along with the contraction of the upper is common both to dead bodies, when anything whatsoever is passing through them, and to living ones, whether they contract peristaltically round their contents or attract them. Curtailment of length, on the other hand, is peculiar to organs which possess longitudinal fibres for the purpose of attraction. But the gullet was shown to be pulled down; for otherwise it would not have drawn upon the larynx.
It is therefore clear that the stomach attracts food by the gullet. Further, in vomiting, the mere passive conveyance of rejected matter up to the mouth will certainly itself suffice to keep open those parts of the oesophagus which are distended by the returned food; as it occupies each part in front [above], it first dilates this, and of course leaves the part behind [below] contracted. Thus, in this respect at least, the condition of the gullet is precisely similar to what it is in the act of swallowing. But there being no traction, the whole length remains equal in such cases. And for this reason it is easier to swallow than to vomit, for deglutition results the coats of the stomach being brought into action, the inner one exerting a pull and the outer one helping by peristalsis and propulsion, whereas emesis occurs from the outer coat alone functioning, without there being any kind of pull towards the mouth. For, although the swallowing of food is ordinarily preceded by a feeling of desire on the part of the stomach, there is in the case of vomiting no corresponding desire from the mouth-parts for the experience; the two are opposite dispositions of the stomach itself; it yearns after and tends towards what is advantageous and proper to it, it loathes and rids itself of what is foreign. Thus the actual process of swallowing occurs very quickly in those who have a good appetite for such foods as are proper to the stomach; this organ obviously draws them in and down before they are masticated; whereas in the case of those who are forced to take a medicinal draught or who take food as medicine, the swallowing of these articles is accomplished with distress and difficulty.
From what has been said, then, it is clear that the inner coat of the stomach (that containing longitudinal fibres) exists for the purpose of exerting a pull the from to stomach, and that it is only in deglutition that it is active, whereas the external coat, which contains transverse fibres, has been so constituted in order that it may contract upon its contents and propel them forward; this coat furthermore, functions in vomiting no less than in swallowing. The truth of my statement is also borne out by what happens in the channae and synodonts; (2) the stomachs of these animals are sometimes found in their mouths, as also Aristotle writes in his History of Animals; he also adds the cause of this: he says that it is owing to their voracity. The facts are as follows. In all animals, when the appetite is very intense, the stomach rises up, so that some people who have a clear perception of this condition say that their stomach "creeps out" of them; in others, who are still masticating their food and have not yet worked it up properly in the mouth, the stomach obviously snatches away the food from them against their will. In those animals, therefore, which are naturally voracious, in whom the mouth cavity is of generous proportions, and the stomach situated close to it (as in the case of the synodont and channae), it is in no way surprising that, when they are sufficiently hungry and are pursuing one of the smaller animals, and are just on the point of catching it, the stomach should, under the impulse of desire, spring into the mouth. And this cannot possibly take place in any other way than by the stomach drawing the food to itself by means of the gullet, as though by a hand. In fact, just as we ourselves, in our eagerness to grasp more quickly something lying before us, sometimes stretch out our whole bodies along with our hands, so also the stomach stretches itself forward along with the gullet, which is, as it were, its hand. And thus, in these animals in whom those three factors co-exist – an excessive propensity for food, a small gullet, and ample mouth proportions – in these, any slight tendency to movement forwards brings the whole stomach into the mouth. Now the constitution of the organs might itself suffice to give a naturalist an indication of their functions.
For Nature would never have purposelessly constructed the oesophagus of two coats with contrary dispositions; they must also have each been meant to have a different action. The Erasistratean school, however, are capable of anything rather than of recognizing the effects of Nature. Come, therefore, let us demonstrate to them by animal dissection as well that each of the two coats does exercise the activity which I have stated. Take an animal, then; lay bare the structures surrounding the gullet, without severing any of the nerves, arteries, or veins which are there situated; next divide with vertical incisions, from the lower jaw to the thorax, the outer coat of the oesophagus (that containing transverse fibres); then give the animal food and you will see that it still swallows although the peristaltic function has been abolished. If, again, in another animal, you cut through both coats with transverse incisions, you will observe that this animal also swallows although the inner coat is no longer functioning.
From this it is clear that the animal can also swallow by either of the two coats, although not so well as by both. For the following also, in addition to other points, may be distinctly observed in the dissection which I have described – that during deglutition the gullet becomes slightly filled with air which is swallowed along with the food, and that, when the outer coat is contracting, this air is easily forced with the food into the stomach, but that, when there only exists an inner coat, the air impedes the conveyance of food, by distending this coat and hindering its action. But Erasistratus said nothing about this, nor did he point out that the oblique situation of the gullet clearly confutes the teaching of those who hold that it is simply by virtue of the impulse from above that food which is swallowed reaches the stomach. The only correct thing he said was that many of the longnecked animals bend down to swallow. Hence, clearly, the observed fact does not show how we swallow but how we do not swallow. For from this observation it is clear that swallowing is not due merely to the impulse from above; it is yet, however, not clear whether it results from the food being attracted by the stomach, or conducted by the gullet. For our part, however, having enumerated all the different considerations – those based on the constitution of the organs, as well as those based on the other symptoms which, as just mentioned, occur both before and after the gullet has been exposed – we have thus sufficiently proved that the inner coast exists for the purpose of attraction and the outer for the purpose of propulsion. Now the original task we set before ourselves was to demonstrate that the retentive faculty exists in every one of the organs, just as in the previous book we proved the existence of the attractive, and, over and above this, the alterative faculty. Thus, in the natural course of our argument, we have demonstrated these four faculties existing in the stomach – the attractive faculty in connection with swallowing, the retentive with digestion, the expulsive with vomiting and with the descent of digested food into the small intestine – and digestion itself we have shown to be a process of alteration.
(2)The channae is a kind of sea-perch; the synodont is supposed to be an edible Mediterranean perch.
9. Concerning the spleen, also, we shall therefore have no further doubts as to whether it attracts what is proper to it, rejects what is foreign, and has a natural power of altering and retaining all that it attracts; nor shall we be in any doubt as to the liver, veins, arteries, heart, or any other organ. For these four faculties have been shown to be necessary for every part which is to be nourished; this is why we have called these faculties the handmaids of nutrition. For just as human faeces are most pleasing to dogs, so the residual matters from the liver are, some of them, proper to the spleen, others to the gall-bladder, and others to the kidneys.
(1) The mesenteric veins.
10. I should not have cared to say anything further as to the origin of these [surplus substances] after Hippocrates, Plato, Aristotle, Diocles, Praxagoras, and Philotimus, nor indeed should I even have said anything about the faculties, if any of our predecessors had worked out this subject thoroughly. While, however, the statements which the Ancients made on these points were correct, they yet omitted to defend their arguments with logical proofs; of course they never suspected that there could be sophists so shameless as to try to contradict obvious facts. More recent physicians, again, have been partly conquered by the sophistries of these fellows and have given credence to them; whilst others who attempted to argue with them appear to me to lack to a great extent the power of the Ancients. For this reason I have attempted to put together my arguments in the way in which it seems to me the Ancients, had any of them been still alive, would have done, in opposition to those who would overturn the finest doctrines of our art. I am not, however, unaware that I shall achieve either nothing at all or else very little. For I find that a great many things which have been conclusively demonstrated by the Ancients are unintelligible to the bulk of the Moderns owing to their ignorance – nay, that, by reason of their laziness, they will not even make an attempt to comprehend them; and even if any of them have understood them, they have not given them impartial examination. The fact is that he whose purpose is to know anything better than the multitude do must far surpass all others both as regards his nature and his early training. And when he reaches early adolescence he must become possessed with an ardent love for truth, like one inspired; neither day nor night may he cease to urge and strain himself in order to learn thoroughly all that has been said by the most illustrious of the Ancients. And when he has learnt this, then for a prolonged period he must test and prove it, observing what part of it is in agreement, and what in disagreement with obvious fact; thus he will choose this and turn away from that. To such an one my hope has been that my treatise would prove of the very greatest assistance.... Still, such people may be expected to be quite few in number, while, as for the others, this book will be as superfluous to them as a tale told to an ass.
11. For the sake, then, of those who are aiming at truth, we must complete this treatise by adding what is still wanting in it. Now, in people who are very hungry, the stomach obviously attracts or draws down the food before it has been thoroughly softened in the mouth, whilst in those who have no appetite or who are being forced to eat, the stomach is displeased and rejects the food. And in a similar way of the other organs possesses both faculties – that of attracting what is proper to it, and that of rejecting what is foreign. Thus, even if there be any organ which consists of only one coat (such as the two bladders, the uterus, and the veins), it yet possesses both kinds of fibres, the longitudinal and the transverse. But further, there are fibres of a third kind – the oblique – which are much fewer in number than the two kinds already spoken of. In the organs consisting of two coats this kind of fibre is found in the one coat only, mixed with the longitudinal fibres; but in the organs composed of one coat it is found along with the other two kinds. Now, these are of the greatest help to the action of the faculty which we have named retentive. For during this period the part needs to be tightly contracted and stretched over its contents at every point – the stomach during the whole period of digestion, and the uterus during that of gestation. Thus too, the coat of a vein, being single, consists of various kinds of fibres; whilst the outer coat of an artery consists of circular fibres, and its inner coat mostly of longitudinal fibres, but with a few oblique ones also amongst them. Veins thus resemble the uterus or the bladder as regards the arrangement of their fibres, even though they are deficient in thickness; similarly arteries resemble the stomach. Alone of all organs the intestines consist of two coats of which both have their fibres transverse. Now the proof that it was for the best that all the organs should be naturally such as they are (that, for instance, the intestines should be composed of two coats) belongs to the subject of the use of parts; thus we must not now desire to hear about matters of this kind nor why the anatomists are at variance regarding the number of coats in each organ. For these questions have been sufficiently discussed in the treatise On Disagreement in Anatomy. And the problem as to why each organ has such and such a character will be discussed in the treatise On the Use of Parts.
12. It is not, however, our business to discuss either of these questions here, but to consider duly the natural faculties, which, to the number of four, exist in each organ. Returning then, to this point, let us recall what has already been said, and set a crown to the whole subject by adding what is still wanting. For when every part of the animal has been shewn to draw into itself the juice which is proper to it (this being practically the first of the natural faculties), the next point to realise is that the part does not get rid either of this attracted nutriment as a whole, or even of any superfluous portion of it, until either the organ itself, or the major part of its contents also have their condition reversed. Thus, when the stomach is sufficiently filled with the food and has absorbed and stored away the most useful part of it in its own coats, it then rejects the rest like an alien burden. The same happens to the bladders, when the matter attracted into them begins to give trouble either because it distends them through its quantity or irritates them by its quality. And this also happens in the case of the uterus; for it is either because it can no longer bear to be stretched that it strives to relieve itself of its annoyance, or else because it is irritated by the quality of the fluids poured out into it.
Now both of these conditions sometimes occur with actual violence, and then miscarriage takes place. But for the most part they happen in a normal way, this being then called not miscarriage but delivery or parturition. Now abortifacient drugs or certain other conditions which destroy the embryo or rupture certain of its membranes are followed by abortion, and similarly also when the uterus is in pain from being in a bad state of tension; and, as has been well said by Hippocrates, excessive movement on the part of the embryo itself brings on labour. Now pain is common to all these conditions, and of this there are three possible causes – either excessive bulk, or weight, or irritation; bulk when the uterus can no longer support the stretching, weight when the contents surpass its strength, and irritation when the fluids which had previously been pent up in the membranes, flow out, on the rupture of these, into the uterus itself, or else when the whole foetus perishes, putrefies, and is resolved into pernicious ichors, and so irritates and bites the coat of the uterus. In all organs, then, both their natural effects and their disorders and maladies plainly take place on analogous lines, some so clearly and manifestly as to need no demonstration, and others less plainly, although not entirely unrecognizable to those who are willing to pay attention.
Thus, to take the case of the stomach: the irritation is evident here because this organ possesses most sensibility, and among its other affections those producing nausea and the so-called heartburn clearly demonstrate the eliminative faculty which expels foreign matter. So also in the case of the uterus and the urinary bladder; this latter also may be plainly observed to receive and accumulate fluid until it is so stretched by the amount of this as to be incapable of enduring the pain; or it may be the quality of the urine which irritates it; for every superfluous substance which lingers in the body must obviously putrefy, some in a shorter, and some in a longer time, and thus it becomes pungent, acrid, and burdensome to the organ which contains it. This does not apply, however, in the case of the bladder alongside the liver, whence it is clear that it possesses fewer nerves than do the other organs.
Here too, however, at least the physiologist must discover an analogy. For since it was shown that the gall-bladder attracts its own special juice, so as to be often found full, and that it discharges it soon after, this desire to discharge must be either due to the fact that it is burdened by the quantity or that the bile has changed in quality to pungent and acrid. For while food does not change its original quality so fast that it is already ordure as soon as it falls into the small intestine, on the other hand the bile even more readily than the urine becomes altered in quality as soon as ever it leaves the veins, and rapidly undergoes change and putrefaction. Now, if there be clear evidence in relation to the uterus, stomach, and intestines, as well as to the urinary bladder, that there is either some distention, irritation, or burden inciting each of these organs to elimination, there is no difficulty in imagining this in the case of the gall-bladder also, as well as in the other organs, – to which obviously the arteries and veins also belong.
13. Nor is there any further difficulty in ascertaining that it is through the same channel that both attraction and discharge take place at different times. For obviously the inlet to the stomach does not merely conduct food and drink into this organ, but in the condition of nausea it performs the neck of the bladder which is beside the liver, albeit single, both fills and empties the bladder. Similarly the canal of the uterus affords an entrance to the semen and an exit to the foetus. But in this latter case, again, whilst the eliminative faculty is evident, the attractive faculty is not so obvious to most people. It is, however, the cervix which Hippocrates blames for inertia of the uterus when he says: Its orifice has no power of attracting semen. Erasistratus, however, and Asclepiades reached such heights of wisdom that they deprived not merely the stomach and the womb of this faculty but also the bladder by the liver, and the kidneys as well. I have, however, pointed out in the first book that it is impossible to assign any other cause for the secretion of urine or bile. Now, when we find that the uterus, the stomach and the bladder by the liver carry out attraction and expulsion through one and the same duct, we need no longer feel surprised that Nature should also frequently discharge waste-substances into the stomach through the veins. Still less need we be astonished if a certain amount of the food should, during long fasts, be drawn back from the liver into the stomach through the same veins by which it was yielded up to the liver during absorption of nutriment. To disbelieve such things would of course be like refusing to believe that purgative drugs draw their appropriate humours from all over the body by the same stomata through which absorption previously takes place, and to look for separate stomata for absorption and purgation respectively.
As a matter of fact one and the same stoma subserves two distinct faculties, and these exercise their pull at different times in opposite directions – first it subserves the pull of the liver and, during catharsis, that of the drug. What is there surprising, then, in the fact that the veins situated between the liver and the region of the stomach(1) fulfil a double service or purpose? Thus, when there is abundance of nutriment contained in the food-canal, it is carried up to the liver by the veins mentioned; and when the canal is empty and in need of nutriment, this is again attracted from the liver by the same veins. For everything appears to attract from and to go shares with everything else, and, as the most divine Hippocrates has said, there would seem to be a consensus in the movements of fluids and vapours. Thus the stronger draws and the weaker is evacuated. Now, one part is weaker or stronger than another either absolutely, by nature, and in all cases, or else it becomes so in such and such a particular instance. Thus, by nature and in all men alike, the heart is stronger than the liver at attracting what is serviceable to it and rejecting what is not so; similarly the liver is stronger than the intestines and stomach, and the arteries than the veins. In each of us personally, however, liver has stronger drawing power at one time, and the stomach at another. For when there is much nutriment contained in the alimentary canal and the appetite and craving of the liver is violent, then the viscus exerts far the strongest traction. Again, when the liver is full and distended and the stomach empty and in need, then the force of the traction shifts to the latter. Suppose we had some food in our hands and were snatching it from one another; if we were equally in want, the stronger would be likely to prevail, but if he had satisfied his appetite, and was holding what was over carelessly, or was anxious to share it with somebody, and if the weaker was excessively desirous of it, there would be nothing to prevent the latter from getting it all. In a similar manner the stomach easily attracts nutriment from the liver when it [the stomach] has a sufficiently strong craving for it, and the appetite of the viscus is satisfied. And sometimes the surplusage of nutriment in the liver is a reason why the animal is not hungry; for when the stomach has better and more available food it requires nothing from extraneous sources, but if ever it is in need and is at a loss how to supply the need, it becomes filled with waste-matters; these are certain biliary, phlegmatic [mucous] and serous fluids, and are the only substances that the liver yields in response to the traction of the stomach, on the occasions when the latter too is in want of nutriment.
Now, just as the parts draw food from each other, so also they sometimes deposit their excess substances in each other, and just as the stronger prevailed when the two were exercising traction, so it is also when they are depositing; this is the cause of the so-called fluxions, for every part has a definite inborn tension, by virtue of which it expels its superfluities, and, therefore, when one of these parts, – owing, of course, to some special condition – becomes weaker, there will necessarily be a confluence into it of the superfluities from all the other parts. The strongest part deposits its surplus matter in all the parts near it; these again in other parts which are weaker; these next into yet others; and this goes on for a long time, until the superfluity, being driven from one part into another, comes to rest in one of the weakest of all; it cannot flow from this into another part, because none of the stronger ones will receive it, while the affected part is unable to drive it away. When, however, we come to deal again with the origin and cure of disease, it will be possible to find there also abundant proofs of all that we have correctly indicated in this book. For the present, however, let us resume again the task that lay before us, i.e. to show that there is nothing surprising in nutriment coming from the liver to the intestines and stomach by way of the very veins through which it had previously been yielded up from these organs into the liver. And in many people who have suddenly and completely given up active exercise, or who have had a limb cut off, there occurs at certain periods an evacuation of blood by way of the intestines – as Hippocrates has also pointed out somewhere. This causes no further trouble but sharply purges the whole body and evacuates the plethoras; the passage of the superfluities is effected, of course, through the same veins by which absorption took place.
Frequently also in disease Nature purges the animal through these same veins – although in this case the discharge is not sanguineous, but corresponds to the humour which is at fault. Thus in cholera the entire body is evacuated by way of the veins leading to the intestines and stomach. 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. During the third period the stomach has reached the stage of receiving nourishment; it now entirely assimilates everything that had become adherent to it: at the same time in the intestines and liver there takes place adhesion of what had been before presented, while dispersal [anadosis] is taking place to all parts of the body, as also presentation.
Now, if the animal takes food immediately after these [three stages] then, during the time that the stomach is again digesting and getting the benefit of this by presenting all the useful part of it to its own coats, the intestines will be engaged in final assimilation of the juices which have adhered to them, and so also will the liver: while in the various parts of the body there will be taking place adhesion of the portions of nutriment presented. And if the stomach is forced to remain without food during this time, it will draw its nutriment the from the veins in the mesentery and liver; for it will not do so from the actual body of the liver (by body of the liver I mean first and foremost its flesh proper, and after this all the vessels contained in it), for it is irrational to suppose that one part would draw away from another part the juice already contained in it, especially when adhesion and final assimilation of that juice were already taking place; the juice, however, that is in the cavity of the veins will be abstracted by the part which is stronger and more in need. It is in this way, therefore, that the stomach, when it is in need of nourishment and the animal has nothing to eat, seizes it from the veins in the liver. Also in the case of the spleen we have shown in a former passage how it draws all material from the liver that tends to be thick, and by working it up converts it into more useful matter. There is nothing surprising, therefore, if, in the present instance also, some of this should be drawn from the spleen into such organs as communicate with it by veins, e.g. the omentum, mesentery, small intestine, colon, and the stomach itself. Nor is it surprising that the spleen should disgorge its surplus matters into the stomach at one time, while at another time it should draw some of its appropriate nutriment from the stomach.
For, as has already been said, speaking generally, everything has the power at different times of attracting from and of adding to everything else. What happens is just as if you might imagine a number of animals helping themselves at will to a plentiful common stock of food; some will naturally be eating when others have stopped, some will be on the point of stopping when others are beginning, some eating together, and others in succession. Yes, by Zeus! and one will often be plundering another, if he be in need while the other has an abundant supply ready to hand. Thus it is in no way surprising that matter should make its way back from the outer surface of the body to the interior, or should be carried from the liver and spleen into the stomach by the same vessels by which it was carried in the reverse direction. 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 recognise is that every thing possessing a large and appreciable cavity must, when it dilates, abstract matter from all its neighbours, 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 neighbouring 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 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 vapour, 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 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 neighbourhood; 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. 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 [translator's note: 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 [translator's note: 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. [translator's note: Galen's conclusion, of course, is, so far, correct, but he has substituted an imaginary direct communication between the ventricles for the actual and more round about pulmonary circulation of whose existence he apparently had no idea. His views were eventually corrected by the Renascence anatomists.] 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 [translator's note: or we may render it "corpuscle"; Galen practically means the cell] 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 humour 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 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 fibres, which are homogeneous – in fact, actual sensible elements; and in the intervals between these fibres is dispersed the humour 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 vapour, pneuma, and thin blood attract either none at all or very little of the juices contained in the stomach and intestines.