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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Commentary. See, in like manner, Galen (de Sanitate tuenda, vi); Oribasius (Synops. v, 51); Aëtius (iv, 9); Actuarius (de Diæta, c. 12.) Of the Arabians, Haly Abbas is the author who has delivered the treatment of the temperaments in the fullest manner. (Pract. i, 15.)
It is to be remarked that the condition of the body named the hot intemperament by the ancients is the same as that now generally called a bilious habit. Accordingly, Galen directs the physician to attend whether any pain or sense of weight be felt in the region of the liver, as, in that case, he judges it unsafe to take the bath after a meal, and recommends him rather to give deobstruents, and to proscribe food of a thick viscid nature. He particularly recommends an attenuant diet, and medicines of the same description, namely, wormwood, anise, bitter almonds, &c. His views of practice, in short, appear to have been very judicious.
SECT. LXXI.—THE CORRECTION OF THE COLD INTEMPERAMENTS OF THE BODY.
Of cold intemperaments there are three varieties, the worst of which is the dry; for such persons are from the first in that state which time brings upon old men. They ought, therefore, to use whatever is diluting and warming, such as moderate exercise, humid and warm food, the heating wines, and much sleep. Care should be taken by us, that all the excrementitious matters collected in the body be evacuated every day. Venery hurts all those who are affected with dryness, and more especially if joined to coldness, and is innocuous to the hot and humid alone. The cold and humid temperaments are bad, and are very subject to rheumatic affections. They are relieved by abstinence from the bath, by frequent and light exercises, and the use of moderately heating unguents. Those that are naturally colder, but are well regulated as to dryness and humidity of temperament, ought to stimulate and increase their heat, but to choose the medium between a humid and dry diet.
Commentary. See the authorities referred to in the preceding Section. All, in a word, copy from Galen. (l. c.)
SECT. LXXII.—THE CURE OF THE DRY INTEMPERAMENTS, OF THE STOMACH FOR EXAMPLE; THEN OF THE OTHER INTEMPERAMENTS.
A dry intemperament may either be occasioned by the parts of uniform texture being drier than natural, in their solid parts, which is incurable; or by the natural moisture from which these parts derive their nourishment being lost. It is contained in all parts of an animal, being diffused through them in the form of dew, and can only be supplied by means of the food. The former variety is utterly incurable; and even the latter is of all states of the body the most intractable. But when the dryness is seated in the small veins and arteries, the cure may be attempted by filling each of the parts of uniform texture with their proper juices by a humid diet. A tepid bath is therefore beneficial, and the patient ought to remain long in the water. Immediately after the bath, let him take the milk of an ass newly drawn, to which a little warm honey has been added. Afterwards he ought to rest until he take a second bath. He ought then to be moderately rubbed with oil, if the milk appears to be digested, which may be judged of from his eructations and the distension of his belly. The proper interval between the first and second bath may be four or five hours at the equinox, if he be to bathe a third time, but, if not, it may be greater. And he ought to be rubbed with oil before putting on his clothes after every bathing. If, therefore, the milk agreed with him, we may give it to him after the second time, or, if not, we may give, instead, a ptisan properly boiled, or alica made into a ptisan; he is then to rest until the third bathing, or otherwise until supper. His bread ought to be carefully prepared, baked in an oven, and of a fine quality; and as a seasoner, he may eat those fishes which are caught among rocks, or the hake in a white soup. In a word, his food ought to be of easy digestion and nutritious, not oily and excrementitious. His drink should be wine that is weak, white, clear, bearing little water, and having some astringency. Such is the mode of cure for the greatest degree of dryness; but the moderate does not require the same restriction as to diet, which may therefore be more generous. Let us suppose a dryness like the former, but mixed with a moderate coldness; and in this case, we must substitute certain calefacient articles; and, with regard to those mentioned above, we must add more honey to the milk, and give wine that is not so watery. We must also not only use things which are naturally heating, but which are so from their acquired qualities. And the body is to be rubbed frequently with the ointment of nard and mastich. When much coldness is joined to the dryness, know in the first place, that the complaint is difficult and intractable, but use the same remedies, and also by itself honey that has been boiled and scummed, along with very old wine. The best possible remedy in such cases is that which is much used by pitchers; and we must likewise rub the belly with it, and tear it away while it is yet warm. Such persons are also relieved by having a child of a full habit sleeping with them, so as to touch their belly. Let us next suppose that a moderate heat is joined to dryness. In this case, our first care ought to be, not to taste honey, and to use wine which is not aged, food which is tepid and milky, and to rub the belly with the oil of unripe olives, or with that of apples. But to cool such persons much is not devoid of danger, as their state is feverish when the heat prevails. Let us next suppose that a hot intemperament prevails, and that humidity is joined to it. Such an intemperament is to be cured by drinking cold water. The use of astringent food is also proper; namely, such things as are austere, without being heating. But when the humid intemperament alone prevails, such articles of food as are desiccant, without heating or cooling much are beneficial, and also abstinence from the common drinks. When the humid intemperament is joined with the cold, the best remedies are all acrid things, and they ought to be mixed with such things as are astringent, without being decidedly refrigerant. The drink should be in small quantity, and consist of some of the strongly heating wines. These are the modes of curing intemperaments proceeding from qualities. But since a humour contained within the cavity of the stomach, or being absorbed within its coats, often occasions intemperaments, it will be proper to treat also of these affections. If the former state occur at once, it may be easily removed by emetics; but if it be a defluxion, the parts it comes from will require very attentive consideration, and the cure will follow, of course; for it is to be applied entirely to the affected part; and of the other parts, we need only take care that they be not thereby affected. The cure is to be performed by astringents, and such things as will bring the whole body to its proper habit. Depraved humours in the coats of the stomach are to be evacuated by moderately cathartic medicines, such as aloes, and the powder prepared from it, called Picra. When a viscid phlegm is contained in the stomach, such persons ought first to take those things which will cut it, and then it may be purged off, or evacuated by vomiting with radishes. When the humour is neither viscid nor thick, a vomit from ptisan, or that from honied water, may be sufficient. The juice of wormwood with honied water may also be drunk. In like manner, intemperaments in other parts may be cured, by finding out the evacuation suited to the humours; or, if the part has no sensible discharge, the prevailing matters and humours may be evacuated in the form of vapour; and in like manner, if it proceed from flatulence.
Commentary. Galen supplies all the matter of this Section. (l. c.)
The modern ideas respecting the temperaments, appear to be founded upon the descriptions given by the Arabians of the symptoms which characterize the prevalence of the four humours, as they were called, namely, blood, yellow bile, black bile, and phlegm, in the body. In proof of this, we subjoin Rhases’ brief description of them: “De complexione autem infirmi scias, quod si fuerit albi coloris admixti rubedini, et si fuerit bonæ carnis, subtilis cutis, et quando locum fricaveris, rubescit statim, significatur quod materia est sanguinea. Et si corpus fuerit pingue, et albi coloris non mixti rubedini, et corpus nudum pilis, venis strictis, carne molli, occultarum juncturarum, gracilium ossium, et generaliter talis dispositio qualis est in corporibus mulierum, significatur quod materia est phlegmatica. Et si fuerit macrum, citrini coloris, pilosum, et cum crassis venis, et manifestis juncturis, ostendit quod materia est cholerica. Et si fuerit niger color, durities corporis, pilositas, asperitas cutis, significatur quod materia est melancholica.” (De Affect. Junct. 2.)
It is to be understood, however, that Galen’s system of the temperaments was not based, as has been often erroneously represented, upon any hypothesis respecting the humours.
SECT. LXXIII.—ON THE POWERS OF THE ARTICLES OF FOOD.
Since an account of the properties of food is a part of the doctrine of Hygiene, we shall add that to the preceding, having premised only a few remarks before delivering the particular rules on this head; for nothing is more indispensably necessary than to be well acquainted with the properties of food. Things of an attenuating power open the pores, and clear away the viscid humours which are impacted in them, and cut and attenuate the thick; but when persevered in as articles of food, they beget serous and bilious superfluities, or, if still longer continued, they render the blood melancholic. One ought therefore to abstain from the continued use of them, and in particular those who are of a bilious temperament; for they only suit with those who have collections of phlegm, and of crude, viscid, and thick humours. Those of incrassating powers are sufficiently nutritious, and, if properly digested in the stomach and liver, they form good blood, but occasion obstructions of the spleen and liver. Of these some have only thick juices, as the dried lentil, but some viscid, as the mallows; and in some they are both thick and viscid, as the testaceous fishes. An attenuating diet is safer than an incrassating for the preservation of health, but yet, as it supplies little nourishment, it does not impart tone or strength to the body. One ought, therefore, to take some moderately nutritious food, when experiencing the effects of a deficient diet. They may do so with the least danger who are given to exercises and can take as much rest as they please. But all those who cannot take exercise before food ought to avoid such things as are incrassating; and those who are of an indolent habit ought by no means to take such food. For complete inactivity is one of the greatest evils for the preservation of health, whereas moderate exercise is particularly good. Those articles of food which are intermediate between the incrassating and the attenuating are the best of all, producing blood of a proper consistency. Such a diet, then, agrees with our bodies, but that which produces a bad chyme ought to be shunned. It is better also to avoid variety of food, more particularly if it consist of contrary qualities; for such things, when taken together, do not digest properly.
Commentary. The ancient writers on Dietetics are, Hippocrates (de Diæta, de Affectionibus, et alibi); Celsus (ii); Dioscorides (Mat. Med. ii); Galen (de Facult. Alim., et de Probis Pravisque Aliment. Suc.); Xenocrates (de Aliment, ex aquat.); Oribasius (Med. Collect. i et seq.); Aëtius (ii); Simeon Seth (de Alimentis); Actuarius (de Spiritu Animali, p. ii); Anonymus (Tract, ap. Ermerins Anecdota Græca); Marcellus (Sideta de Piscibus); Psellus (Carmen de Re Medica); Rhases (ad Mansor. iii, Cont. xxxiii); Avicenna (Cantic. p. ii); Averrhoes (Comment. de Cantic); Haly Abbas (Theor. v, 15); Athenæus (Deipnos. passim); Plutarch (de Sanitate tuenda, Symposiacon); Macrobius (Saturnal. vii); Cælius Apicius (de Opsoniis); Geoponica (xii); Horace and Martial (pluries.)
Of all the ancient writers on Dietetics, Galen is beyond dispute the best. In the two treatises mentioned above, he has treated of everything connected with this subject so fully and so correctly, as to leave little to be supplied even at the present day. All the subsequent authorities in general are his servile copyists, with the exception of Averrhoes, who commonly differs from him only by deviating into error.
The ancient philosophers were at great pains to explain why a regular supply of food is necessary to the existence of animals. On this subject, Timæus Locrus, Plato, and Aristotle have philosophized with great acuteness and ingenuity. No one, however, has given a plainer account of the matter than the poet Lucretius in the following verses: