Chapter V: Part 5

With regard to the vomitings which occur to people at sea, it is neither easy nor expedient to contend with those which happen first; for, upon the whole, they are generally beneficial. After vomiting, one ought not to partake of much nor of ordinary food, but either lentils, dried and boiled with a small quantity of pennyroyal, or bread pounded in a weak and fragrant wine. One ought also to use but little drink, and that containing a weak watery wine, or vinegar with honey. The lentils ought to be first boiled, and then when they become soft, to be triturated, and afterwards dried and put into an earthen vessel. When severe vomiting lasts for a long time, one should resolutely abstain from all kinds of food, and take only a little drink, which ought to be vinegar and honey with water, containing thyme infused in it, or pennyroyal water with some fine polenta, or some fragrant weak wine with fine polenta also. In order to overcome the disagreeable stench on board ships, one may smell to quinces, thyme, or pennyroyal. One ought also to look as seldom as possible upon the sea, until one has been accustomed to live in a ship. One must likewise attend, that the water which is drunk be not muddy, ill-smelled, or saltish.

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COMMENTARY. This Section likewise is taken from Oribasius (Synop. v, 33), who copies from Diocles. Similar directions are given by Rhases, Avicenna, and Haly Abbas. Haly remarks that persons on board of a ship are often infested with lice, which are engendered by want of cleanliness. For them he recommends mercury killed, with oil, the long bithwort, &c. (Pract. i, 31.) Avicenna says that, by wearing wool smeared with oil and mercury, the lice will be killed. (Cant. p. ii.)

When the vomiting is unusually severe and protracted, Rhases recommends it to be treated with anti-bilious remedies. (Ad Mansor. vi, 14, Contin. 34.)

SECT. LVII.—ON THE MEANS OF DIMINISHING OBESITY.

When the body gets to an immoderate degree of obesity, it will be necessary to melt it down and reduce it. It was mentioned formerly that the warm temperament renders the body lean, and therefore it ought to be superinduced, if possible, upon that of fat people, in order to reduce them to the proper state. You have also learned that active exercise, an attenuant regimen, medicines of the same class, and mental anxiety, bring on the dry temperament, and thereby render the body lean. What an attenuant diet consists of is perfectly obvious; but the more powerful medicines, such as the seed of rue, particularly the wild, with its tops, the round birthwort (_aristolochia rotunda_), the small centaury, gentian, poley, and the stronger diuretic medicines, as Macedonian parsley: all such medicines, either alone, or together, attenuate the humours, and evacuate the body. The salts also from burned vipers and the theriac attenuate the body. The body may also be reduced and attenuated, by having an oil rubbed into it, containing the root of the wild cucumber, marshmallows, gentian, and the root of the all-heal and birthwort, or the poley and centaury. One ought not to take food immediately after the bath, but should first sleep for a little time. And it will be better if the water of the bath possess diaphoretic properties, and, more particularly, if we can have recourse to a natural one, such as that in Mitylene. If it cannot be procured, the flower of salt may be mixed with sea water. Thin white wines ought to be used. Dry rubbing with thick towels is calculated to reduce the fat. A smaller quantity of food ought to be given in proportion to the exercise taken. Insolation also is of use for obesity. Fat persons ought not to take a fragrant draught before a meal; and it will be best if they eat only once in the day. The body ought to be rubbed with nitre (soda), and the rougher salts. A large quantity of nitre in the bath is attenuant, but a small quantity only stimulates to nourishment. The following mixture is attenuant: Of pepper and Macedonian parsley, two parts, of asarabacca and anise, one half. This acts well, both as a diuretic and a cathartic.

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COMMENTARY. This is taken from Oribasius. (Synops. v, 40.) Aëtius uses nearly the same words. (iv, 32.) Celsus recommends the tepid salt-water bath, hard exercise, food of an acid or austere kind, and restricted sleep. (i, 3.)

Galen gives an interesting account of the manner in which he cured a person of obesity in a very short space of time. He says, “I first made him take quick exercise, and afterwards wiped off the sweat with a linen cloth. I then rubbed his body with the volatile ointments called acopa, and after this friction I led him to the bath. I did not then give him food at once, but directed him either to rest, or to follow any occupation he was inclined for, and then repeated the bath; after which I gave him as much food, not of a very nourishing description, as he was disposed to take.” (De Sanit. tuendâ, vi, 8.)

Avicenna recommends hard exercise and frequent baths, and vinegar to drink. (i, 3, 4.) Rhases recommends fat persons to abstain from animal food, wine, milk, and all sweet things; to live upon pot-herbs, and such things as are saltish and sour; to take purgatives and diuretics, to use much hard exercise, and to remain long in the bath. (Ad Mansor. v, 61.) In another work he treats of this subject at great length. He recommends acids, and especially vinegar. In short, he agrees with Galen, that all things of a bitter, sour, and attenuant nature reduce obesity; and also that saltish things which have the property of opening the bowels do the same. Nothing, he says, tends more to reduce corpulency than frequent baths and hard friction. (Contin. iv.)

The directions given by Haly Abbas are to the same effect as those of Rhases, that is to say, he recommends fat persons to take hard exercise, to remain long in the bath, to use friction with oil of dill and the like, to live upon articles of food not too nutritious, not to indulge in protracted sleep, and to have frequent recourse to laxative and purgative medicines. (Pract. i, 16.)

Some remarkable cases of obesity are related by Athenæus. (Deipnos, xii, 12.)

The practice of the Methodists is described in a very circumstantial manner by Cælius Aurelianus. (Tard. Pass. v, 9.) They very properly condemned bleeding and purging, and depended principally upon strong exercise, hot baths, insolation, the sand-bath, hard friction, and a restricted diet.

SECT. LVIII.—HOW TO RECRUIT THOSE WHO ARE EMACIATED.

When we wish to recruit those who are reduced in flesh, we must give them thick wine and food containing thick juices, and prescribe slow exercise and moderate friction,—in a word, every thing contrary to the method we have been just describing. It may also be of use to be pitched for three or four days. If a person go into the bath with an empty stomach, he ought beforehand to get his body rubbed with linen cloths until it become ruddy, and afterwards, by hard but not frequent friction, the skin may be rendered thick and hard. Those who are pale, and not properly nourished, ought to be roused to anger and mental emotions.

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COMMENTARY. This is either copied from Oribasius (Synops. v, 41), or from Aëtius (iv, 58.) The process of pitching the body is thus described by Aëtius: “Dried pitch is melted in a moderate quantity of oil, and, while still warm, is to be rubbed into the skin (the part having been previously shaved), and before it cools completely it is to be torn away. The plaster is to be again heated at the fire, and spread upon the skin; and before it becomes cold it is to be torn away. This process is to be frequently repeated.” (iii, 180.) See Celsus (i, 3.)

Galen, in his Commentary on the second Aphorism of Hippocrates, expresses himself strongly on the danger of using precipitation in recruiting a person that has been emaciated. He evidently writes from ample experience, acquired in training the Athletæ. Hippocrates and his commentator repeat this rule the “ne quid nimis” in another place. See Galen (Op. t. v, 251, ed. Basil.)

Haly Abbas recommends moderate exercise, a short continuance in the bath, friction with emollient oils, much sleep, two or three meals every day, food consisting of fat meat, bread, almonds, &c. He also approves of pitching. (Pract. i, 16.)

Avicenna recommends pitching, the bath soon after taking food, soft friction, and the rest of the treatment recommended by Paulus. (i, 3, 4.)

Rhases treats of the same at great length. He approves of protracted sleep; of food consisting of fat meat, wheat, and pulse; after food, of the bath, friction with oil, and the affusion of tepid water over the body; and also of red, thick, and sweet wines. (Ad Mansor. v, 60.) In another work he delivers the opinions of preceding authorities, accompanied with his own remarks. He agrees with Galen, that emaciation generally depends upon the state of the liver. They recommend nutritive articles of food, such as boiled and roasted flesh, and the bath, without friction, after a meal. Both speak favorably of pitching. They also approve particularly of sulphureous and bituminous baths. With regard to the bath, they explain, in another place, that it is proper in these cases only after the food is digested; for, if taken too soon after, it loads the body with unconcocted chyle; and that, if had recourse to at other times, it rather induces emaciation. Rhases again repeats that many of the legumina are very nutritive. He states that the wine should be particularly thick. (Contin. xiv.) Galen further says, that emaciated persons are to be recruited by thick wines, food consisting of thick juices, short exercises, and moderate friction. (Meth. Med. xiv, 16.) In another place he gives a very striking description of the bad effects of inanition. (De Venesect. adv. Erasistrat.) We would further direct attention to the description given by Hippocrates of a febrile state of the system, attended with delirium, which is sometimes brought on by too restricted a regimen in disease. (De Diæta morb. acut. § 11.)

On the treatment of convalescents, consult Celsus (iv, 25); Galen (Hyg.); and particularly Rhases (Contin. xxxiv). We shall give Celsus’ directions in his own words: “Ex quocunque autem morbo quis convalescit, si tarde confirmatur, vigilare primâ luce debet; nihilominus in lecto conquiescere: circa tertiam horam leniter unctis manibus corpus permulcere: deinde delectationis causa, quantum juvat, ambulare, circumcisa omni negotiosa actione: tum gestari diu: multa frictione uti: loca, cœlum, cibos sæpe mutare: ubi triduo quatriduove vinum bibit, uno aut etiam altero die interponere aquam. Per hæc enim fiet, ne in vitia tabem inferentia incidat, et ut mature vires suas recipiat. Cum vero ex toto convaluerit, periculosè vitæ genus subito mutabit, et inordinatè aget. Paulatim ergo debebit, omissis his legibus, eo transire, ut arbitrio suo vivat.” Galen and Rhases particularly recommend to convalescents to drink white astringent wines diluted with water. Both enjoin a restricted diet at first, gentle exercise, and the bath in moderation. Haly Abbas cautions against premature friction and exercise, but recommends the tepid bath, and gentle unction with oils. (Pract. i, 25.) Syrasis recommends the warm bath, moderate friction with rough towels, and unction with a little oil. (Auctores de Balneis, p. 334.)

SECT. LIX.—HOW TO REMEDY EMACIATED PARTS OF THE BODY.

When emaciation takes place in any part of the body, it is commonly occasioned by long-protracted rest, or by bandaging for fractures. We must, therefore, stimulate their vital powers, and attract the blood to them, by using moderate friction, suitable exercise, and by the affusion of warm water upon them in moderate quantity. This must be done until the part becomes red and swells, and we must desist before it subsides. We must also use pitching, as formerly described. When there is a sense of cold in the part, it ought to be rubbed with linen cloths, or some calefacient medicine. For this purpose, I have sometimes used the thapsia, rubbing it in either with honey or cerate.

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COMMENTARY. This is taken from Oribasius (Synops. v, 42), or Aëtius (iv, 34). See also Galen (de Sanit. tuendâ, v); Rhases (Contin. xiii); Haly Abbas (Pract. i, 16); Avicenna (i, 3, 4.) All recommend water to be poured on the part, and then it is to be rubbed with towels and hot stimulant oils, so as to produce a redness and glow in it. Most of them also approve of the pitch plaster.

SECT. LX.—THE DIAGNOSIS OF THE BEST TEMPERAMENT.

That man is in the best temperament of body when it is in a medium between all extremes, of leanness and obesity, of softness and hardness, of heat and cold, of moisture and dryness; and, in a word, who has all the natural and vital energies in a faultless state. His hair, also, should be neither thick nor thin, and in colour neither black nor white. When a boy, his locks should be rather tawny than black, but, when an adult, the contrariwise.

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COMMENTARY. This Section is copied from Oribasius (Synops. v, 43), or Aëtius (iv, 53). See also Galen (de Temperam., de Opt. Corp. Constit., de Sanit. tuendâ, v, and Ars Med.) In the last mentioned, which was long the most celebrated of all his admired works, he has treated of the temperaments very systematically. Whatever Oribasius, Paulus, or any subsequent author, whether Greek or Arabian, have delivered on this subject is altogether derived from the works of Galen.

None of the Arabians has treated of the temperaments so learnedly as Haly Abbas. (Theor. i.) See also Averrhoes (Collig. vi); Alsaharavius (Theor. vi); Avicenna (Cant.)

SECT. LXI.—DIAGNOSIS OF THE TEMPERAMENTS.

Those bodies which are of a hotter temperament than the moderate will have their teeth earlier than usual, and will grow in like manner. They feel warmer to the touch, and have less fat; they are of a ruddy colour, have their hair black and moderately thick, and their veins are large. But if such a one be also fat and brawny, and have large veins, he is fat from habit and not from nature. The following are the marks of a cold temperament: Such bodies appear cold to the touch, are without hair, and are fat; their complexion, like their hair, being tawny. But when the coldness is great, they are pale, leaden-coloured, and have small veins; and if lean, this does not proceed from nature, but habit. The dry is harder and more slender than the temperate—the hardness, indeed, being inseparable from the dry temperament; but leanness not only follows the congenital temperaments, but also those which are acquired by long habit. It is a mark of hardness when the body is rendered unapt for motion, dry and parched, by drying applications. The humid, in all other respects, is like the temperate, but is softer and fatter, and the softness is inseparable from it; but the grossness not only follows the connate temperament, but also that acquired by long habit. It is peculiar to the humid temperament that the body is oppressed by things of a moist nature. The warm and dry temperament is extremely shaggy, having the hair of the head in early age of rapid growth, black, and thick; but, in after-life, baldness follows. The veins are large, as are likewise the arteries, which beat strongly. The whole body is firm, well articulated, muscular, and without obesity; and the skin is hard and dark. When the temperament is cold and humid, the chest is narrow, and, like the rest of the body, without hairs; the skin is soft and white, and its hairs somewhat tawny, especially in youth; and such persons do not get bald when they grow old; they are timid, spiritless, and inactive; their veins are invisible; they are gross and fat; their muscles and legs are feeble, and their joints ill-formed; and they are bandy-legged. But should the humidity and coldness increase, the colour of their skin and hair becomes tawny, or, if they increase still more, pale. The hot and humid temperament is softer and more fleshy than the best temperament, and, when it increases much, is subject to putrid disorders; but, if it be only a little more humid and much hotter than the moderate, the bodies of such persons are only a little more soft and fleshy than the moderate, but they are much more hairy and hotter to the touch. But if the cold and the dry grow equally together, such persons have naturally their bodies hard, slender, and white, with fine muscles, small joints, and little hair; and they are cold to the touch. Although slender, fat is mixed with their flesh. The colour of their hair is correspondent to the degree of constitutional coldness. As to disposition of mind, they are spiritless, timid, and desponding. To say all in a word, with regard to the compound temperaments, they are always to be distinguished by the marks of the prevailing quality.

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COMMENTARY. This Section is taken from Oribasius (Synops. v, 44), who borrows from Galen (Ars Med. c. 15.) See also all the authorities referred to in the preceding chapter.

The ancients, it will be perceived, connected the passions and desires of the mind with the temperaments; and, to establish the alliance between them, Galen wrote a treatise, wherein he has handled the subject very ingeniously, and has delivered many profound views of the animal economy. Galen’s work, to which we allude, is entitled, ‘Quod Animi Mores Corporis Temperamenta sequuntur.’

SECT. LXII.—ON THE FORM OF THE HEAD.

A small head is the peculiar mark of a faulty configuration of the brain, but a large is not necessarily a good one; for if occasioned by the strength of the vital powers of the part fabricating an abundant and proper material, it is a good sign; but if occasioned by the quantity of matter alone, it is not good. We must judge of heads then from their shape, and from the processes which arise from them: from their shape, if well formed, for that is always a good sign; and from the processes of the brain, if they be in their proper state, and if the nervous parts be all properly nourished, have their suitable tone, and if the sight be acute. Sharp heads are defective in the protuberance of the front or hind-head, or else it is unnaturally increased. Now, in most cases we shall find that these last, like the large, are faulty, and yet some of them, though rarely, are good, the formative principle being strong.

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COMMENTARY. This Section is taken from Oribasius (Synops. v, 45); Aëtius (iv, 63); or direct from Galen (Ars Med. c. 6.)

Psellus, like our author, remarks, that a small head, by contracting and binding, as it were, the brain, is necessarily a bad formation; whilst a large head, if it arises from excess of the natural powers, is good; but if it is occasioned by a collection of superfluous matter, the contrary. We would refer, in this place, to the curious account of the _Macrocephali_ given by Hippocrates in his treatise ‘On Airs,’ &c. (§ 14), and to the interesting remarks in the same by M. Littré (t. iv, p. xi.)

SECT. LXIII.—THE MARKS OF THE TEMPERAMENT OF THE BRAIN.

A brain of the proper temperament has its vital energies and excretions moderate, and is not liable to be affected by any externals. Such persons, when infants, have the hair of their head somewhat tawny—when boys, yellowish—and when adults, a bright yellow; being also intermediate between the curly and the straight, and they do not readily fall out. When the temperament is hotter than moderate, all the parts about the head are hotter and redder, the veins in their eyes are perceptible, their hair is grown at birth; and if much hotter, it is black, strong, and curly; but if not much, it is yellowish at first, and then grows black, and in more advanced life such persons become bald; their excretions are small when they enjoy good health; their head becomes filled and oppressed by heating food, drink, and odours, or by any external casualties. Such temperaments are satisfied with little sleep, and even that is generally not profound. The following are the marks of a brain which is colder than proper: The excretions are excessive; the hairs are straight, yellow, and durable; and it is hurt readily by cold things. Such persons are constantly seized with catarrhs and defluxions, the veins of their eyes are not visible, and they are much given to drowsiness. The following are the marks of a brain which is drier than natural: In the excretions nothing redundant, the senses acute, not being given to drowsiness, the hair strong and soon formed, rather curly, and soon falling out. In the more humid temperament, the hairs are straight, do not readily drop out; the senses are muddy, and the excretions redundant, sleep long and profound. In the compound of the hot and dry, the excretions of the head are small, the senses acute, there is a disposition to watchfulness, and baldness. Their hair at first is formed quickly and abundantly, is of a black colour, hot to the touch, and they are ruddy until manhood. But if moisture be joined to heat, and they are not immoderate, the colour and heat are good, and the veins of the eyes large. The excretions are plenteous and moderately concocted. The hair is straight and yellowish, and does not readily drop out. The head is easily filled and oppressed by heating and moistening things. But should an increase of humidity and heat take place, the head becomes diseased, and easily affected by heating and diluent things. Such persons cannot endure long watchfulness, but their sleep is disturbed by fantastical dreams, their sight is dim, and their senses not distinct. The cold and dry temperaments of the brain conjoined together render the head cold and pale, the veins of their eyes do not appear, and they are readily hurt by cold things: wherefore, their health is precarious. Their senses in youth are distinct and faultless, but as they advance in life soon decay. In a word, as far as regards the head, they experience a premature old age; their hair after birth is of slow growth, stunted, and tawny. The humid and cold temperaments of the brain render those affected with them prone to lethargy and drowsiness; their senses are bad; they abound with recrementitious humours; are easily affected with cold and fulness of the head; and are liable to catarrhs and defluxions; but such persons do not readily become bald.

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COMMENTARY. This is taken from Oribasius (Synops. v, 46), who abridges Galen. (Ars Med.)

As our author’s description of the temperaments is sufficiently intelligible, and the others, whether Greeks or Arabians, deliver exactly the same views of the subject, without any material improvement, we consider it unnecessary to multiply references to, and extracts from them, on the present occasion; and, therefore, instead of crowding our pages with superfluous repetitions, we shall give in this, and the five following Sections, a brief exposition of the physiological doctrines of the ancients, with regard to the principal organs of the human body:

The ancients divided the powers or faculties of the human body into the Natural, the Vital, and the Animal. The brain they held to be the seat of the animal powers—that is to say, they considered it to be the organ from which sensation and motion are derived, and these, they maintained, are the powers by which animals are distinguished from vegetables. This doctrine is fully explained by Galen, in his work, ‘De Facultatibus Naturalibus,’ and by several of the Arabian authors, among whom we will venture to mention Haly Abbas, as being particularly worthy of being consulted on this subject. The brain, then, was accounted the seat of the five external senses, and of muscular motion, which also was reckoned as one of the senses by Hippocrates. (De Insomniis, c. 1.) Galen and his followers decidedly taught that the nerves of the senses are distinct from those which impart the power of motion, that the former derive their origin from the anterior part of the brain or cerebrum, and the latter from the posterior, called by the Greeks encephalis (under this term they comprehended the cerebellum, tuber annulare, and medulla oblongata of modern anatomists), or from its process, the spinal cord. They maintained that the nerves of the finer senses are formed of matter too soft to be the vehicles of muscular motion; whereas, on the other hand, the nerves of motion are too hard to be susceptible of fine sensibility. See Galen (de Usu Partium, ix; de Administ. Anat. vii); Haly Abbas (Theor. iv); Averrhoes (Collig. iii, 33); Avenzoar (ii, 7); and Rhases (Contin. i.)

The ancients were also of opinion that the brain is the coldest viscus in the animal frame, being in this respect the antagonist of the heart, the heat of which they supposed that it counteracts. See Aristot. (De Part. Anim. ii, 7); and Pliny (Hist. Nat. xi, 49.) There appears to be some foundation for this opinion, since, as is remarked by Haly Abbas, those parts of the body which are vascular, and contain much blood, are naturally hot; whereas such as contain little blood are comparatively cold. Of this latter class are the brain, nerves, and fat. (Theor. i.)

The later Greek authorities, as, for example, Theophilus Protospatharius and Nemesius, adopt a division of the brain as regards its connexion with mind, to which Galen and his immediate followers appear to have been strangers. According to it, Fantasy is connected with the anterior part of the brain; Cogitation, or the _discursus mentis_, with the middle; and Memory with the posterior. See, in particular, Theophilus (p. 184, ed. Greenhill.) This hypothesis was received by all the Arabian writers on medicine. See, for example, Averrhoes (Collig. ii, 20.) It was evidently an approach to the arrangement adopted by the phrenologists of the present day, who maintain that intellect is seated in the anterior part of the brain; the moral feelings in the middle; and the animal appetites in the posterior.

SECT. LXIV.—THE MARKS OF THE TEMPERAMENTS OF THE STOMACH.

The marks of a preternatural dryness of the stomach are, that those affected with it are liable to thirst, but little drink satisfies them; and they feel heavy with much drink, as the superfluity occasions gurgling in the stomach, or floats upon it; of those of a more humid, that they are not addicted to thirst, and bear readily much liquids, and rejoice in humid food. A stomach preternaturally hot has a better digestion than appetite, particularly with regard to those things which are hard and difficult to digest; it delights in much food and drink; neither is it hurt by the moderate use of cold things. A preternaturally cold stomach has a good appetite but not a good digestion, in particular with regard to such things as are of difficult digestion, and are of a cold nature, which therefore are apt to turn acid in it. And it delights indeed in cold things, but is readily hurt by the immoderate use of them. The intemperaments proceeding from disease differ from the congenital in this, that they long for opposite things, and not always alike. If the stomach then digests properly, it is of a moderate temperament; and if it does not it is of a bad; but if its eructations are fetid, its heat is inordinate and inflammatory; but if acid, the contrary. And in those who digest properly things of difficult digestion, the heat of the stomach is inordinate, and weak in those who cannot digest those things, but digest fishes. It must also be observed, whether or not the symptom is occasioned by any humour flowing from another part; for in pituitous constitutions acid eructations are apt to occur; but in the bilious, fetid airs and other disagreeable qualities are apt to prevail. The common symptom of them all is nausea. If the depraved humours swim within the cavity of the stomach, they float on the surface, and are discharged by vomiting; but if they are contained in the substance of it within its coats, they annoy it with vain attempts to vomit.

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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.

Galen has very ingenious ideas respecting the first organization of the fœtus, which he ascribes to a certain power in the semen, like that which Blumenbach calls a _nisus formativus_. (De Form. Fœtus.)

SECT. LXIX.—ON THE PARTS THAT ARE OMITTED.

Each of our members has its own proper temperament and faculty; but it is not necessary for us to describe the characters of all, since they are unlimited, and we propose to give only a brief system of instruction. Having treated of those which principally affect the whole body, of the others we shall merely direct them to be judged of in the same way, forming an opinion of the temperaments from their excretions, their other energies and symptoms. It is now time to treat of the cure of the intemperaments of the whole body.

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COMMENTARY. On these consult Galen (de Temperamentis); Haly Abbas (Theor. iii); Avicenna (i, 1, 3.) We may mention that, generally speaking, all those parts which possess much blood were supposed to be of a hot temperament, and those which have little of a cold.

SECT. LXX.—THE CORRECTION OF HOT INTEMPERAMENTS OF THE BODY.

Since, in the hot intemperaments, the bile exceeds in quantity, if it pass downward, little, it is obvious, need be done; but, if carried upwards to the stomach, it ought to be evacuated by vomiting, by taking tepid water after exercise, and before food. It will be better that the exercise taken be not swift nor hard; but, on the contrary, rather slow and gentle. Some of those who are very hot do not at all require gymnastic exercises, but walking and the bath are sufficient for them. These delight, also in baths after a meal. But those who have heat combined with dryness, require a diluent regimen by means of succulent food, baths, and abstinence from much and hard exercise; so that in the season of summer they ought to bathe early, and after a meal a second time. Cold drink is of service to them. Venery is most inimical to dry temperaments. Such ought also to abstain from exertions producing lassitude, exposure to the sun, and to avoid cares and watchfulness. Those who are naturally humid are apt in infancy to be seized with rheumatic and plethoric complaints, and also with putrid. They stand in need of more exercise, of a proper digestion in the stomach, and of secretions by urine. Wherefore such persons are much benefited by taking before diet the bath two or three times, particularly the natural hot ones. They ought also to promote the secretions by means of exercises, and the bath, and by procuring the alvine and urinary discharges before taking food. And nothing hinders them to use masticatories and cathartics, as also a wholesome diet, and wine of a diuretic quality.

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