Part 29

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COMMENTARY. We shall now state briefly the opinions of the ancients with regard to the functional office of the stomach.

Actuarius says, “I am of opinion, that there are four species of concoction which are performed in different parts of the body: the first in the stomach; the second in the vena ramalis (vena portæ?), meseraic veins, and concave part of the liver; the third in the convex part of the liver and veins proceeding from it; and the fourth, consisting of fabrication or assimilation, which takes place in the extreme parts of the body.” (De Urinis.) The various modes of change or concoction which the food undergoes in the body, are minutely described by Macrobius. (Saturnal. vii.) In another place, Actuarius says, “Digestion is performed by moderate heat and moisture.” (De Spiritu Animali, p. ii, s. 1.) Alsaharavius in like manner states, that the digestive faculty depends partly on the heat, and partly on the humidity of the stomach. (Pract. tr. xvi, c. 1.) It is impossible not to see that the gastric juice is alluded to in these passages. It is particularly stated of Asclepiades, that he held digestion to be the solution of the food. See C. Aurelianus. (Morb. Acut. i, 14.) And that the ancients were aware that the stomach secretes a fluid possessed of solvent properties, is put beyond a doubt, by the following extract from the works of Haly Abbas. Speaking of the changes which the food undergoes in the mouth and stomach, he says: “Immutantur cibi in ore, retinenturque, et flegmati admiscetur quod digestum est, calorque ei datur. Quod autem flegma hoc hujusmodi sit, signum nobis est quod impetigines et sarpedones curat, quædam maturat ulcera, scorpiones necat. Hac ergo de causa et in ore cibus immutatur. Sic et stomachus ipsum immutat: ejus etenim circum amplectitur substantia, quasque habet imprimit qualitates, immutaturque ipsius naturali calore cibus: Sed et quoniam cibus ipse in eo flegmati admiscetur humido.” (Theor. iv, 3.) The whole bearing of this passage, but more especially the last clause, puts it beyond a doubt that the process of digestion was supposed to be performed, in a certain measure, by the solvent powers of a fluid secreted in the stomach. And the ingenious Alexander Aphrodisiensis, in like manner, treating of the digestion of mustard, pepper, and other acrid substances, says decidedly, that their acrimony is dissolved in the copious fluid of the stomach. (Probl. i, 30.) See also Macrobius (Saturnal. vii, 8.) He calls the fluid ventralis humor, which may be literally translated, “gastric juice.” Part of the process was, no doubt, supposed to be performed indirectly by heat; and deservedly, for even Spallanzani was compelled to admit, that the comparative temperature of animals exerts a considerable influence on their digestive powers. Hence, as was stated by Averrhoes, and as is confirmed by Cuvier, Birds, which are the warmest class of animals, likewise digest the fastest. At all events, the ancients were well aware, that digestion is not a mechanical, but a vital process, being performed by the principle of life. “Digestion,” says Averrhoes, “is performed by concoction, and the concoction is influenced by heat, not that the first mover in the operation is heat, but the nutritive soul; because the operations of heat are indeterminate, and not directed to any manifest end.” (Collig. v, 3.) In the ‘Averroeana’ or ‘Letters from Averrhoes to Metrodorus,’ (which, whether genuine or not, contain a curious and interesting exposition of the Great Commentator’s opinions on various subjects, and at all events must be of considerable antiquity,) the doctrine of a gastric menstruum is discussed with singular ability. Metrodorus states, that “he found, by the writings of the physicians and philosophers of these times, that they make the menstruum, as they call it, whereby both appetite is provoked, and food in the stomach is digested, to be a certain juice or humour in the stomach,” &c. Averrhoes denies that this menstruum acts by its acidity alone.

SECT. LXV.—DIAGNOSIS OF THE TEMPERAMENTS OF THE LUNGS.

Not only does the stomach render us thirsty and otherwise, and excite a desire of warm and cold drink, but also the thoracic viscera, namely, the heart and lungs, and likewise the liver. And drinking does not straightway allay the desire, but a small quantity of cold drink will rather allay the thirst than a great quantity of warm. Persons so affected are refreshed by inhaling cold air, which has no effect in alleviating the thirst of the stomach. Thus, also, those who are contrariwise affected, suffer sensibly from breathing cold air; this is the strongest mark of coldness of the lungs; but they also hawk up phlegm, and expectorate it with coughing. Dryness of the lungs is marked by freedom from excrementitious discharges and from phlegm; and humidity, by being excrementitious, and rendering the voice dull and hoarse; and the recrementitious discharge is also very great when they attempt to speak in a louder or sharper tone.

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COMMENTARY. The ancients were of opinion, that the lungs are an accessory organ, made to administer to the heart. “It is the heart,” says Aretæus, “which imparts to the lungs the desire of drawing in cold air.” And in like manner, Theophilus holds that the other organs of respiration were made for the sake of the heart, in order that its innate heat may be cooled, increased, and nourished. (De Fabrica Hominis, p. 89, ed. Greenhill.) The physiologists differed respecting the uses of respiration. Thus, according to Galen, the famous Asclepiades held that it is for the generation of the soul itself, breath and life being thus considered to be identical; Philistion, Diocles, and Aristotle, for the ventilation of the innate heat; Hippocrates for its nutrition and refrigeration; and Erasistratus for the filling of the arteries with spirits. All these opinions are discussed and commented upon by Galen, who determines the purposes of respiration to be twofold: first, to preserve the animal heat; and second, to evacuate the fuliginous portion of the blood. He was aware of the analogy between respiration and combustion, and comes to the conclusion that they are processes of a similar nature: he accordingly compares the lungs to a lamp, the heart to its wick, the blood to the oil, and the animal heat to the flame. (Galen, de usu Respir.) Aristotle gives the name of pneuma to the vital heat of animals, and ascribes the source and maintenance of it to the double functions of respiration and digestion. (De Pneumate.) See further, Third Book, s. 27.

The following extract from Alexander Aphrodisiensis will explain the opinions entertained by physicians and savans of a later age: “Wherefore there is a natural tepidity, the same I mean as the innate heat, whence springs the origin of the animal, its nature; for it is congenital with the animal, and therefore is called natural, being in the main the instrument of the soul’s powers.” (De Feb. viii.)

The following extract from Haly will show that the opinions of the Arabians on this subject did not differ from those of their Grecian masters, and more especially of Galen: “Respiration is necessary, for the sake of the heart, which is the fountain, and, as it were, the focus of vital heat, whence it is diffused over the rest of the body. It requires some aerial substance to ventilate the heat and ebullition of the heart, and in order to evacuate the fuliginous vapours which are found in it.” (Theor. iii.)

SECT. LXVI.—THE MARKS OF THE TEMPERAMENTS OF THE HEART.

These are the marks of an unusually warm heart: largeness of respiration, quickness and density of pulse, boldness and maniacal ferocity, the chest is covered with hair, particularly the breast, and usually the parts of the hypochondriac regions adjoining to it; and the whole body is hot, unless the liver powerfully antagonise. And capacity of chest is also a mark of heat, unless the brain in that case antagonise. But an unusually cold heart has the pulse smaller than moderate, and such persons are timid and spiritless, more especially if there be no hairs on the breast. Dryness of the heart renders the pulse hard, and the passions ungovernable, fierce, and difficult to quell; and, for the most part, the whole body is drier than usual, unless the parts about the liver antagonise. These are the marks of a more humid temperament: a soft pulse, a disposition easily roused to anger, and easily pacified, and the whole body more humid than common, unless antagonised by the parts about the liver. When the temperament is both hotter and drier, the pulse is large, hard, and quick and dense; and the respirations large, quick, and dense. And of all others such persons have the most hair upon the breast and præcordia; they are prone to action, given to anger, fierce and tyrannical in their dispositions; for they are both passionate and implacable. But, if humidity prevails with heat, such persons are less covered with hair than the afore-mentioned; they are prompt to action, their disposition is not fierce, but only prone to anger; their pulse is large, soft, quick, and dense. But when the temperament is more humid and cold than common, the pulse is soft, the disposition spiritless, timid and sluggish; they have no hair on the breast, and neither indulge in lasting resentment, nor are prone to anger. A cold and dry heart renders the pulse harder and small. Of all others, such persons are least given to anger, but when provoked they retain their resentment. They are also particularly distinguished by having no hair on the breast.

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COMMENTARY. In the ancient system of physiology, the heart was considered as the seat of the Vital powers, its office being the preservation of the innate heat of the body. The philosopher, Aristotle, had pointed out the connexion between heat and vitality, and had taught that the heart, as being the centre of heat, is the prime organ in the animal frame. Hence, as his commentator, Averrhoes, remarks, it is the primum movens et ultimum moriens. Galen, however, maintained with Hippocrates, that the animal frame is a circle, having neither beginning nor end, and that, consequently, it has no prime organ. He taught that the brain does not, properly speaking, derive its powers from the heart, nor the heart from the brain; but that these organs are mutually dependent upon one another, the heart being indebted to the brain for supplying the parts concerned in respiration with muscular energy, and the brain being indebted to the heart for its vital heat, without which it could not continue to be the vehicle of sensibility and motion. (De Placitis Hippocrat. et Platon. pluries.) We have mentioned in the preceding Section, that the ancient physiologists looked upon respiration as being a process similar to combustion. See Galen (de Usu Respirationis), Alexander Aphrodisiensis (Probl. i, 16.)

The heart, then, was supposed to convey heat to all parts of the body, by means of the animal spirits incorporated with the blood in the arteries. Respecting the contents of the arteries, two hypotheses divided the ancient schools of medicine. The first was that of the celebrated Erasistratus, who maintained, that the arteries do not contain a fluid, but merely certain airs or vapours. The other hypothesis was that of Galen, who keenly attacked this, as he did most of the tenets of Erasistratus, and endeavoured to prove, by experiment, observation, and reasoning, that the contents of the arteries is blood, mixed, indeed, with a certain proportion of heat and airs, but in every respect a fluid, little different from that contained in the veins. It was also part of his system, that the right cavity of the heart attracts blood from the liver, and conveys it to the left, from which it is diffused all over the body by the arteries. He taught that, at every systole of the arteries, a certain portion of their contents is discharged at their extremities, namely, by the exhalents and secretory vessels; and that at every diastole a corresponding supply is attracted from the heart. He decidedly inculcates, in opposition to Asclepiades, that it is the expansion or diastole of the artery which occasions the influx of the blood, and not the influx of the blood which occasions the expansion of the artery; or, in other words, that the systole is the function of the heart, and the diastole its return to its natural state. (De Diff. Puls. iv, 10.) Though he demonstrated the anastomosis of arteries and veins, he nowhere hints his belief, that the contents of the former pass into the latter, to be conveyed back to the heart, and from it to be again diffused over the body. In a word, his system appears to have been nearly, or altogether, the same as that which was afterwards taught by the unfortunate Servetus.

It is clear, therefore, that Galen had made a very near approach to the Harveian theory of the circulation; indeed, Harvey himself candidly admits this. It will be perceived, from what we have stated, that the grand point of difference between Galen and Harvey, and that upon which the theory of the latter mainly rests, is the question whether or not at every systole of the left ventricle more blood be thrown out than is expended on exhalation, secretion, and nutrition. Upon this point Galen held the negative, Harvey, as we all know, the affirmative.

In proof of the opinions which we have attributed to Galen, we refer the reader to ‘An Natura Sanguinis sit in Arteriis;’ ‘Administ. Anatom.’ (vii, 15); ‘de Usu Partium,’ (vi and vii, 7, 8, 9); ‘de Placitis Hippocr. et Plat.’ (i, 5.)

See also Averrhoes (Colliget. ii, 8, ii, 9; Collect. i, 9; in Cant. Avic. i, 1); Avicenna (iii, xi, 1); Actuarius (de Spiritu Animali, i, 6; de Causis Urinarum, ii, 2); Nemesius (de Natura Hominis, 24.)

With regard to the passages collected by the ingenious M. Dutens and others, from the works of Hippocrates, Plato, Nemesius, Pollux, and Theodoret, to prove that the ancients were acquainted with the circulation of the blood, as taught by Harvey, we shall only remark, that, after having attentively considered them, we cannot but draw the conclusion, that some of these authors must have had, at least, an obscure idea of this doctrine, although, in general, these passages may be understood to refer merely to the lesser circulation and the movement of the blood from the centre to the extremities, as maintained by Galen. See Dutens (Origine des Découvertes attribuées aux Modernes, p. 157); Drelincurtius (de Lienosis Epimetris); and Littré (Introduction aux Œuvres d’Hippocrate.) The last of these writers, whose minute acquaintance with the earlier works on medicine entitles his opinion to every consideration, after a searching investigation into the state of anatomical knowledge in the days of Hippocrates and his immediate successors, comes to the conclusion, that the germ of the theory of the circulation is, beyond doubt, to be found in the Hippocratic treatises. (T. i, 223.)

SECT. LXVII.—DIAGNOSIS OF THE TEMPERAMENTS OF THE LIVER.

The marks of a hot liver are, largeness of the veins, redundance of yellow bile, and, in manhood, of black; the blood hotter than natural, and by means of it the whole body, unless the parts about the heart antagonise; and thick hairs upon the hypochondriac regions, and over the stomach. Those of a cold are, smallness of the veins, much phlegm, cold blood; the whole habit of the body colder than common, unless warmed by the heart; no hair on the hypochondriac regions, nor over the stomach. Those of a dry are, thick and scanty blood, and the veins and the habit of the whole body drier. Those of a humid are, the blood abundant and liquid, the veins softer, as also the whole body, unless the heart antagonise. The marks of a temperament at once hot and dry are, the hairs very thick on the hypochondrium, the blood at the same time thicker and more scanty, a redundance of bitter bile, and in manhood, of black, largeness and hardness of the veins, and the whole body hot and dry. The heat proceeding from the heart may indeed overcome the coldness proceeding from the liver, in like manner as the coldness may the heat; but it is not possible for the dryness to be changed to the contrary state by the humidity of the heart. It is obvious that, when the temperaments of those two prime organs combine together, the whole body is affected accordingly. The humid and hot liver, less than the hot and dry, renders the hypochondrium shaggy; but the blood is abundant, the veins large, and the whole habit humid and hot, unless the heart antagonise. But, should it be preternaturally changed as to both these qualities, persons so affected will be readily seized with putrid diseases and disorders from bad humours; and more particularly if the humidity be much increased, and the heat but little, they will be liable to cacochymies. In the humid and cold, the hypochondrium is free from hairs, but the blood is pituitous, the veins contracted, and the whole body in like manner, unless changed by the heart to the opposite state. The cold and dry renders the blood scanty, the veins of the body contracted, and the body colder; and the hypochondrium is without hair, unless the heart overcome this state.

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COMMENTARY. According to the views of the ancient physiologists, the liver is the seat of the Natural powers, being the grand organ of sanguification, and the blood being the pabulum which nourishes the whole body. That the liver performs an important part in the fabrication of the blood seems probable from all the veins of the stomach and upper portion of the intestines passing to the liver, whereby it is to be supposed, that a considerable proportion of the nutritive juices will be conveyed to it; and from this viscus being proportionally large in the fœtus when it is much required to form blood, and cannot be supposed necessary for any other purpose. The ancients taught that the liver, by its attractive power, attracts the chyle from the stomach; that, by its retentive, it retains the same until the alterative convert it into blood; and that then the expulsive separates the superfluities of the blood, namely, the bile, and conveys them to the gall-bladder. See Galen (T. ii, 285, ed. Basil), and Avicenna (iii, 4, 1.)

Aristotle held that the spleen is part of the hepatic system. (De Partibus Animal. iii, 7.) His commentator, Averrhoes, in like manner, considers the spleen as a second liver. (Collect. i, 9.) Their reasoning, on this point, appears to me exceedingly acute and conclusive.

The following extract from Actuarius contains a clear exposition of ancient opinions on the subject we are treating of: “When the food in the stomach is changed and digested, the meseraic veins, which derive their origin from the liver, by their vein called ramalis, suck the stomach and intestines; and having emulged, as it were, the purer part, (namely, the food converted into chyle,) and having drawn it as if through a strainer, they convey it to the concave part of the liver, and deliver it over to the sanguificatory power. Here, then, if nothing impede it, when it is changed into blood, whatever is subtile and acrid is received by the gall-bladder, which is placed at the convex part of the liver, and attracts the bile; but whatever the blood possesses of a terrene and melancholic humour is attracted to the spleen, by some natural faculty, whereby every part attracts whatever suits its nature. Thirdly, the serous humour remains. It is attracted by the kidneys.” (De Urinis, § 4.)

SECT. LXVIII.—DIAGNOSIS OF THE TEMPERAMENTS OF THE TESTICLES.

Of the temperaments of the testicles, the hot is lustful, apt to generate, particularly males, and at an early age has the genital parts covered with thick hairs, which extend to the surrounding part. The cold is the reverse. In the humid, the semen is copious and watery. In the dry, it is scanty and thick. A temperament which is moderately hot and dry has very thick semen, is most prolific, and rouses the person to early indulgence. Such persons have, at a very early period, thick hairs on their genital organs, and on the surrounding parts, as high up as the navel, and as low down as the middle of the thighs. Such a temperament is prone to venery, but is soon satiated, and readily hurt if compelled. When humidity combines with heat, such persons have thick hair, and much semen; yet they have not greater desires than others, but they can bear much venery without injury; and if both the moist and the hot combine properly together, they cannot safely abstain from venery. Those whose testicles are of the humid and cold temperament have no hair on the neighbouring parts; they are slow in beginning to copulate, and not much prone to the exertion. Their semen is watery, thin, without strength, and fit only for begetting females. The dry and the cold temperament together, resembles the former in every other respect, except that the semen is thicker, and altogether scanty.

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COMMENTARY. The testicles were described by the ancient anatomists as being bodies composed of white glandular flesh, and surrounded by coats which they knew to be processes of the peritoneum. The semen they considered as a white frothy fluid, elaborated from the blood, by passing through the convolutions of the spermatic vessels. Aristotle held it to be a superfluity collected from all parts of the system. His theory of generation is similar to that of Buffon. For the hypothesis of the Epicureans, see Lucretius (de R. N. iv.) They taught that the fœtus is the joint production of the male semen, and something analogous secreted by the ovaria of the female.