Werring Worlds

by D. Fambresarius

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*This modernized herbal is a work in progress and will be continuously updated.

**You can access the origin text at: University of Michigan Library Digital Collections

The Project | Historical Background | Summaries | Humoral Medicine | Dictionary | Download

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The Definition of Medicine

There was a saying by the famous Philosopher and Orator Tully, that a conversation about any subject could be undertaken. But it should begin always begin with a definition of the subject.

What is Medicine?

Medicine has been defined in various ways by ancient physicians:

• Galen:
  • The art of preserving present health and restoring lost health. (Constitution of Art)
  • The knowledge that protects health and expels disease. (Introductory Book)

• Hippocrates:
  • The process of supplementing what is lacking and removing what is excessive in the body. (Treatise on Wind)

• Herophilus:
  • The knowledge of what is healthy, unhealthy, or neutral. (The Subject)

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Note: What follows is a simplified dialogue between the Dean and a Candidate on medicine.

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Dean:

• Medicine is not an art because:
  • An art is a system of consistent principles used to obtain an end. However, the principles of Medicine are not consistent but varied.
  • Medicine deals with both healthful and harmful things, which are inherently different.

Candidate:

• Medicine as an art:
  • While the subject matter may seem varied, the precepts are unified in purpose.
  • All medical principles work toward the same end.

Dean:

• Medicine is not a science because:
  • Science deals with consistent and unchanging phenomena. Medicine is concerned with inconsistent states of being. It is subjective as opposed to objective.
  • In medicine there are many controversial and disputed topics and the theories of medicine are not always certain.

Candidate:

• On medicine as a science:
  • While outcomes may be changeable, medicine is based on necessary and permanent axioms.
  • Universal principles in medicine are established by demonstration and are certain.

Dean:

• Medicine is not knowledge because:
  • Medicine deals with specific cases through direct observation of sensory details. These cannot be known through demonstration as intellectual knowledge is acquired. It cannot give us universalizing concepts.
  • The end goal of science is understanding. The end goal of medicine is to obtain health.

Candidate:

• On medicine as knowledge:
  • Medicine discusses healthy and sick bodies in general, not particular individuals.
  • It uses methods of knowledge, even if physicians consider sensory details in practice.

Dean:

• Hippocrates’ definition of medicine:
  • Hippocrates’ definition of medicine is false, because neither addition nor removal are categories of medicine.

Candidate:

• Hippocrates’ definition of medicine:
  • Neither of these actions alone (addition or removal), but both in combination, are a category of medicine.

Dean:

• Category of Medicine:
  • If there must be a category it is neither addition nor removal, but aptitude.
  • A category includes specific characteristics, for example, an ‘animal’ is a category for both humans and other animals.
  • Addition and removal are outcomes of medical treatment, not defining characteristics. Neither of which can be considered a category of medicine.

Candidate:

• Classification of Medicine:
  • Hippocrates definition of medicine isn’t based not Essential, but from the Effects.
  • In the definition, the actions of medicine are a figure of speech for the underlying aptitude of the actions.

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What is Health?

Dean:

• Then for the definition of Herophilus’ I refute it: There is no such thing as a neutral body. His definition of medicine as ‘a science of things, wholesome, unwholesome, or neither’ is flawed.

Candidate:

• I disagree.

Dean:

• A wholesome body is one which is healthy, an unwholesome body struggles with disease. But the body is always either in a state of health or illness. There is no neutral body.

• I will prove it. Health and illness are direct opposites according to Aristotle. Therefore, since health and sickness are diametrically opposed, there can be no intermediate state between them.

Candidate:

• It is said that there is a neutral constitution, when the body is neither completely sick nor completely healthy.
• Health and sickness are completely opposite according to Aristotle but not according to the physicians.

Dean:

• Galen teaches that health is balance and sickness is an inbalance. But there is no medium between them.
• Note:
  • The original text uses Symmetry and Disorder instead of Balance and Inbalance. This is because the principles of holistic medicine were based on the ‘nature of being’ rather than anatomy. The symmetrical whole instead of the mechanistic frameworks of later medical practice.
• Health in a condition that produces good actions. Sickness produces bad actions. There is no middle ground.
• I declare this based on the authority of Galen who said, When a body ceases to be healthy, it becomes unhealthy. And in another place, he says: When the body transitions from health into sickness, the transition is imperceptible. And in another place, he states: One who can act and do as they were accustomed, according to all the body’s functions, is in good health; one who cannot is unsound or sick. The spectrum of health extends from the most perfect operation to a noticeable decline in operation- the disease beginning from that noticeable deterioration.

Candidate:

• Galen sometimes views health in a larger perspective, than at other times. I assert that there are two different states – one that is firm and stable and another in disposition and feeling, which is not as long-lasting but rather unstable and susceptible to every minor disruption or injury.
• Galen considers someone healthy if the habitual functions of their body do not cease their proper activities, even though they operation only weakly. Certainly, he also counts among the healthy those neutral states in decline that are falling into sickness, as well as those neutral states in health who are in recovery. He encompasses the state of neutrality within the bounds of health.
• However, when Galen excludes both conditions as unsound and insufficient to act as nature requires, he acknowledges a neutral condition that is not sound. This is because preservation isn’t appropriate, but it is necessary for neutral states falling into disorder, by way of maintenance, and for those newly recovered from a disorder, by way of restoration.

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What are the Parts of Medicine?

Dean:

• Natural philosophy is a speculative science, while medicine is an active practice. Therefore, physiology cannot be a part of both disciplines. Physiology is a subdomain of natural philosophy and so it should not be considered a part of medicine.
• Natural philosophy perfectly describes the human body. Therefore, physiology is a part of natural philosophy.

Candidate:

• There are four parts to medicine. Physiology or the study of nature and natural processes. That which understands and takes into consideration health. Pathology, which addresses symptoms and conditions. The treatment of disease and remedies. Some divide these into five parts, separating the consideration of causes and symptoms into two distinct areas, those they are both encompassed within pathology.
• Physiology is not a part of natural philosophy.
• Philosophy understands the body in general terms, considering its natural state. In contrast, physiology, which is regarded as the primary branch of medicine, studies the body in detail – whether it’s healthy, diseased, or in a state between the two. Some even argue that medicine is specifically focused on humans.

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What are the Essential Components for Acquiring a Comprehensive Understanding of Medicine?

Candidate:

• Three things, the natural which is studied through physiology. The non-natural which are examined in relation to health and maintenance. Disease processes where pathology focuses on understanding them and therapeutics deals with treating and preventing them.

Dean:

• What things do you call ‘natural’?

Candidate:

• What is ‘natural’ is what constitutes the Nature of Man.

Dean:

• How many things do you believe to be ‘Natural’ to Man?

Candidate:

• Seven things. The Elements. The Temperaments. The Parts. The Humors. The Spirits. The Faculties and Functions. Of the Elements.
• See: 7 Natural Things

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What is an Element?

Candidate:

• An ‘Element’ is the most fundamental unit of matter. According to Galen’s definition, it represents the simplest possible component – one that cannot be further subdivided into different substances. Thus, an element is the most basic component of a complex substance.
• An element is a simple substance from which things are originally created and into which they ultimately break down.
• See: 7 Natural Things

Dean:

• By this logic bones, muscles, flesh and other tissues would be considered the elements of the human body, since they are simple structures from which complex organs are built and into which organs can ultimately break down.
• Note:
  • Candidate is explaining the term ‘element’ from a Humoral / Galenic perspective, where the elements are fire, air, water, and earth that all things are made of and eventually return to.
  • The dean is explaining that their definition would also explain an almost mechanistic approach to the parts of the human body. This is an early attempt at identifying what we know understand to be cells, molecules, atoms etc.

Candidate:

• Not true: They appear simple to our senses, but they are all composed of the four Elements and when they ultimately breakdown they return to their basic Elements which can then form new combinations.

Dean:

• How can this be!? Aren’t the Elements themselves the common beginnings of all natural substances dissolved into Matter and Form?
• Note:
  • The Dean is asking for clarification, is the candidate actually saying that we can then manipulate the elements and return them to their natural state?

Candidate:

• This seems true in theory, but it doesn’t reflect reality. The Elements can only be divided through analysis or reason and not by Operation.
• Note:
  • The Candidate says, while in theory we could, we cannot physically do so. We can only rely on the theory that the elements return, it cannot actually be proven.

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What is the Difference Between Principles and Elements?

Candidate:

• First, the Elements can emerge as individual elements or emerge from one another (via interaction and decay processes). But Principles emerge from neither, they are the foundations that produce all phenomena.
• Secondly, the Elements are related to Principles. However, the Elements are the building blocks of physical tangible matter. Principles are abstract laws that govern nature and are intangible.

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How Many Elements Are There?

Candidate:

• Four: Fire, Air, Water, and Earth. Which Hippocrates called: Hot, Moist, Cold, and Dry.
  • See: Primary Qualities

Dean:

• What evidence do you give that there are only four Elements?

Candidate:

• I will give you three pieces. First, they are the first four Elements observable with the senses. Second, because they work together to form all known matter. Third, because everything eventually reverts back into these four Elements.

Dean:

• Demonstrate how Human Bodies are composed of all four Elements.

Candidate:

• It is the general consensus that all our bodies follow a clear organization. This form originating from the seed and maternal blood of our parents, creating a mixture of the Humors. This mixture of Humors is influenced by what is put into the body for nourishment. Whether that nourishment be meat from land or sea, fruit, herbs and flowers, it is all a mixture of the Elements.
• Our nourishment comes from the Elements.
• The Elements influence the Humors.
• The Humors influence the Similar Parts.
• The Similar Parts influence the Organic Members.
• The Organic Members influence the Organic Parts of the Human Body.
• That human bodies consist of the elements is obvious from the last part of our conversation. When a person dies, according to the laws of nature, they return to nature.This natural process demonstrates how humans are composed of the four fundamental elements. The bodies natural warmth disperses like heat or fire. The breath divides; part fire, part air. The bodies fluids revert to water. The solid parts- once they lose their moisture- dry out and crumble to earth.
• Hippocrates was the first to explain the concept. He taught that when a person dies, everything returns to its original elemental state. As he described it:
• Moist elements return to moisture. Dry elements return to dryness. Hot elements return to heat. Cold elements return to cold.

Dean:

• Explain more clearly how the human body is created from the four elements. The human body isn’t made directly from the elements themselves, but rather from their combined properties. And even these properties aren’t pure, but are mixed and balanced through their interactions with each other.
• List the properties of each element.

Candidate:

• Fire: Extremely hot. Moderately dry.
• Air: Extremely moist. Moderately heat.
• Earth: Extremely cold. Moderately moist.
• Water: Extremely dry. Moderately cold.
• These elements are the basic carriers of these qualities. Our bodies are composed of their mixture and their balance. When this balance is maintained, we experience good health. When the balance is disrupted or altered by some external factor, illness occurs.
• Note:
  • Here the candidate is explaining the 4 qualities and what they give rise to in the body. You can think of each element has have a major vs a minor quality.

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What is a Mixture?

Candidate:

• A mixture is the combination of altered substances that are capable of being blended together.

Dean:

• How is a mixture made, according to either the qualities, forms, or complete substances?

Candidate:

• The qualities are altered, the forms are united, and the complete elements mix with each other as wholes.

Dean:

• Explain the process of mixing more precisely.

Candidate:

• Alteration comes before mixing – specifically, the conflict between opposing qualities precedes the interaction through physical contact. All physical reactions require contact. Therefore, when elements combine to form a mixed substance:
  • They must make physical contact.
  • They then interact through their opposing properties.
  • Through this mutual interaction, they break down into the smallest possible parts.
  • These parts intermingle completely.
• This is what we call a complete mixture.

Dean:

• So you’re saying substances mix with substances?

Candidate:

• Why wouldn’t they?

Dean:

• Because mixing requires opposition and substances themselves don’t oppose each other.

Candidate:

• A substance doesn’t naturally oppose another substance simply because it’s a substance. Rather, substances oppose each other through their properties. For example:
  • Fire doesn’t resist fire in it’s basic nature.
  • But fire and water oppose each other through their properties (fire being hot, water being cold).
• Alteration changes properties, not fundamental forms. When elements interact:
  • Their properties change through mutual interaction.
  • They become balanced through breaking down and mixing.
  • Once their opposing qualities are neutralized, they can easily combine.
  • From the union of each element’s form, a new composite substance emerges with its own unique form.
• Note:
  • This is a basic description of the process used in modern chemistry via chemical reactions, neutralizing through mixing, and the creation of new compounds. It demonstrates that medical professionals at the time were well versed in at least the basics of alchemy.

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What is a Temperament?

Candidate:

• A temperament is a balanced proportion of the four primary elemental qualities (hot, cold, wet, dry) that allows natural bodily functions to work properly. Different authorities defined it in various ways:
  • Avicenna (Ibn Sina) defined temperament as a quality that emerges when elements are mixed in proper proportion.
  • Galen described it as the foundation of natural functions and capabilities.
  • Averroes (Averröes) the form of a mixed (combined) substance.
• However, I disagree with the last definition because the form of a combined substance is a substance itself, while temperament is merely a property or characteristic related to qualities.

Dean:

• Do you think the primary qualities can be mixed without mixing their elemental substances?

Candidate:

• No, that’s impossible. While temperament and mixture are different concepts – mixture referring to the elements themselves and temperament referring to their qualities- they are inseparable.
• You cannot have:
  • A mixture without active qualities.
  • Temperament without all the elemental substances.
• Therefore, temperament is the harmony of the four main qualities, arising from the mixture of all the elements.
• Note:
  • The four main qualities were heat, dry, moist, and cold. Candidate is saying that without the elements mixing (fire, water, earth, and air), we wouldn’t have their qualities. And without the qualities themselves in harmony within the body, we wouldn’t have a temperament.

Dean:

• How many different types of temperament are there?

Candidate:

• There are nine types.
• Eight imbalanced types, which include four simple types.
• Four Simple Types:
  • Hot
  • Cold
  • Moist
  • Dry
• Four Compound Types:
  • Hot & Moist.
  • Hot & Dry.
  • Cold & Moist.
  • Cold & Dry.

Dean:

• What is considered the ‘temperate’ state?

Candidate:

• The temperate states is what the Greeks referred to as ‘well-tempered’. It is seen as the ideal temperament that all others are compared to.

Dean:

• How many types of temperate state are there?

Candidate:

• There are two types of temperate state:
  • An absolute and balanced temperament.
  • A temperament that is calibrated for ‘justice’ across different categories.
• Note:
  • A balanced temperament is one which contains a balanced proportion of all four qualities (hot, cold, wet, dry).
  • The second temperament is described in more detail by the Candidate further down.

Dean:

• What do you mean by an ‘absolute and balanced’ temperament?

Candidate:

• That is a temperament in which the elements are mixed together in an even, equal proportion – no more heat than moisture, no more cold than dryness.
• Galen believed that this absolutely balanced temperament is more imaginary that real. Even if such a perfect equilibrium were to occur, he thought that it would only last for a very short time.

Dean:

• What do you mean by a temperament “calibrated for justice across different categories?

Candidate:

• The “temperament calibrated for justice across different genres” refers to a state that does not contain an exact, evenly balanced blend of opposites. Rather, it is a moderate midpoint that is appropriate for the specific nature and requirements of a given context or category.
• In other words, the ideal temperament is not determined by a strict mathematical or arithmetic equivalence between the elements. Instead, it is defined by a kind of geometrical proportion – a balanced mean that best suits the particular genus or species in question.
• ‘Justice’ in this context refers to giving each thing what it is due, according to its proper nature or worthiness.
• Note:
  • The idea is that there may not be a single universal ideal temperament, but rather temperaments tailored to the needs and characteristics of different people, environments, or situations. A “just” or appropriate temperament would be one balanced for the particular circumstances.

Dean:

• What are simple, uncompounded temperaments?

Candidate:

• Such temperaments are those which one of the four qualities (heat, cold, moist, dry) predominates excessively.

Dean:

• And what are the compounded temperaments?

Candidate:

• Compounded temperaments are those which two qualities predominate excessively. The “hot and moist” temperament has an excess of both heat and moisture, with heat overpowering cold, and moisture overpowering dryness. The “cold and dry” temperament has more cold than heat, and more dryness than moisture.

Dean:

• You have distinguished the temperaments into simple and compound types, but that is misguided, because there are no truly simple temperaments.

Candidate:

• I disagree.

Dean:

• Prove it. A simple temperament would be one where a single element predominates, like heat in a fiery temperament or cold in a watery one. However, each element possesses two qualities. For example, fire is both hot and dry. Therefore, there can be no temperament that is truly simple.

Candidate:

• What is considered a “simple” temperament is one where a single quality predominates, not a single element.
• Note:
  • This is the difference between elements (fire, water, air, earth) and qualities (heat, cold, moist, dry).

Dean:

• I disagree. Since a quality is an accident (i.e. a non-essential property), it cannot exist on its own without a subject. Therefore, if a particular quality of an element is superior, the element itself to which that quality belongs must necessarily prevail.
• Note:
  • Since the elements create the qualities, when one quality is dominate, shouldn’t it mean that element is dominate as well?
  • This assumes that each element has one quality.

Candidate:

• Although each element has two qualities, there is only one that is dominant. This is what gives the temperament its name – it is called “hot” or “cold” because heat or cold prevails over the opposing quality, with an equality of moisture and dryness. Similarly, it is called “moist” or “dry” because moisture or dryness is more powerful than the other, with an equality of heat and cold.
• Note:
  • Candidate asserts that each element has two qualities. Fire can be hot or dry for instance. But only one of these two qualities can be dominant. If the quality is dry, would we still say that the temperament is fire? No, we would say it was dry.

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What is a Part?

Dean:

• That’s enough of the Elements and Temperaments. What is a part?

Candidate:

• The term “part” in a broad sense refers to anything that makes up the whole human body. Galen notes that whatever completes and perfects the whole is considered a “part.”
• Hippocrates used the term to include even bodily fluids and spirits.
• However, Fernelius more precisely defines a part as a body that coheres to the whole, is joined by shared life, and serves a specific use or function. By this definition, fluids and spirits would be excluded from the category of “parts” since they do not stay fixed but rather flow rapidly through the veins and arteries.
• Note:
  • Fernelius, may be a reference to Jean Fernel via his latinized name.

Dean:

• What are the main divisions of parts?

Candidate:

• The division of parts is complex, but the primary distinction is between containing parts and contained parts.

Dean:

• What are the containing parts?

Candidate:

• The containing parts are the solid structures that maintain their own form.

Dean:

• How are these classified?

Candidate:

• They are divided into Similar (homogeneous) and Dissimilar (heterogeneous) parts.

Dean:

• What are the similar parts?

Candidate:

• Similar (homogeneous) parts are those composed of a single, uniform substance throughout. They are the smallest visible units into which the body can be broken down. For this reason, they are sometimes called:
  • Simple or primary parts
  • Sensible elements (as they appear simple to our senses)

Dean:

• How are Similar parts categorized?

Candidate:

• They are divided into Spermatic (derived from seed/embryonic tissue) and Sanguine (derived from blood).

Dean:

• What are the Spermatic parts?

Candidate:

• Those that develop from embryonic tissue.

Dean:

• How many Similar Spermatic parts are there?

Candidate:

• Nine types:
  • Bones
  • Muscles
  • Ligaments
  • Fibers
  • Membranes
  • Nerves
  • Veins
  • Arteries
  • Skin
• Note: This is a debate about tissue classification and how early anatomists struggled with categorizing simple and complex tissues.

Dean:

• I argue that nerves, veins, arteries, and skin are actually heterogeneous (dissimilar) parts. Here’s why, according to Galen, Hippocrates, and Plato in their work on body parts:
• Nerves have:
  • A marrow-like interior
  • A membranous exterior
• Veins and nerves are:
  • Interwoven with membranes
  • Contain various fibers
• Skin is composed of:
  • Nerves
  • Veins
  • Arteries
• Therefore, these structures should not be classified as homogeneous (similar) parts since they are clearly made up of different components.

Candidate:

• I argue, There are two categories of Similar (homogeneous) parts:
• Truly homogeneous parts:
  • Bones
  • Muscles
  • Ligaments
  • Fibers
  • Membranes
• Apparently homogeneous parts (appearing uniform to observation):
  • Nerves
  • Veins
  • Arteries
  • Skin

Dean:

• What are the Blood-derived parts?

Candidate:

• Those that develop from blood, namely:
  • Flesh
  • Fat

Dean:

• What are the Dissimilar (heterogeneous) parts?

Candidate:

• These are parts composed of several types of tissue.They are also called Organic parts because they serve as instruments through which mental faculties and bodily functions operate.

Dean:

• How are these Organic parts classified?

Candidate:

• They are divided into three main categories:
  • Animal (related to cognitive / nervous functions)
  • Vital (essential life functions)
  • Natural (basic biological functions)
• And within each of these categories, the parts are further subdivided into:
  • Principal (primary) organs
  • Assistant (supporting) organs
• Note: See: Spirits

Dean:

• What do you call the Animal, Vital, and Natural parts?

Candidate:

• These are the instruments responsible for the three types of functions.

Dean:

• What do you call the principle part?

Candidate:

• A principle part is one that governs other parts.

Dean:

• What are the assisting parts?

Candidate:

• Assisting parts are those that serve the Principle part and usually develop or are derived from them.

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What Are The Organs?

Dean:

• What is the principle organ of Animal Function?

Candidate:

• The brain is the principle organ because it:
  • Is the source of all animal functions (cognitive/ neural activity)
  • Houses the animal spirit (cognitive /neutral activity)
  • Is the origin point of all the nerves.
• Note: This is an example of early recognition of the brain as having a central role in controlling bodily function via the nervous system. It is usually defined as ‘animal spirit’.

Dean:

• How many types of organs assist the brain in carrying out Animal (neutral / cognitive) function?

Candidate:

• There are two types of organs that assist the brain in carrying out the Animal (neutral / cognitive) function.
  • Conductive Organs:
    • Transmit the brain’s commands for sensation and movement.
    • Note: Nerves & Neural Pathways.
  • Executive Organs:
    • Perform the functions.
      • Sensory organs (perception)
      • Voluntary muscles (movement)
• Note: This roughly corresponds in modern times to nervous system pathways, sensory receptors, and motor effectors.

Dean:

• Which organs transmit the capacity for sensation and motion?

Candidate:

• The sensory and motor nerves.

Dean:

• What are the specific organs for each sense?

Candidate:

• Each sense has its dedicated organ:
  • Eyes: for vision
  • Ears: for hearing
  • Nose: for smell
  • Tongue: for taste
  • Skin: for touch
• Note: This is an early understanding in the differences between nerves that carry signals and organs that receive sensory input.

Dean:

• What are the specific organs for voluntary motion?

Candidate:

• The muscles.

Dean:

• What is the principle organ of the Vital Functions?
• Note: See: Vital Functions

Candidate:

• The heart, because it is:
  • The source of vital force and spirit.
  • The primary site of natural body heat.
  • The origin point of all arteries.

Dean:

• Which organs are subordinate to the heart?

Candidate:

• There are two types:
  • Organs of respiration.
  • Organs of circulation / pulse.

Dean:

• What are the organs of respiration?

Candidate:

• There are three types of organs of respiration:
  • Transmission:
    • Wind-pipe & rough Artery (transmit air)
  • Reception:
    • Lungs (receive & prepare air for the heart)
  • Motion:
    • 65 Muscles that expand and contract in the chest which are essential for breathing and expelling vapors.

Dean:

• What are Pulse instruments?

Candidate:

• The Arteries

Dean:

• What is the main Organ of Natural Functions?

Candidate:

• Liver (origin of natural faculty, veins, and blood generation)

Dean:

• How many types of organs support natural bodily functions?

Candidate:

• Two types; some are for nourishment and others are for generation (digestion & reproduction).

Dean:

• What are the Organs of nourishment?

Candidate:

• Preparation organs
• Purgation organs (Organs that remove the waste from the blood)
• Distribution organs (of nourishment)

Dean:

• What Organs are for preparation of Nourishment?

Candidate:

• Preparation organs
  • Mouth (Mastication)
  • Stomach (Digestion / Concoction)

Dean:

• What Organs are for Purgation?

Candidate:

• There are two types of purgation organs (Organs that remove the waste from the blood). Those that purge the Chylus (Chyle) and those that purge the Blood.
  • Purges Chylus:
    • Belly
  • Purges Blood:
    • Spleen
    • Kidneys
    • Bladder
  • The purgative organs of the Blood receive and separate the blood from those Humors which received the Chylus, creating Blood.
• Note: This describes the process where the stomach creates the Chyle and sends it to the spleen, kidneys, and bladder which then converts it into blood.

Dean:

• What Organ distributes Nourishment?

Candidate:

• The veins.

Dean:

• What are the Organs of Generation?

Candidate:

• Some are common to both Male and Female sexes.

Dean:

• Which ones are common to both?

Candidate:

• Testicles
• Spermatic vessels

Dean:

• Which ones are sex specific?

Candidate:

• Male: Penis.
• Female: Womb.

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Of The Humors

Dean:

• Having covered the containing parts, what are the contained parts?

Candidate:

• The fluid parts that are supported by other structures – specifically, the Humors and Spirits.

Dean:

• How many Humors are contained in the Body?

Candidate:

• Three Types:
  • Primogeneous Humor (naturally occurring)
  • Alimentary Humor
  • Excrementitious Humor

Dean:

• What is the Primogeneous Humor?

Candidate:

• An oily substance originating in the body’s solid parts, serving as the foundation for vital spirit and innate body heat and is called ‘Radical Moisture’.

Dean:

• What do you call the Alimentary Humors?

Candidate:

• The juices from solid body parts, created by mixing the four classical elements.

Dean:

• What are Excrementitious Humors?

Candidate:

• Excess bodily moisture that serves a useful purpose for the body.

Dean:

• How are Alimentary Humors categorized?

Candidate:

• Into Primary and Secondary humors.

Dean:

• What are the Primary Humors?

Candidate:

• Those distributed by chyle through the liver’s natural heat via veins to nourish body parts.

Dean:

• How many Primary Humors exist?

Candidate:

• Four:
  • Blood
  • Choler (Yellow Bile)
  • Melancholy (Black Bile)
  • Phlegm
• These are mixed together in the veins, with blood being the predominant humor – hence called the “Sanguinary Mass” of which blood has the greatest quantity.

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Of The Blood

Dean:

• Define ‘Blood’.

Candidate:

• ‘Blood’ can be defined in two ways. The first, refers to the entirety of blood volume in the body. The second, is more specific and refers to the more pure and vital component of it.

Dean:

• What is the nature of blood’s composition (Temperature)?

Candidate:

• Blood, when considering the total blood volume, is considered well-balanced because it contains a proportionate mixture of different humors in harmony with each other. However, when looking at pure blood itself, it is characterized as pure and clear, hot and moist, somewhat similar to air in nature. It is not distinguished from the rest of the humors by temperature alone, but also by consistency, color, taste, and function.

Dean:

• What are blood’s physical properties, and what is its function?

Candidate:

• Blood has a specific consistency so thin that, when functioning normally, it appears neither too thick nor too thin. It is red in color and sweet in taste. It primarily nourishes muscle tissue when it is in proper balance, and is associated with people who are muscular, energetic, attractive, good-natured, and cheerful.

Dean:

• At what ages is blood most dominant?

Candidate:

• Blood is most prevalent in children, adolescents, and young adults. According to Galen, boys, young men, and those in between these ages have the highest proportion of the sanguine humor, as their life force is still at its strongest.

Dean:

• When is blood most abundant in the body?

Candidate:

• According to Hippocrates, blood is most abundant during spring, when frost thaws and water flows freely.

---

Choler

Dean:

• What is Choler?

Candidate:

• Alimentary Choler is a thin component of the blood that behaves like a warming agent, it’s Temperament is hot and dry. It appears pale to yellow in color and has a bitter taste. Those who possess an abundance of it tend to be slim, resilient, energetic, impulsive and hasty. It differs from excrementitious choler.

Dean:

• What is excrementitious Choler?

Candidate:

• Choler is sent to the Bladder (Gallbladder) to aid in digestion by helping move waste through the intestines and clearing away any mucus that adheres to the intestinal walls.

Dean:

• What type of person tends to produce more Choler?

Candidate:

• Choler production peaks during young adulthood according to Galen.

Dean:

• When is Choler production highest?

Candidate:

• It was believed that Choler increased during summer and in dry weather conditions of the season of Air, as dryness was thought to increase Choleric qualities.

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Melancholy

Dean:

• What is Melancholy?

Candidate:

• Melancholy was considered the denser component of blood, associated with Earth, believed to be cold and dry in nature, dark in color, and sour-tasting. People with high levels of Melancholy were thought to be serious, contemplative, stern, and steady. It was believed to nourish dense body tissues like bones.

Dean:

• What is the excrementitious Melancholoy?

Candidate:

• The spleen was thought to filter this substance, separating useful components for nourishment from waste products. The filtered substance was believed to flow into the stomach to stimulate appetite and aid digestion. Strengthening the Faculty which retains meat during Concoction.

Dean:

• Who tends to have more Melancholy?

Candidate:

• It was believed to increase in older adults according to Galen.

Dean:

• When does Melancholy peak in the body?

Candidate:

• It was thought to be highest during autumn according to Hippocrates.

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Phlegm

Dean:

• What is phlegm?

Candidate:

• Alimentary Phlegm was considered the more fluid component of blood, associated with Water, believed to be cold and moist, white in color, and either sweet or tasteless. People with high levels were thought to be lethargic, drowsy, heavy, pale, and soft. It was believed to nourish the brain and other cool, moist organs.

Dean:

• What is Excrementitious Phlegm?

Candidate:

• This refers to the watery waste that the kidneys filter from blood and send to the bladder through the ureters, what we now call urine.

Dean:

• At what age is phlegm most prevalent?

Candidate:

• It was thought to increase in old age due to declining “natural heat.”

Dean:

• When does phlegm production peak in the body?

Candidate:

• Winter was believed to increase phlegm due to abundant rain and long nights. A moist Constitution of Air has a similar effect. Moisture in ambient Air, increases phlegmatic Humors and thus increases phlegm and water retention.

---

Secondary Humors

Dean:

• What are the secondary humors?

Candidate:

• These are humors that originate from the primary humors in various parts of the body, where they are refined through the final stage of concoction. This process produces two visible waste products – sweat and feces – along with invisible waste that leaves the body through perspiration.

Dean:

• How many secondary humors are there?

Candidate:

• There are four, classified according to how they change while being prepared to nourish different parts of the body.
• 1st: Fluid contained in the small veins, ready to flow into empty spaces.
• 2nd: Fluid that spreads through body tissues, penetrating them like dew.
• 3rd: Fluid that collects around and adheres to hair.
• 4th: Thick fluid that adheres to muscle fibers so thoroughly that it appears to transform into body tissue. Through these progressive changes, the humors eventually become part of the body itself.
  

Dean:

• Do you think the humors that make up the body’s nature always remain in their natural state?

Candidate:

• No, they don’t. When humors maintain their proper mixture and balance, they’re natural. However, when they lose their balanced constitution, they become abnormal and deviate from their natural state. This explains why bodies are sometimes healthy and sometimes sick. As Hippocrates said, the body contains blood, phlegm, black and yellow bile – these constitute the body’s nature and determine health or illness.
• Health exists when these humors are properly balanced in terms of Temperament, Quantity, and Quality, and in reference to mixture, when they are mixed and not separated from each other.
• The body becomes ill when these humors malfunction in three ways:
  • When the balance of Temperament is disturbed. Some become excessive while others become deficient.
  • When the Quality in imbalanced. When one of the Faculties becomes excessive while others become deficient.
  • When the mixture is compromised and one humor separates from the rest.
    • When a humor separates from the whole, it necessarily causes illness both in the area it left and where it accumulates abnormally. If this separated humor leaves the body, it causes a simple illness. If it remains inside, it causes a double illness – one from the depletion in the area it left, through evacuation, and another from excess where it accumulates.

---

Blood

Dean:

• How does blood become unnatural?

Candidate:

• Blood becomes unnatural when it corrupts: its thinner portion turns into yellow bile and its thicker portion into black bile, making it overly rich in both Choler and Melancholy. It can also be corrupted by other humors that flow into the veins from the gallbladder or other organs.

---

Choler / Yellow Bile

Dean:

• How does bile deviate from its natural state?

Candidate:

• It can change its nature either inside or outside the blood vessels.

Dean:

• How many types of unnatural bile form in the blood vessels?

Candidate:

• Three types: pale, egg-yolk colored, and black.

Dean:

• What causes bile to become pale?

Candidate:

• It becomes pale when mixed with serous Humor.

Dean:

• How does it become egg-yolk colored?

Candidate:

• It’s a combination of yellow and pale bile, where Acrimony of abnormal heat concentrates it, transforming it from a thin to thick substance. Its color intensifies until it resembles a raw egg yolk.

---

Melancholic / Black Bile

Dean:

• How does black bile become unnatural?

Candidate:

• Black bile forms from yolk-colored bile through extreme heat and burning.

Dean:

• How many types of unnatural bile form outside the blood vessels?

Candidate:

• Three types: leek-colored, rust-colored, and woad-colored (blue-green).
• Note: Woad is the dye and medicinal plant Isatis tinctoria. See: A Modern Herbal

Dean:

• What creates these types?

Candidate:

• They mainly form in the stomach from poorly digested foods like meat. Yolk-colored bile that enters the stomach often changes into one of these types due to the cold environment.

Dean:

• What causes melancholy to become unnatural?

Candidate:

• When melancholic humor is essentially burned by extreme heat, it becomes sharp and corrosive, differing from normal melancholic fluid like burned dregs differ from unburned ones. This is called black bile or black choleric humor.

---

Phelgmatic

Dean:

• What causes phlegm to become unnatural?

Candidate:

• It becomes unnatural when it’s corrupted either inside or outside the blood vessels.

Dean:

• How many types of unnatural phlegm form in blood vessels?

Candidate:

• Two types: acidic and salty.

Dean:

• What is acidic phlegm?

Candidate:

• It’s raw and unprocessed phlegm that has only undergone initial digestion in the stomach without further processing.

Dean:

• How does phlegm become salty?

Candidate:

• Sweet phlegm becomes salty when corrupted by mixing with the serous Humour.

Dean:

• How many types of phlegm form outside blood vessels?

Candidate:

• Four types: watery, mucous, glassy, and plaster-like.

Dean:

• What is watery phlegm?

Candidate:

• It’s so thin it drips from the nose or flows down from the brain to the lower parts like water.

Dean:

• What is mucous phlegm?

Candidate:

• It’s phlegm thickened by body heat into the consistency of mucus.

Dean:

• What is glassy phlegm?

Candidate:

• It resembles melted glass in color and consistency, being thicker and colder than mucous phlegm.

Dean:

• What is plaster-like phlegm?

Candidate:

• It becomes as thick and hard as plaster, sometimes found in joints after thinner fluids evaporate, leaving behind phlegm as hard as pumice stone.

---

Spirits

Dean:

• Moving on from humors to spirits, why does Hippocrates call them “impulsive”?

Candidate:

• Because they enable living creatures to move, sense, live, and exist. Through them, the otherwise sluggish bodies of living things come under the soul’s control and authority. Moreover, they allow physical matter to connect with the non-physical, essentially serving as the bridge between soul and body.

Dean:

• What is the spirit?

Candidate:

• A spirit is an airy, thin, transparent substance that serves as the seat of natural heat, carries the body’s faculties, and is the primary instrument that activates bodily functions.

Dean:

• How many types of spirits are there?

Candidate:

• Two types: innate and infused.

Dean:

• What is the innate spirit?

Candidate:

• It’s the spirit that was embedded in various similar body parts during early development, with its foundation being the body’s Radical Moisture.

Dean:

• What is the infused spirit?

Candidate:

• It’s the spirit that flows in from elsewhere, nourishing and maintaining the innate spirit, while carrying Faculty and Heat throughout the body to enable various functions.

Dean:

• How many types of infused spirit are there?

Candidate:

• Three types: animal, vital, and natural.

Dean:

• What is the animal spirit?

Candidate:

• It’s a spirit generated in the brain’s Ventricles from Vital Spirit and inhaled Air. When distributed through the motor and sensory nerves, it enables the body’s parts to feel and move.

Dean:

• What is the vital spirit?

Candidate:

• It’s produced in the left side of the heart from natural spirit and air taken in by the lungs. From there, it travels through the arteries to all parts of the body to sustain the innate Spirit, strengthen natural Heat, and restore energy.

Dean:

• What is natural heat?

Candidate:

• It’s the heat that originates from the liver and spreads with blood through all veins, enabling generation, nourishment, and growth.

---

Faculties

Dean:

• Now that we’ve discussed both solid and fluid parts of human bodies, let’s talk about the soul’s faculties and functions. First, define what a soul is.

Candidate:

• A soul is the form of a living body. According to Aristotle,Entelechia, is the actualization of a natural, organic body potentially having life.

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What is Entelechia?

Dean:

• What does Entelechia mean?

Candidate:

• Some interpret it as “achieving perfection,” while others see it as “the state of perfection.” I disagree with the latter, as the soul doesn’t cause action, it is the action itself. Life is what the soul does, not what the soul is.

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What is the Soul?

Dean:

• Since we’re discussing human nature, explain what the human soul is.

Candidate:

• It’s what gives humans vegetal, sensual, and intellectual life. Aristotle defined it as the source of living, perceiving, and understanding. Others call it the primary cause of all bodily functions, equipped with multiple capabilities or Faculty.

Dean:

• What is a faculty?

Candidate:

• It’s the soul’s innate power to produce actions. Galen defined it as the cause of actions – it’s called a faculty because it has the power to act.

Dean:

• Why does Galen connect action to temperament?

Candidate:

• Because temperament enables the soul’s actions. Without proper temperament, the soul cannot act. As Galen wrote, the Soul works through balanced temperament of the Parts – they function best when properly balanced and poorly when imbalanced.

Dean:

• Does this mean the soul comes from temperament, or is it temperament itself?

Candidate:

• The soul isn’t temperament – it’s a substance, while temperament is an attribute. Faculty comes from both: the soul as the essential form and primary cause of all actions we perform, and temperament as the assisting cause that enables these actions.

---

What are the Faculties?

Dean:

• How many types of faculties are there?

Candidate:

• While the soul’s essence is unified,however, physicians recognize three faculties: Animal, Vital, and Natural.

Dean:

• Since Nature gives different parts of the body different faculties for overall preservation, shouldn’t there be as many faculties as Parts of the Body?

Candidate:

• Each body part has its own faculty to serve the whole through necessary actions. While the number of specific faculties matches body parts, they all fall under the three main categories: Animal, Vital, and Natural.

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Animal Faculty

Dean:

• What is the Animal Faculty?

Candidate:

• It’s the faculty unique to animals, hence its name.

Dean:

• How many types of Animal Faculty are there?

Candidate:

• Three: Principal, Perceiving, and Moving.

Dean:

• What’s the Principal Faculty?

Candidate:

• It’s exclusively located in the brain.

Dean:

• How many types?

Candidate:

• Galen identifies three: Imagination, Ratiocination, and Memory. Though some consider Understanding, unique to humans, as the only true Principal faculty.

Dean:

• What’s Imagination?

Candidate:

• It receives and processes sensory images, combining them to create new concepts beyond direct sensory experience.

Dean:

• What’s Ratiocination?

Candidate:

• The mind’s ability to understand abstract and incorporeal concepts, forming universal principles from specific instances.

Dean:

• What’s Memory?

Candidate:

• It stores and retrieves images presented by imagination for rational analysis.

Dean:

• Where are these Principal Faculties located in the brain?

Candidate:

• Arabs place imagination in front ventricles of the brain, reason in middle, memory in back. Greeks argue they’re distributed throughout the brain.

Dean:

• Your thoughts on this debate?

Candidate:

• I disagree with the Arabian view, despite its plausible basis. While Avicenna and Averroes argue that mental faculties must have separate locations because one can fail while others remain intact, I see this differently.
• Consider these cases:
  • Theophilas hallucinated musicians but remained rational (impaired imagination)
  • A man obsessively asked passersby about throwing dishes (impaired reason)
  • During Greece’s plague, people forgot their own families (impaired memory)
• These selective impairments stem from bodily conditions, not separate brain locations. The soul, being pure, expresses differently through varying physical states and structures. Like an instrument that plays differently based on its condition, the soul’s faculties operate with varying effectiveness depending on bodily temperament.
• We see natural variations in mental abilities – some excel in imagination but have poor memory, others have strong memory but weak reasoning, and some show good judgment despite limited imagination and memory.
• When illness strikes, stronger faculties resist damage while weaker ones fail more easily. Just as digestive functions (attraction, retention, etc.) can share one location while being independently affected, mental faculties can occupy the same brain regions.
• The Arabians argue that imagination resides in the soft frontal brain (suited for receiving ideas) and memory in the harder posterior region (better for retention). While I disagree with this separation, I acknowledge that frontal regions process information more quickly but less thoroughly than posterior regions. Overall brain condition matters too – dry brains favor memory, moist ones imagination, and balanced ones judgment.
• Arabian followers cite Galen to argue for hierarchical brain regions housing nobler faculties. However, Galen preferred the posterior ventricle not as memory’s location, but because mental processes become more refined as they move from front to back, where the “animal spirit” reaches its peak development.
• They also claim Galen treated disordered imagination by applying remedies to the forehead, but this was due to practical anatomy – the thin skull and coronal suture allow better medicine penetration – not because faculties have specific locations. He used similar treatments for various brain conditions.
  

Dean:

• Excellent refutation of the Arabian theory about faculty locations. What’s the sensible faculty?

Candidate:

• It transmits sensation from brain to body through nerves.

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Assistant Faculties (Senses)

Dean:

• What is sense?

Candidate:

• While sometimes meaning the act of feeling, it’s properly a faculty that perceives sensory information through animal spirits and sense organs.

Dean:

• How many types of senses are there?

Candidate:

• There are two categories: Internal and External senses.

Dean:

• What is the Internal sense?

Candidate:

• The Internal sense distinguishes the Objects of the Exterior senses.
• The Internal sense, traditionally called “Common Sense,” integrates and processes information from all the External senses. It’s located in the brain, where nerve pathways from all sensory organs converge.
• This allows the brain to:
  • Combine and interpret different types of sensory information
  • Coordinate sensory processing
  • Make sense of our overall sensory experience
  • Note: The original uses a description of King and Judge having the Seat in the Body and Brain where he rules and processes this information via ‘Administring senses’ and ‘Actions’.
• Galen understood the Imagination to be under common Sense.
  • Note: What Galen historically included under “common sense” would today be understood as various cognitive processes including sensory integration and aspects of perception.

Dean:

• How many External senses are there?

Candidate:

• There are five primary External senses:
• Vision (sight)
• Audition (hearing)
• Olfaction (smell)
• Gustation (taste)
• Somatosensation (touch)

Dean:

• What is Vision?

Candidate:

• Vision is the sense processed by the eyes, Vision is the sense processed by the eyes, which is used to perceive (colors, shapes, movement, and depth) through transparent media like air.

Dean:

• What is Hearing?

Candidate:

• Hearing is the sense processed by the ears, which detect and interpret sound.

Dean:

• What is Smell?

Candidate:

• Smell is the sense processed by olfactory receptors in the nose,(which detect and interpret airborne chemical compounds).

Dean:

• What is Taste?

Candidate:

• Taste is the sense processed by the tongue, which detects the tastes of things (detect and interpret chemical compounds in food and beverages to distinguish different flavors).

Dean:

• What is Touch?

Candidate:

• Touch is a complex sense distributed throughout the body via the nervous system. It processes various physical sensations including:
• Temperature (hot/cold)
• Pressure
• Texture (rough/smooth)
• Pain
• Position and movement of body parts (proprioception)

Dean:

• What is the moving (motor system) Faculty?

Candidate:

• The motion system controls bodily movement via the Muscles and the command of the Will.
  • Note:The motor system controls bodily movement through:
    • Voluntary muscle control via motor neurons
    • Coordination between the brain, spinal cord, and muscles
    • Both conscious and unconscious movement regulation

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Vital Faculty (System)

Dean:

• What is the vital system?

Candidate:

• It originates in the Heart and spreads through the Arteries to preserve life.

Dean:

• What is Life?

Candidate:

• Life is a continuance of Natural Heat and Death is the extinction of the Vital Heat. Aristotle defined life as, the continuance of the Vegetable Soul in the Body or Energy of the Body. Others have described it as a Union between the Soul and Body. When the Soul is separated from the Body, there is Death or Corruption.

Dean:

• How many Faculties (components) are under the Vital Faculty?

Candidate:

• The vital system has two primary functions:
  • Respiration: Inhalation & Exhalation.
  • Circulation: The rhythmic beating of the heart via Dilation and Contraction (blood flow through the vessels).

Dean:

• If emotion was placed in the Heart by the Philosophers, does it belong to the Vital?

Candidate:

• The emotional and motivational systems help organisms pursue beneficial stimuli and avoid harmful ones (Concupiscible Faculty). This is also known as the Vital Faculty.

Dean:

• Galen and Hippocrates assign the emotions (Irascible Faculty) to the Heart and the (Concupiscible Faculty) to the Liver.

Candidate:

• Galen makes an important distinction here – he’s not talking about conscious desire or cravings, but rather about the body’s natural metabolic needs. While he attributed this function to the liver, we now understand these processes differently.

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Natural Faculty

Dean:

• What is the Natural Faculty (metabolic system)?

Candidate:

• Nutrients are transported from the Liver through the Veins to nourish the entire body.

Dean:

• What are the main biological systems involved?

Candidate:

• Three; Metabolism, Growth, & Reproduction (of new cells etc.).

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Nourishing Faculty

Dean:

• What is the Nourishing Faculty (Nutritional System)?

Candidate:

• It’s the body’s system for converting food into usable nutrients and energy. This process maintains and repairs tissues throughout life through metabolism and cellular regeneration.

Dean:

• How many Faculties are under the Nourishing Faculty?

Candidate:

• Four; Absorption, Storage, Metabolism, Elimination.

Dean:

• What is Absorption (Attractive)?

Candidate:

• That which draws together all Moisture.

• Note: The digestive system breaks down food and absorbs nutrients through specialized cells in the intestines.

Dean:

• What is Storage (Rententive)?

Candidate:

• That which is retained from the Attracted Nourishment until altered (Altering Faculty)(Metabolism) have changed it.

• Note: The body stores nutrients in various forms – like glycogen for carbohydrates and fat tissue for lipids – until they’re needed for energy or tissue repair.

Dean:

• What is the Concoctive Faculty (Metabolism)?

Candidate:

• That which alters retained Nourishment and assimilates it for Nourishment.
• Note: Metabolism is the process of converting stored nutrients into forms that cells can use for energy and building new tissues.

Dean:

• What is the Expulsive Faculty (Elimination)?

Candidate:

• That which divides Nourishment from what isn’t and expels it.
• Note: It’s the body’s process of removing waste products and unused materials through various systems including the digestive, urinary, and respiratory systems.

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Other Faculties

Dean:

• What is the Growth (Increasing) Faculty?

Candidate:

• The biological function that controls bodily growth and development until maturity, as determined by natural processes.

Dean:

• What is the Reproductive (Generative) Faculty?

Candidate:

• The biological function that enables reproduction of one’s own kind. This consists of two distinct processes (Faculties).

Dean:

• What are they?

Candidate:

• The Transformation (Changing Faculty) and Formation (Forming Faculty) processes.

Dean:

• What is the Transformation Faculty?

Candidate:

• The process that transforms the initial reproductive material into the appropriate matter needed for reproduction and development.

Dean:

• What is the Formation Faculty?

Candidate:

• The process that shapes and develops the body’s form.

Dean:

• We’ve discussed the Animal, Vital, and Natural Faculties. Do they work together?

Candidate:

• According to Fernelius, these systems are interconnected and interdependent. The Vital system energizes the others and coordinates their functions, while receiving support from them in return. The Natural system provides nutrients, while the Animal system, through breathing and chest movements, enables nutrition and temperature regulation.
• The Animal system receives materials from the other two, while the Vital system, working through the arteries, maintains and enhances it. The Animal system constantly requires support from the Vital system.

Dean:

• What is the accepted hierarchy of the Faculties?

Candidate:

• In terms of development, the Natural system develops first, followed by the Vital, then the Animal system. In terms of complexity, the Animal system is most sophisticated, followed by the Vital, then the Natural system. However, for sustaining life, the Vital system is most crucial, followed by the Natural, then the Animal system.

---

Actions

Dean:

• After discussing these faculties, let’s discuss Actions. What is an Action?

Candidate:

• An Action is a movement or function arising from a Faculty. It’s sometimes called Energy in Greek, or Function/Operation in Latin.

Dean:

• How are Functions categorized?

Candidate:

• Like Faculties, Functions are categorized as Animal, Vital, and Natural.

Dean:

• But doesn’t Galen only recognize two types of Functions – Animal and Natural?

Candidate:

• Yes, but in that context, Galen included Vital functions within the category of Animal functions.

Dean:

• How do Intellectual functions differ from Sensory functions?

Candidate:

• The key difference is that Sensory functions each have specific physical organs: vision uses eyes, hearing uses ears, smell uses the nose, taste uses the tongue, and touch uses the skin. In contrast, Intellectual functions don’t require specific physical organs because they are not capable of Corporeality.

Dean:

• But isn’t the brain the organ responsible for mental functions? After all, its condition is essential for understanding, thinking, and reasoning – when it’s impaired, psychosis (Phrensie) can result.

Candidate:

• While the brain is indeed the organ of perception (imagination) and processes sensory information, higher cognitive functions are more complex. The brain handles physical sensory processing, but abstract thinking and consciousness involve more than just physical processes.

Dean:

• How are voluntary actions categorized?

Candidate:

• They fall into two categories: those that are completely under voluntary control, and those that are partially controlled by bodily needs and reflexes.

Dean:

• Which actions are completely voluntary?

Candidate:

• These are actions we can perform at will, without impediment, such as speaking and walking (assuming normal physical function).

Dean:

• Which actions are influenced by bodily needs?

Candidate:

• These are actions that respond to physiological needs rather than pure voluntary control, such as urination and defecation.

Dean:

• How are vital functions classified?

Candidate:

• Vital functions include one primary function – the maintenance of life-sustaining processes (Vital Spirit) – and two supporting functions (two Ministerial): respiration and circulation (pulse). The circulatory system (Pulsatii Actions) is also influenced by emotional states (Motions of the Heart via irascible & cupscible Faculties): positive emotions like joy, hope, and love can increase heart rate and blood flow, while negative emotions like sadness, fear, and anxiety can cause cardiovascular constriction and stress (evil Object).

Dean:

• Is breathing a voluntary (Animal) or involuntary (Natural Action) function?

Candidate:

• Breathing is a semi-voluntary function – while we can consciously control it using our respiratory muscles to expand and contract the chest, it’s not entirely under voluntary control since it’s necessary for survival. Some consider it a hybrid function: it’s partly voluntary in terms of the muscular control we can exert, and partly involuntary as it’s linked to automatic cardiac function and continues during sleep when voluntary actions cease. This automatic regulation ensures continuous respiration even when we’re unconscious and Animal Actions cease.

Dean:

• Is the heartbeat voluntary (Animal) or involuntary (Natural Motion)?

Candidate:

• The heartbeat doesn’t depend on conscious will or simple biological processes alone. We cannot consciously start, stop, or control our heartbeat. The cardiovascular system is regulated by complex neurological and biochemical mechanisms that maintain life functions. This system coordinates with other vital processes including digestion and metabolism to sustain bodily functions. Therefore, the pulse represents an involuntary, vital function of the heart. it’s not under voluntary control but is essential for life.

Dean:

• What are the main actions of the Natural Faculty?

Candidate:

• The primary biological functions are nutrition (metabolism)(Nutritive), growth (Increasing), and reproduction (Generative) Faculties.

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Nutrition

Dean:

• What is nutrition?

Candidate:

• Nutrition is the process by which the body converts consumed food into substances used for building, maintaining, and repairing body tissues.

Dean:

• How does nutrition work?

Candidate:

• Nutritive fluids from blood vessels are distributed throughout the body in three steps:
• Distribution to all parts.
• Binding to tissues.
• Integration into body tissue through assimilation.

Dean:

• What processes support nutrition?

Candidate:

• Four key processes: Attraction, Retention, Digestion, and Expulsion.

Dean:

• How do these processes work?

Candidate:

• Three types of muscle fibers control these processes:
• Straight fibers handle attraction.
• Oblique fibers manage retention.
• Transverse fibers control expulsion.
• These muscles contract instinctively, like voluntary muscles during movement. The transverse fibers expel substances through contraction, while oblique fibers maintain stable containment without attraction or expulsion.

---

Digestion

Dean:

• How is digestion (concoction) completed?

Candidate:

• Through the body’s natural (innate) heat.

Dean:

• How many types of digestion are there?

Candidate:

• Three stages:
• Stomach
• Liver
• Body tissues (several Parts)

Dean:

• What is growth?

Candidate:

• The expansion of body parts in length, width, and depth.

Dean:

• What is generation?

Candidate:

• The creation of new tissue (substance) through two processes:
• Transformation – Converting one substance to another (like seed and bloud becoming bone or nerve)
• Formation – Shaping the tissue according to natural patterns
• This primarily occurs during fetal development.
• It is therefore, a compounded action of Nature via Mutation and Formation.

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Dean’s Judgement

Your physiological knowledge is impressive. If you demonstrate similar expertise in other medical areas during your examination, you will earn high honors. You are worthy of Apollo’s Laurel.

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Second Disputation

External Factors in Health Preservation

Dean:

• After covering natural body functions, what are we discussing next?

Candidate:

• External factors that maintain health.They are those that preserve the Natural Constitution.

Dean:

• Why are they called “non-natural”?

Candidate:

• Because they’re neither inherent to human nature nor harmful to it.

Dean:

• What are these factors?

Candidate:

• Six key elements:
• Air quality (ambient air)
• Food and drink
• Sleep/wake cycles
• Activity/rest
• Waste elimination
• Mental state (passions of the mind)

Dean:

• Are all essential for survival?

Candidate:

• Yes. The body constantly uses three resources and could not survive without them:
• Air replenishes vital energy
• Food rebuilds tissue
• Water maintains hydration
• Additionally,
• Sleep enables digestion and recovery
• Wakefulness allows mental function
• Exercise activates metabolism
• Rest enables recovery
• Waste elimination is essential
• Emotional responses are unavoidable reactions to experiences.

---

Health

Dean:

• What’s the key to maintaining health?

Candidate:

• Proper management of the six external factors, considering:
• Quality
• Quantity
• Method
• Timing
• [Regarding Air Quality (Ambient Air)]

Dean:

• What air conditions are best for health?

Candidate:

• Ideal air should be:
  • Clean and clear, not heavy or foggy.
  • Moderate temperature and humidity.
  • Free from:
    • Stagnant water vapors
    • Sewage gases
    • Cemetery emissions
    • Waste smells
    • Dunghills
    • Church-Yards
• Well-ventilated with good airflow. Not like valleys surrounded with high mountains or hollow places with no air-flow.

Dean:

• How much air does a person need to breathe?

Candidate:

• Healthy individuals benefit from deeper breathing. However, for those who are weak or recently recovered from illness, moving suddenly from confined to open air environments can be dangerous.

Dean:

• How should those recovering manage their air exposure?

Candidate:

• They should gradually and subtly acclimate themselves to fresher and more abundant air.

Dean:

• When is it safest for them to experience more open air?

Candidate:

• On clear days when the air is neither too hot from sunshine nor excessively cold, and when wind conditions are mild.

Diet

Dean:

• What types of food should be selected for maintaining health?

Candidate:

• Choose foods that contain good nutrients, are easily digestible, and produce minimal waste. Conversely, avoid foods with poor nutritional value, difficult digestion, or that generate excessive waste.

Dean:

• What constitutes nutritious food?

Candidate:

• Food that is neither too hot nor cold, neither too dry nor moist, but balanced. It should be neither too sticky nor too thin. Such food creates blood with healthy temperature and consistency—neither too thick nor too watery.

Dean:

• How much should one eat?

Candidate:

• Enough to replenish the body’s depleted resources. Those with higher metabolism and who exercise frequently experience greater resource depletion and therefore require more food. Conversely, those with slower metabolism who are less active should eat moderately. The simpler the diet, the more compatible it is with our natural needs. While moderation is healthiest, excessive quantity and variety of food overwhelms the stomach.

Dietary Habits

Dean:

• What approach should be taken when eating?

Candidate:

• Food should be thoroughly chewed before swallowing. Follow this order when eating: consume liquids before solids, lighter foods before heavier ones, and foods that aid digestion before those that are more binding.

Dean:

• When is the best time to eat?

Candidate:

• Establish regular mealtimes, waiting until your previous meal has been digested and moved to your intestines. Eat after sufficient physical activity and when you feel hungry, so your body can enthusiastically focus on the digestive process.

Dean:

• What drinks are best for maintaining health?

Candidate:

• Wine is highly recommended—preferably somewhat red or white, clear, light-bodied, neither sweet nor acidic, refined, and moderate in alcohol content rather than too strong. Dilute with more water in summer than in winter. For people with warmer body types, water is more suitable than wine. The best water is crystal clear, light, and free from any unpleasant odor or taste. Cider and Perry are preferable to plain water. Well-brewed ale and beer made from barley water and hops are good options for those living in northern regions, provided they’re clear, light, neither too fresh nor too weak.
  • Note: Perry is an alcoholic beverage made from fermented pears and known as pear cider.

Dean:

• How much should one drink?

Candidate:

• Drink in proportion to the food consumed. Solid and dry foods require more generous fluid intake, while liquid and moist foods need less. However, excessive wine consumption undermines both physical and mental strength and accelerates aging.

Dean:

• What’s the proper approach to drinking?

Candidate:

• Too much liquid during meals causes food to float in the stomach; too little doesn’t adequately quench thirst. Frequent drinking between meals hinders digestion. Artificially cooled beverages—whether wine or ale chilled with water, snow, or saltpeter to counter summer heat—should be avoided as they harm the nervous system.

Dean:

• When should one drink during meals?

Candidate:

• Just as hunger signals the need to eat, thirst indicates the need to drink to replenish essential moisture. Even if you don’t feel thirsty halfway through your meal, it’s beneficial to drink then to help mix and moisten food in the stomach, facilitating digestion and transfer to the liver. Drink serves as a carrier for food. However, avoid drinking immediately before meals, right after eating, after bathing, or while sweating.

Sleep and Wakefulness

Dean:

• What kind of sleep supports bodily health?

Candidate:

• Peaceful, deep, and moderate sleep is ideal. Sleep disturbed by restless dreams is not beneficial, nor is light sleep easily interrupted by minimal noise. Excessive sleep is worst of all: it prevents proper elimination of waste from the body, creates numerous excesses, makes the brain colder and more moist, causes headaches, and leads to mental grogginess and dulled senses.

Dean:

• How long should a person sleep?

Candidate:

• This should be determined by how completely the body processes nutrients, as no single time frame applies to everyone—some digest faster than others. Generally, six, seven, or at most eight hours is appropriate for sleep. When determining ideal sleep duration, consider temperament, age, food consumption, and physical exertion. Those with more energy need less sleep than those with sluggish metabolism, younger people need less than older people, those who eat more need more sleep than those who eat sparingly, and those who have exerted themselves physically or mentally need more rest than those who haven’t.

Dean:

• What’s the best sleeping position?

Candidate:

• Begin by lying on your right side to help food descend more quickly to the bottom of your stomach. Then switch to your left side, allowing your stomach to rest against your liver, which promotes digestion. Afterward, return to your right side so nutrients can be more easily distributed to your liver. Additionally, changing positions refreshes the body and reduces discomfort. Sleeping on your back is universally discouraged as it can cause various health problems, while sleeping face-down is problematic for those with eye conditions.

Dean:

• When is the healthiest time to sleep?

Candidate:

• Night is most suitable, particularly two or three hours after dinner. Nighttime provides ideal conditions for sleep due to its natural tranquility and appropriate moisture levels. It also allows sufficient time for complete digestion without interruptions from daily responsibilities. Conversely, daytime sleeping is harmful as it fills the brain with excessive moisture, which should instead be reduced during waking hours.

Dean:

• What constitutes healthy wakefulness?

Candidate:

• Just as moderate sleep is beneficial and excessive sleep is harmful, the same applies to wakefulness. Excessive sleep over cools and moistens the brain, while too much wakefulness weakens brain function, impairs the senses, hinders digestion, and creates unprocessed waste—because while awake, natural heat, blood, and energy remain in the body’s outer regions. Night is for sleeping, and day is for being awake. Hippocrates advised sleeping at night and remaining awake during the day, as nighttime promotes better digestion while daytime enhances nutrient distribution and waste elimination. Additionally, mental functions are stimulated by daylight and warmth.

Exercise

Dean:

• What exercise is necessary?

Candidate:

• Neither too easy nor too strenuous, neither too fast nor too slow, but moderate. People with sluggish metabolism require more vigorous exercise than those with higher energy. Consistency in exercise is preferable to irregularity. The most beneficial exercise is that which brings mental enjoyment.

Dean:

• How long should exercise continue?

Candidate:

• Continue exercising until:
  • Your body becomes warm
  • A healthy color appears in your face
  • You experience perspiration mixed with warm vapor
  • Your breathing becomes deep yet comfortable
  • Your movements remain consistent and energetic
  • When any of these indicators diminish, it’s time to stop to prevent the body from becoming too cold, dry, or lean from prolonged activity. Always match your exercise intensity to your food intake—the more generously or sparingly you eat, the more or less you should exercise.

Dean:

• What approach should be taken to exercise?

Candidate:

• Exercise is necessary each time the body is nourished. Begin with gentle movement, progress to more vigorous activity, then return to gentler movement to finish.

Dean:

• What is the most suitable time for exercise?

Candidate:

• Exercise should be done when digestion is complete. Since physical activity stimulates natural body heat—essential for proper digestion—exercise should always precede meals. Additionally, exercise burns excess substances that should be eliminated before consuming more food.
• Exercise after meals is harmful because body movement can push food out of the stomach before it’s properly digested, causing unprocessed nutrients to enter the bloodstream and potentially lead to various illnesses. Also, avoid exercising before emptying your bowels and bladder, as the increased body heat from exercise might carry waste products into the body’s tissues.

Rest

Dean:

• When is rest necessary?

Candidate:

• Rest is needed when the body becomes fatigued from significant exertion. Hippocrates noted that whenever someone becomes tired from physical activity, rest immediately remedies the fatigue. Ovid confirmed this, stating that anything deprived of periodic rest cannot sustain itself long-term. Rest restores strength and rejuvenates tired muscles. The mind, likewise, requires relaxation and rest when exhausted by worries and mental exertion—without it, maintaining mental sharpness becomes impossible.
• Rest nourishes both body and mind. However, while moderate rest is beneficial, excessive inactivity is harmful as it dulls mental acuity and impairs digestion. Just as exercise increases natural body heat and accelerates digestion, inactivity diminishes it and hinders proper digestive function.

Waste Elimination

Dean:

• What constitutes healthy waste elimination?

Candidate:

• Various bodily wastes are healthy when moderate in amount and eliminated in a timely manner. If retained too long, they decompose and cause numerous health problems. For health maintenance, they should be expelled promptly, sometimes with therapeutic assistance.

Dean:

• But isn’t medically assisted elimination inappropriate, since Hippocrates taught that healthy people who take purgative medicines rapidly deteriorate?
  

Candidate:

• This applies only to those with excellent physical condition who exercise consistently before meals, both physically and mentally, and carefully maintain proper digestion. For those who follow inconsistent eating patterns—whether due to overindulgence, work demands, or lack of knowledge—even if healthy and strong, they cannot avoid illness without occasionally using gentle laxatives, sometimes stronger purgatives, timely bloodletting, or remedies that improve digestion and cleansing, as Galen explains in his book “De Euchymia.”

Dean:

• What should be considered when determining the amount of elimination?

Candidate:

• Always consider the individual’s strength, as excessive elimination is dangerous because it weakens the body.

Dean:

• What approach should be taken for elimination?

Candidate:

• Where excess matter accumulates, elimination should occur gradually rather than all at once to prevent sudden, severe weakening. Therefore, frequent small blood lettings are preferable to a single large one. Similarly, moderate repetition of gentle purgatives is safer than one powerful dose. Likewise, it’s better to stimulate perspiration, urination, or menstruation through gentle repeated remedies rather than one strong medication. Similarly, moderate sexual activity with appropriate intervals may be healthy, while excessive indulgence destroys health.

Dean:

• When is the most appropriate time for elimination?

Candidate:

• Regarding seasons, spring is best for bloodletting and purging according to Hippocrates. Philotheus explains this is because spring’s temperature is neither too hot (which would cause bodily dissolution) nor too cold (which would thicken bodily fluids). Galen also recommends preventative elimination of excess fluids in autumn. Naturally harmful waste products—such as intestinal waste, urine, sweat, mucus, and saliva—should be eliminated daily, while those only harmful in excess—such as reproductive fluids and menstrual blood—may be retained until their quantity becomes problematic.
• Moderate sexual intercourse after the first sleep cycle is most beneficial for both health maintenance and reproduction, as reproductive fluids are fully developed then, and the loss of energy can be replenished by subsequent sleep. Sexual activity during menstruation is discouraged due to concerns about potential birth defects. It’s also inadvisable on either a full or empty stomach. Spring is the most appropriate season and youth the most suitable age for sexual activity. At other life stages, reproductive fluids are either absent or unsuitable for reproduction. If menstruation doesn’t occur naturally, it may be medically stimulated at the time it normally would have occurred. However, pregnant women, nursing mothers, young girls, and elderly women should not use artificial means to stimulate menstruation.

Passions of the Mind

Dean:

• Of all the non-natural things which relate to health preservation, only the mental disturbances (which the Latins call Perturbations of the Mind) remain. Please explain what these are, how many exist, and whether they are wholesome or not.

Candidate:

• Passions are violent movements of the mind that go against right reason and cause alterations in the body due to the extraordinary force of natural heat acting with the spirit and blood, both internally and externally. There are four principal passions: two arising from the perception of something good—joy and desire—and two from the perception of something bad—sadness and fear. Anger and shame are also included, though anger (being a burning desire for revenge) relates to desire, while shame relates to fear.
• The first two types of passion, if moderate, are healthy; otherwise, they’re harmful. Many timid people have died from excessive joy, as various authors have documented. All other passions are harmful—many have died from intense, sudden grief when their weak spirit, overwhelmed by strong emotion, was quickly extinguished and suffocated as blood rushed violently to its origin. Pliny reports that P. Rutilius instantly died upon hearing news of his brother’s failed consulship bid. Similarly, on August 16, 1619, Monteler—a noble young gentleman from Tours and Lieutenant Colonel of the Ments Regiment—suddenly died while talking in the street due to extreme grief. When his body was examined, all organs appeared sound except his pericardium, which contained not only water but a large quantity of thick blood. This occurred because his heart, contracted by overwhelming grief, forced blood through its chambers, suddenly extinguishing his life principle.
• During fear, spirits and blood withdraw to their source, causing coldness, paleness, trembling, loss of speech, and overall weakness. Conversely, anger causes more intense natural heat movement that eventually projects violently outward, resulting in a red face and a warmer body that becomes bolder and ready to face danger. In shame, both internal and external parts are affected as heat first rushes inward, then outward again. Since mental disturbances have such powerful effects, physicians must use all possible skills to correct or eliminate them.

---

The Third Discourse on Unnatural Things

The study of Pathology concerns itself with this knowledge.

Dean:

• Having discussed natural and non-natural things, we must now address unnatural things. What are unnatural things?

Candidate:

• Those things that destroy the natural constitution of the human body are called affections or postures of evil under which the body suffers. The Greeks call these “Pathe,” hence the study dealing with these affections is called Pathology.

Dean:

• How many unnatural affections are there?

Candidate:

• Three: Disease, Cause, and Symptom. Every bodily affection deviating from its natural state is either a disease, a cause of disease, or a symptom, as Galen testifies in his first book ‘on the Difference of Symptoms’.

Dean:

• How are they distinguished from one another?

Candidate:

• The affection that hinders action is called disease; whatever follows this is a symptom; and whatever occasions it is the cause.

On Diseases

Dean:

• What is a disease?

Candidate:

• A disease is an unnatural affection by which action is primarily harmed.

Dean:

• I argue against this: Not every disease is a disposition; therefore, Galen has defined it incorrectly.

Candidate:

• I deny the premise.

Dean:

• I prove it thus: Disease is generally a habit, but disposition is not a habit. Indeed, Aristotle opposes disposition to habit because habit is a permanent quality not easily removed from the subject, whereas disposition is a quality easily removed from the subject.

Candidate:

• The term “disposition” (or affection) is understood by Galen not in the more specific sense where disposition is a preparation for habit (as used by Aristotle), but in a more general sense that encompasses both disposition and habit. Some diseases come easily and depart quickly; others are difficult to remove.

Dean:

• Furthermore, I prove that disease does not primarily injure action: Faculty differs from action as cause from effect; disease primarily injures the faculty; therefore, action is not primarily injured.

Candidate:

• That’s false in an organic disorder, where the instrument’s use may be hindered without any injury to the faculty.

Dean:

• However, in a similar disease, the faculty is injured before the action.

Candidate:

• I respond that a physician makes judgments based on what can be observed through the senses: we do not detect damage to the faculty until we observe the action failing.

Dean:

• Furthermore, I prove that not every disease injures action: A wound is a disease, but the functions of the wounded part remain intact—it still attracts, retains, and assimilates blood, and ultimately restores the portion of flesh that was cut off. Therefore, not every disease injures action.

Candidate:

• I respond that these functions are performed by the found parts adjacent to the wound.
  • Note: It’s difficult to know what ‘found parts’ means in this case from a humoral medicine approach. However, it’s possible that it relates to trace elements or substances in the body that were thought to influence the four humors. In today’s terms this could be a reference to blood cells, plasma, platelets, or trace minerals that promote an immune response and eventual repair of a wound site.

Dean:

• How many general divisions of disease are there?

Candidate:

• Disease is threefold: Similar, Organic, and Common.

Dean:

• What is a Similar Disease?

Candidate:

• A disorder that primarily injures the action of the similar part.

Dean:

• How many types of disorders are there?

Candidate:

• Disorders are either Simple or Compound. A Simple Disorder is either hot, cold, moist, or dry. A Compound Disorder is either hot and moist, hot and dry, cold and moist, or cold and dry—either occurring alone or joined with matter.

Dean:

• What is an Organic Disorder?

Candidate:

• A disproportion in structure that primarily impairs the use of an organ.

Dean:

• How many types are there?

Candidate:

• It is fourfold: affecting either the form, magnitude, number, or situation.

Dean:

• What is a Disease of Form?

Candidate:

• A Disease of Form occurs when the natural shape of the structure is corrupted, or when a passage or cavity is excessively dilated, narrowed, or obstructed where it shouldn’t be; or when a part is rough where it should be smooth, or smooth where it should be rough.

Dean:

• What is a Disease of Magnitude?

Candidate:

• A Disease of Magnitude is when any part is increased or decreased beyond or below its proper proportion.

Dean:

• What is a Disease of Number?

Candidate:

• A Disease of Number is when any part is missing or exists in excess.

Dean:

• What is a Disease of Situation?

Candidate:

• When any part is displaced from its proper location, as when the omentum (Kall) or large intestine descends into the scrotum.

Dean:

• What is the Common Disease?

Candidate:

• The separation of continuity, which hinders the functions of both similar and organic parts.

Dean:

• How many types of separation of continuity are there?

Candidate:

• Four: Wound, Ulcer, Fracture, and Dislocation (which may also be called a Disease of Situation).

Dean:

• Why do you omit abnormal tumors here?

Candidate:

• Because an abnormal tumor is considered a compound disease consisting of disorder, abnormal shape, and separation of continuity, called an Aposteme in Greek.

Dean:

• How many meanings does the word Aposteme have?

Candidate:

• Two: General and Specific. Generally, Aposteme refers to any abnormal tumor; specifically, it means an inflammation that has progressed to suppuration, and often refers to a tumor where certain matter appears in the vesicle resembling honey, fat, or thick porridge.

Dean:

• Where do these Apostemes form?

Candidate:

• In the extremities of the body.

Dean:

• They typically form there, but we recently observed a new location never before discussed in medical schools.
• The most illustrious Marquess of Monte-pezzati, a person of sharp wit, in the 49th year of his age in 1619, upon the cessation of dysentery (which he had suffered since youth) and after an eight-year suppression of hemorrhoids, was afflicted in Tours with severe, persistent headache leading to delirium. Despite all remedies applied by Tours’ most famous physicians, he showed no improvement. He was therefore moved to Pressignac, far from the King’s Court, where I was summoned along with three other eminent physicians to attempt treatment. Despite using all rational and powerful remedies, we could not overcome the disorder, and he eventually died in a lethargic state.
• Upon autopsy, under the right anterior ventricle of the brain, part of it was visibly corrupted, displaying various forms of aposteme, with vesicles about the size of pine nuts. I thought it appropriate to share this observation. Now let us return to our general discussion of apostemes.
• How many types of abnormal tumors are there?

Candidate:

• Four: Phlegmon, Erysipelas, Edema, and Scirrhus.

Dean:

• What is Phlegmon?

Candidate:

• It is an abnormal tumor caused by blood escaping from veins and expanding the part with heat, redness, pain, pulsation, and resistance to touch.

Dean:

• What is Erysipelas?

Candidate:

• A very hot inflammation in the skin, sometimes extending to the underlying flesh, arising from hot, choleric blood, which due to its thinness doesn’t cause significant swelling but spreads in length and breadth.

Dean:

• What is Edema (Oedema)?

Candidate:

• A cold, loose, white tumor, painless, retaining the impression of a finger that touches it, arising from phlegmatic humor.

Dean:

• What is Scirrhus (Skirrhus)?

Candidate:

• A hard, resistant tumor, painless, with little or no sensation, arising from melancholic humor.

Dean:

• What is a Wound?

Candidate:

• A fresh separation of contiguity in soft parts caused by a cut, bite, or other external accident.

Dean:

• What is an Ulcer?

Candidate:

• The separation of continuity in soft parts caused by corrosion.

Dean:

• What is a Fracture?

Candidate:

• It is the separation of bone caused by some external accident bruising or breaking it.

Dean:

• What is Dislocation (Luxation)?

Candidate:

• It is the displacement of a joint from its proper place to another, impeding voluntary motion.

On Morbific Causes

Dean:

• What is meant here by the word Cause?

Candidate:

• An unnatural condition that causes disease; the study of which is called Etiology.

Dean:

• The cause of disease is generally substantial, like some humor, wind, or other abnormal thing (such as a stone); but an affection is a quality. Therefore, affection is not properly the cause of disease.

Candidate:

• The word Affection is used differently by Galen and Aristotle—it refers to anything capable of destroying the natural temperament and structure of the body and injuring its actions, whether substance or quality.

Dean:

• How many types of morbific causes are there?

Candidate:

• Two: Internal and External.

Dean:

• What is the Internal Cause?

Candidate:

• That which exists within the body.

Dean:

• How many types of this are there?

Candidate:

• Two: the preceding and the containing.

Dean:

• What is the Antecedent Cause?

Candidate:

• That which nourishes the disease.

Dean:

• How many kinds are there?

Candidate:

• Two: Plethoric and Cacochymic.

Dean:

• What is Plethora?

Candidate:

• An excess of all humors equally increased, or an excess of blood alone.

Dean:

• How many kinds of Plethora are there?

Candidate:

• Two: one in relation to strength, the other in relation to the vessels.

Dean:

• What is Plethora in relation to strength?

Candidate:

• When blood, neither excessive in quantity nor quality, nevertheless overwhelms strength weakened by some other cause.

Dean:

• What is Plethora in relation to vessels?

Candidate:

• When humor exceeds its proper measure—either slight, when it merely fills the cavity of the veins and exceeds proportion by a little, or distensive, when it stretches and almost tears the coatings of the veins.

Dean:

• How do Plethora in relation to vessels and Plethora in relation to strength differ?

Candidate:

• In vessel Plethora, the body grows heavy but the strength of all parts remains equal—there is only a fullness of vessels. But in strength Plethora, the body and arteries grow heavy, movement slows, drowsy and disturbed sleep follows, and the patient complains of feeling oppressed by weight, carrying a burden, or dreams of being unable to move—indicating an excess that overwhelms the body’s strength.

Dean:

• What are the Signs of Plethora (Excess Blood)?

Candidate:

• Antecedent Causes:
  • Factors that lead to excessive blood production include proper body composition, youth, springtime, temperate climate, good diet, and suppression of regular blood release.
• Consequent Signs:
  • Symptoms demonstrating blood excess include facial redness, swollen veins, dilated blood vessels, spontaneous fatigue, increased body mass, fleshy physique, jovial disposition, mental sluggishness, drowsiness, strong thick pulse, breathing difficulty, and tendency to bleed.

Dean:

• What is Cacochymy?

Candidate:

• Cacochymy refers to an excess of bodily humors: yellow bile, black bile, or phlegm. It comes in three forms: Choleric, Melancholic, and Phlegmatic.

Dean:

• How is Choleric Cacochymy Identified?

Candidate:

• Causes:
  • Hot and dry constitution, youthful age, summer season, dry environment, hot/dry climate, and hot/dry diet.
• Signs:
  • Pale, yellowish or blackish face, dry body composition, lean build, excessive hairiness, acute senses, quick movements, sharp mind, light and disturbed sleep, war-related dreams, rapid frequent pulse, poor appetite, unquenchable thirst, bile-filled vomit and stool, yellowish or flame-colored urine with minimal sediment.

Dean:

• How is Melancholic Cacochymy Recognized?

Candidate:

• Causes:
  • Cold and dry temperament, spleen weakness, advanced age, autumn season, heavy diet, and melancholy lifestyle.
• Signs:
  • Leaden facial complexion, dry and lean body, fixed grim expression, fearfulness, sadness, disturbed sleep, slow and minimal pulse.

Dean:

• How is Phlegmatic Cacochymy Distinguished?

Candidate:

• Causes:
  • Cold and moist temperament, old age, winter season, moist air, irregular eating, sedentary lifestyle, and excessive sleep.
• Signs:
  • Pale or livid complexion, swollen cheeks, large fat body, small veins, white hair, slow movements, thick skull, deep sleep, frequent dreams of water and drowning, slow soft pulse.

Dean:

• What is the Containing Cause?

Candidate:

• That which most directly produces the disease, sometimes called the conjoined cause.

Dean:

• If the containing cause is what maintains a disease when present and ends it when removed, but removing every cause doesn’t eliminate the disease, then there is no containing cause.

Candidate:

• I disagree.

Dean:

• I argue that if removing every cause of a disease automatically removed the disease itself, there would be no need for remedies. Yet we see that beyond treatments targeting the root cause—such as those prescribed to eliminate harmful humors that cause an imbalanced temperament—additional remedies are often required to correct the imbalance itself, like using warming treatments for cold conditions. Therefore, eliminating the cause doesn’t necessarily eliminate the disease.

Candidate:

• When a cause is directly joined with the disease, removing that cause will eliminate the disease without requiring further treatment. However, for diseases without other internal causes beyond blood excess (plethora) or humor imbalance (cacochymy)—such as essential fevers—even after addressing these underlying causes, specific remedies are still needed to complete the healing process.

Debate on Inflammation (Phlegmone) and Conjoined Causes

Dean:

• If conjoined causes exist, they would be most evident in inflammation (phlegmone), where the humor fixed in the inflamed area would be considered the conjoined cause. However, I argue this humor isn’t the conjoined cause of inflammation—therefore conjoined causes don’t exist.

Candidate:

• I disagree.

Dean:

• My reasoning is that a disease and its cause must be different entities. The humor in question is the inflammation itself, not its cause.

Candidate:

• I disagree with that assertion.

Dean:

• When a definition applies to something, the thing defined must also apply. The definition of inflammation perfectly matches the humor fixed in the inflamed part—proving it is the inflammation itself.

Candidate:

• I disagree with that claim.

Dean:

• Inflammation is a hot condition that inflames the affected area, causing swelling and distension that directly impairs the function of that part. The humor fixed in the area burns, distends, and oppresses—becoming the inflammation itself and directly impairing function without any other contributing factors.

Candidate:

• My counterargument is fundamental: the humor fixed in the inflamed part is a substance, while inflammation is a condition or accident. They differ entirely in their basic nature, making it impossible for the definition to apply to both.

External Causes of Disease

Dean:

• What constitutes an external cause?

Candidate:

• External causes originate outside the body and significantly alter its state. These are also called pre-incipient, evident, or primitive causes. A factor becomes an evident cause of disease when it represents something unnatural:
  • Air becomes a cause when intemperate or impure
  • Nourishment when excessive, deficient, poor in quality, or improperly consumed
  • Movement or rest, sleep or wakefulness when immoderate
  • Retention of substances that should be expelled
  • Expulsion of substances that should be retained
  • Excessive emotional states or passions.

Of Symptoms

Dean:

• What is a Symptom?

Candidate:

• The term “symptom,” in its broadest sense, refers to anything that occurs abnormally in a living organism. It’s commonly used to describe any abnormal condition. More precisely, a symptom is defined as an abnormal condition that follows a disease, much like a shadow follows a body. Some Greek physicians preferred to call it a “succedent” rather than a symptom, though the word “symptom” is perfectly appropriate as it derives from Greek meaning “to fall together” – simply because symptoms accompany diseases.

Dean:

• What are the types of symptoms?

Candidate:

• There are three main categories:
  • Impairment of normal actions (functions)
  • Abnormal excretion and retention patterns
  • Perceptible abnormal physical conditions

Classifications of Impaired Actions

Dean:

• What are the different types of impaired actions?

Candidate:

• The classification of impaired actions is determined by examining the range of normal, unaffected actions. Impairments can affect cognitive (animal), vital, or physiological (natural) actions.

Dean:

• How are these actions impaired?

Candidate:

• Each cognitive, vital, and physiological action can be impaired in two primary ways: either by complete absence or by dysfunction. Dysfunction further divides into two categories: weakened performance or improper operation. Therefore, every action can experience three types of impairment.

Dean:

• What are the impairments (annoyances) of cognitive (animal) functions?

Candidate:

• The impairments of primary cognitive functions include weakening, corruption, and destruction of imagination, memory, and reasoning. Major conditions in this category include madness, lunacy and delirium.
• Common sensory impairments include loss of sensation and difficulty processing sensory information, indicating compromised sensory function. Insomnia and hypersomnia represent impairments of internal sensory function.
• Specific sensory impairments include:
  • Vision: Blindness, visual impairment, or distorted vision
  • Hearing: Deafness, hearing impairment, or distorted hearing
  • Other senses follow similar patterns, though lacking specific terminology
  • Touch uniquely presents with pain as a specific symptom. Movement impairments include immobility, difficult movement, or abnormal movements such as tremors, convulsions, or panting. Speech impairments include inability to speak, difficulty speaking, or disordered speech.

Dean:

• What are the impairments (annoyances) of vital functions?

Candidate:

• Vital function impairments include absence of pulse, abnormal pulse, respiratory arrest, and breathing difficulties.

Dean:

• What are the impairments of physiological (natural) functions?

Candidate:

• Appetite impairments include loss of appetite, excessive hunger, and abnormal appetite patterns.
• Digestive impairments include slow digestion and difficult digestion. Similar impairments affect retention and elimination functions, though lacking specific terminology. Generally, any function may be impaired by weakness, dysfunction, or complete absence.

Disorders of Excretion and Diagnostic Signs

Dean:

• Why do abnormal elimination and retention accompany functional impairments?

Candidate:

• The normal elimination process is disrupted when the expulsive faculty is severely disordered; the same applies to the retention faculty.

Dean:

• What is Ametry or a disorder of waste products?

Candidate:

• It is a harmful abnormality that bodily waste products develop when deviating from normal physiological processes.

Dean:

• How many types of these disorders exist?

Candidate:

• There are three types: abnormalities in substance, quantity, and quality. These occur when bodily waste products are abnormally retained or deviate from normal patterns in their composition, amount, or characteristics, as described by Galen in his work on symptoms.

Dean:

• What constitutes an abnormality (default) of substance?

Candidate:

• When the excretory material is entirely abnormal in nature, such as stones, gravel, or parasites. Alternatively, when the method of elimination is abnormal while the material itself is normal, such as bleeding from the nose, ears, mouth, genitals, or intestines.

Dean:

• What constitutes an abnormality of quantity?

Candidate:

• When the natural balance of elimination is disrupted, resulting in either excessive or insufficient waste elimination.

Dean:

• What constitutes an abnormality of quality?

Candidate:

• When the characteristics of waste products deviate from normal patterns—for example, unusual coloration (black, livid, or green); unusually offensive odor; abnormal taste characteristics (bitterness, saltiness, or acidity); or unusual consistency (clamminess, hardness, or excessive thinness).

Dean:

• Why are Ametry or excessive excretion and retention disorders grouped together?

Candidate:

• Because waste products deviate from normal physiological processes and become corrupted both when materials that should be eliminated are retained and when materials that should be retained are eliminated.

Dean:

• What symptoms relate to abnormal retention?

Candidate:

• Suppression of (the flowers) menstruation and hemorrhoidal bleeding, constipation, inability to produce sweat, and retention of other excretions necessary for health maintenance.

Dean:

• Why are perceptible physical abnormalities discussed after excretory irregularities?

Candidate:

• Because they typically develop from the corruption of (excrementitious humors) retained waste materials.

Physical Affections / Abnormalities

Dean:

• How many categories of perceptible physical abnormalities exist?

Candidate:

• They correspond to the five senses through which they can be perceived: some are visible, others audible, others detectable by smell, others by taste, and others by touch.

Dean:

• What are the visible (preternatural affections) physical abnormalities?

Candidate:

• Abnormal coloration resulting from underlying humoral imbalances, such as yellow in jaundice, pallor in phlegmatic conditions (leukophlegmasia), black in leprosy; also changes in body shape, size, and other visible characteristics.

Dean:

• What are the audible abnormalities?

Candidate:

• Abnormal sounds such as tinnitus, respiratory rattling, teeth grinding, belching and flatulence, as well as incoherent and tremulous speech.

Dean:

• What abnormalities relate to smell?

Candidate:

• Unpleasant odors emanating from the armpits, ears, nostrils, mouth, feet, or the entire body.

Dean:

• What abnormalities relate to taste?

Candidate:

• Bitter taste in the mouth arising from yellow bile, acidic taste from black bile, and saltiness from phlegm.

Dean:

• What abnormalities relate to touch?

Candidate:

• All primary tactile qualities—hot, cold, moist, and dry—and their derivatives such as softness, hardness, roughness, looseness, ruggedness, and similar characteristics detectable in the skin through touch.

Understanding Disease Diagnostics and Prognosis

Dean:

• What is a sign in medical context?

Candidate:

• Anything perceptible to our senses that indicates something hidden. Thus, a symptom, being observable, is the definitive sign of the underlying condition from which it originates; similarly, an evident cause, such as poor diet, is a sign of the resulting disease.

Dean:

• How many types of signs are there?

Candidate:

• Three principal types: healthful signs indicating wellness; unhealthful signs indicating illness; and neutral signs indicating a state between health and illness.

Dean:

• What are signs?

Candidate:

• Two main categories: diagnostic signs that reveal the current state of the disease, and prognostic signs that predict the patient’s future condition. Some add anamnestic signs, which use past information to assess the present and future state of the disease.

Dean:

• What types of diagnostic signs exist?

Candidate:

• Three types: some identify the affected part, others the cause, and others the nature of the disease. Those that are specific and inseparable from the condition are called pathognomonic signs; those that are common and non-specific are called associated signs.

Dean:

• What signs are important for prognosis (indicate unsoundness of health)?

Candidate:

• Beyond the specific and inseparable symptoms of the disease, there are additional signs that indicate disease severity, and others that reveal the progression and nature of the disease.

Dean:

• What are Diagnostic Symptoms and Why Are They Considered Prognostic?

Candidate:

• Diagnostic symptoms are crucial in predicting the course and outcome of a disease. Different diseases have distinct characteristics that inform their potential progression:
  • Some diseases are inherently incurable, like cancer
  • Others are treatable, such as a tertian fever
  • Some diseases are short-lived, like quotidian fevers
  • Some are prolonged, like hectic and quartan fevers
• Specific symptoms can indicate the severity of a disease. For example, in a serious condition like pleurisy, the following signs would suggest a dangerous progression:
  • Intense pain spreading from the side to the throat or abdomen
  • Significant breathing difficulties
  • Severe coughing

Dean:

• What do you call these supervening (supervenientia) symptoms, or symptoms that come over and above the initial condition?

Candidate:

• These are symptoms that emerge as the disease progresses and intensifies. They indicate the disease is getting worse. Think of it like watching a storm grow. In a condition like pleurisy, you might see:
• Looseness (likely referring to bodily functions)
• Breathing difficulties
• Redness in the face and eyes
• Spots appearing on the chest
• Redness developing on the back and shoulder blades

Dean:

• And what about those symptoms that appear over and above the main symptoms (insuper apparentia) – what do you call those?

Candidate:

• These are additional symptoms that reveal themselves beyond the core, unavoidable symptoms. They’re like subtle signs that help us understand how the disease might develop. These signs can show whether the disease is in a state of rawness or maturation, which helps us predict how quickly or slowly the crisis might come.

The Intricacies of Disease Crisis and Recovery

Dean:

• What exactly is this “crisis” you keep mentioning?

Candidate:

• The crisis is a critical turning point in a disease – a sudden change that could mean life or death. It can be good or bad, and each of those can be either complete or incomplete.

Dean:

• What does the word “crisis” actually mean?

Candidate:

• It comes from a Greek word meaning “to judge” or “make a judgment.” So a crisis is essentially a moment of judgment. We use it in several ways:
  • The body’s battle against the disease
  • The process of expelling harmful substances from the body
  • The ultimate outcome of the illness

Dean:

• What would you consider a perfectly good crisis?

Candidate:

• A perfectly good crisis occurs when:
• Signs of the disease’s maturation appear on the expected day
• It resolves on the critical day without dangerous complications
• There’s a clear expulsion of harmful substances
• The resolution matches the specific nature of the disease and the patient’s condition.

Dean:

• What would you call an imperfectly good crisis?

Candidate:

• It’s a stage where the disease isn’t completely eliminated, but the patient feels somewhat better – perhaps more comfortable or hopeful about their condition.

Dean:

• And what constitutes a perfectly bad crisis?

Candidate:

• Simply put, a crisis that accelerates the patient’s journey toward death.

Dean:

• What about an imperfectly evil crisis?

Candidate:

• That’s when the patient’s condition deteriorates, moving them into an even more precarious state of health.

Dean:

• How are these critical signs categorized?

Candidate:

• They fall into three groups: signs that come before the crisis, signs that occur during the crisis, and signs that follow the crisis.

Dean:

• What types of signs precede the crisis?

Candidate:

• There are two main types:
  • Signs that predict the exact day and time of the crisis
  • Signs that indicate what kind of crisis might occur

Dean:

• How can you tell the timing of a crisis?

Candidate:

• We look at two key indicators:
  • The body’s waste products – particularly urine and stool
  • These can reveal whether the crisis will happen sooner or later
• For instance, if the urine appears processed and has a white, smooth sediment on the fourth day, it suggests the crisis might occur on the seventh day.

Dean:

• Tell me more about these signs of processing (concoction & crudity) and rawness.

Candidate:

• It’s fascinating. Signs of rawness can suggest not just a prolonged illness, but potentially fatal outcomes. Conversely, signs of processing promise not just a shorter illness, but a potential recovery.

Dean:

• Is this indication constant?

Candidate:

• It depends on consistency. Hippocrates believed the best indicator is urine that remains white, smooth, and uniform throughout the illness. If the urine’s appearance fluctuates – sometimes clear, sometimes raw – it suggests a longer, less predictable recovery.

Dean:

• Are there other ways to predict the crisis?

Candidate:

• Absolutely! We also observe the disease’s movement. Violent, swift diseases are judged more quickly:
• Extremely acute diseases: judged within 4 days
• Highly acute: judged by the 7th day
• Standard acute: judged by the 14th day
• Complex acute: potentially assessed up to the 40th day

Dean:

• What are the signs that a crisis is imminent?

Candidate:

• Classic warning signs include:
  • Intense headaches
  • Restlessness
  • Anxiety
  • Unquenchable thirst
  • Irregular pulse
• As Hippocrates noted, the night becomes particularly challenging for patients about to experience a medical crisis.

Dean:

• How many types of crisis are there?

Candidate:

• Two primary types: Excretion and Removal. This means the body either expels harmful substances or transfers problematic humors from one part of the body to another.

Dean:

• What are the methods of excretion?

Candidate:

• We observe several key pathways:
  • Nosebleeds
  • Sweating
  • Loose bowel movements
  • Vomiting
  • Increased urination

Dean:

• How are the signs of a crisis categorized?

Candidate:

• They’re divided into two types: universal signs that apply broadly, and signs specific to each type of disease.

Dean:

• Where do these universal signs come from?

Candidate:

• Three key factors: the disease’s movement, the affected body part, and the patient’s age.

Dean:

• Can you explain the disease’s “motion”?

Candidate:

• It’s fascinating. Acute diseases are typically resolved through evacuation or excretion, while longer-term diseases are managed through removal and settlement. Acute diseases are characterized by quick, intense progression, whereas chronic diseases move more slowly.

Dean:

• Are there interesting historical examples of disease resolution?

Candidate:

• Absolutely! Take Nicodemus, who was diagnosed on the 24th day by urine. Anaxion was assessed on the 34th day through sweating. And Cleonaectides had a complete resolution on the 80th day.
  • Note: These were called ‘diuturnal diseases’.

Dean:

• How do you determine a crisis based on the affected part?

Candidate:

• It depends on the specific organ. For instance:
• If the liver’s outer parts are inflamed, we might expect resolution through:
  • Nosebleed
  • Sweating
  • Increased urination
• If the inner parts are affected, the disease might resolve through:
  • Diarrhea
  • Vomiting

Dean:

• How does age influence disease progression?

Candidate:

• Galen had an interesting observation. In burning fevers:
  • Young men typically experience nosebleeds
  • Older men more often have diarrhea
• He explained this by the different nature of bodily humors: young people have thin, sharp humors that move upward, while older people have more phlegmatic humors that flow downward.

Dean:

• We’ve discussed universal signs of a crisis. Now, what are the specific signs that indicate an imminent nosebleed during an acute fever?

Candidate:

• Look for these key symptoms:
• Redness spreading across the entire face
• Intense pain in the head and neck
• Rapid pulse in the temple arteries
• Blurred vision
• Swelling of the upper abdomen
• Difficulty breathing
• These symptoms collectively suggest an impending nosebleed.

Dean:

• Explain the physiological reasoning behind each of these signs.

Candidate:

• Each symptom reveals the body’s complex internal processes:
• Facial Redness: Blood begins migrating from lower to upper body parts, preparing to exit through the nostrils. It’s like the body is redirecting its internal traffic.
• Head and Neck Pain: The movement of harmful bodily humors causes tearing through sensitive membranous tissues. These delicate areas are extremely sensitive, generating sharp, intense pain.
• Rapid Arterial Pulse: The veins become overly full, compressing the arteries. This compression causes the arteries to beat more intensely, like a river trying to force its way through a narrowing channel.
• Blurred Vision: Thick bodily spirits flood the upper body, blocking the pathways normally used by “animal spirits” – essentially, disrupting the neural pathways that enable clear vision.
• Abdominal Swelling: The liver begins to swell as blood initiates movement from the root of the veins, creating internal pressure.
• Breathing Difficulty: The ascending blood puts pressure on the diaphragm, the primary organ of respiration, making breathing laborious.

Dean:

• Are there any additional signs of imminent bleeding?

Candidate:

• Galen noted some fascinating additional indicators:
• Noises in the ears
• Tingling sensations in the nostrils
• Hallucinations involving red objects
• He once predicted a nosebleed for a young fever patient who suddenly jumped out of bed. When asked why, the patient claimed he saw a red serpent crawling through the window – a classic sign of the body’s impending internal shift.

Dean:

• What signs suggest an impending critical sweat?

Candidate:

• The key indicators include:
  • Suppression of urination
  • Sudden, cold trembling or shivering

Dean:

• Why does urination become suppressed?

Candidate:

• This occurs because urine and sweat share a common origin—they are composed of the serum components found in bodily fluids. When these serous fluids are distributed throughout the body, urinary output becomes restricted.

Dean:

• Why does shuddering occur?

Candidate:

• The shuddering is caused by the acrid nature of the serous humor irritating the highly sensitive nervous membrane.

Dean:

• Are there any additional signs that might predict an impending sweat?

Candidate:

• Modern medical observations suggest additional indicators:
  • A slow, weak pulse
  • An irregular, fluctuating heartbeat
  • Hot vapor emerging from the head

Dean:

• What symptoms suggest an approaching digestive disturbance?

Candidate:

• Warning signs include:
• Persistent belching
• Excessive gas
• Abdominal rumbling and swelling
• These symptoms indicate the movement of harmful fluids from the mesenteric veins into the intestinal tract. Additionally, the urine may appear pale and watery, suggesting the relocation of choleric substances into the digestive system.

Signs of Impending Vomiting

Dean:

• What are the warning signs of approaching vomit?

Candidate:

• According to Hippocrates, the key indicators include:
  • Nausea and urge to vomit
  • Stomach cramping due to problematic bodily fluids
  • Frequent spitting
  • Fluid rising from the stomach to the mouth
  • Visual disturbances caused by vapors from the stomach
• Additional observations suggest:
  • Bitter taste on the tongue
  • Twitching of the lower lip

Dean:

• What signifies a flux of urine?

Candidate:

• While Hippocrates did not specify, Galen advises assessing this through the absence of other bodily purges. If no signs of bleeding, sweating, diarrhea, or vomiting are present, and critical stages of disease progression have occurred, urinary examination becomes crucial.
• Key diagnostic signs include:
• Heaviness in the abdominal region
• Burning sensation in the urinary tract
• Consistent production of thick, abundant urine

Signs of Disease Settlement

Dean:

• Describe the signs of disease settlement.

Candidate:

• In chronic diseases where the body struggles to expel thick fluids, settlement is likely, especially during winter. This may occur if:
  • Natural purging was initiated but incomplete
  • Patient consistently produces thin, unprocessed urine
  • Other health indicators remain relatively stable

Dean:

• How do you determine whether a medical crisis is good or bad?

Candidate:

• We evaluate the crisis through:
• Concurrent signs
• Subsequent symptoms
• The nature of excretion or settlement

Purgation

Dean:

• What makes an excretion successful?

Candidate:

• Four critical factors are required:
• Appropriate Quality
  • The problematic bodily fluid must be fully processed before elimination
  • Expulsion of unrefined fluids is considered harmful
• Sufficient Quantity
  • Moderate expulsion is key
  • Excessive discharge is dangerous
  • Insufficient purging indicates the body’s inability to manage harmful fluids
  • Complete removal of noxious substances is essential to prevent disease recurrence
• Appropriate Timing
  • Occur on the critical day of the disease
  • Other timing is considered suspicious
• Natural Method of Purgation

Dean:

• Why is the timing so specific?

Candidate:

• Excretions outside the critical day are potentially dangerous and may not effectively resolve the underlying condition.

Dean:

• What determines the quality of purging?

Candidate:

• The most commendable purging occurs when:
  • The problematic bodily fluid is fully processed before elimination
  • Expulsion of unrefined or “crude” humors is considered harmful

Dean:

• What is the appropriate quantity of purging?

Candidate:

• The quantity must be carefully moderated:
• Excessive discharge is dangerous
• Insufficient purging is equally problematic
• Small discharges (minimal sweating, bleeding, or vomiting) indicate:
  • The body’s inability to manage harmful fluids
  • Potential imminent breakdown of bodily systems
• The key principle is complete removal of harmful substances to prevent disease recurrence.

Dean:

• What is the proper method of purging?

Candidate:

• Ideal purgation should:
  • Occur all at once in substantial quantity
  • Follow direct, open passages
  • Emerge through appropriate bodily channels
• Specific observations:
  • Blood from the right nostril when the spleen is affected is considered harmful
  • Blood from the left nostril when the liver is affected is problematic
  • Straight-line excretion suggests strong natural healing
• Oblique or indirect purging indicates:
  • Malignancy of bodily fluids
  • Weakness in the affected body part
  • Obstructed pathways

Conditions of a Healthy Abscess or Humor Settlement

Dean:

• What constitutes a wholesome abscess?

Candidate:

• According to Hippocrates, three critical factors are essential:
• Location
  • Settlement should occur in a lower, less critical body part
  • Must be distant from the originally affected area
  • Must have capacity to contain all problematic matter
• Origin of Removal
  • Should follow a straight, direct pathway
  • Precise directional movement is crucial
• Reason for Removal

Assessing Crisis Outcomes

Dean:

• How do we determine if a medical crisis is favorable or uncertain?

Candidate:

• Evaluation comes from three primary sources:
  • Body Quality
    • Facial color and swelling
    • Healthy color indicates successful purging
    • Livid, yellow, or black coloration suggests complications
    • Reduction of facial swelling indicates complete crisis
  • Patient Actions and Functions
    • Proper digestive processes
    • Smooth, even pulse
    • Easy respiration
    • Moderate body temperature
    • Mental clarity and sensory function
    • Peaceful, undisturbed sleep
  • Excretory Indicators
    • Properly colored and formed waste
    • Urine resembling that of a healthy individual
    • Thin or reddish excretions suggest potential relapse

Dean:

• What makes these indicators significant?

Candidate:

• They collectively reveal the body’s healing process, indicating whether the disease has been truly resolved or remains a potential threat.

Types of Critical Days

Dean:

• Explain the different types of critical days in medical observation.

Candidate:

• There are three distinct categories of critical days:
• Truly Critical Days (Principal Days)
• Indicatory Days
• Transitional Days (between Principal and Indicatory)

Principal Critical Days

Dean:

• What characterizes the truly critical days?

Candidate:

• These are days that:
  • Provide a perfect and faithful assessment of the disease
  • Offer clear diagnostic insights
  • Carry minimal risk of misinterpretation

Dean:

• How many principal critical days are there?

Candidate:

• Three key critical days exist:
  • Seventh Day:
    • Indicates resolution of extremely acute diseases
    • Marks the first critical point
  • Fourteenth Day:
    • Signifies resolution of standard acute diseases
    • Represents the second critical point
  • Twentieth Day:
    • Indicates resolution of slowly developing acute diseases
    • Diseases with intermittent intensity

Causes of Critical Days

Dean:

• What determines these critical days?

Candidate:

• The causes are twofold:
• Material Cause:
  • Presence of harmful bodily fluids
  • Imbalance in fluid quality and quantity
• Efficient Cause (with two components):
  • Universal/Cosmic Influence:
    • Celestial bodies’ impact
    • Lunar influences transmitted to human physiology
  • Natural/Biological Influence:
    • Inherent bodily processes
    • Unconscious but systematically ordered healing mechanisms
    • Specific selection of 7th, 14th, and 20th days for crisis resolution

Nuanced Calculations of Critical Days

Dean:

• Why is the twentieth day more critical than the twenty-first?

Candidate:

• The twenty-first day marks the end of the third seven-day cycle. Specifically:
  • Only the first seven-day period is counted fully
  • The second and third seven-day periods are interconnected
  • The fourteenth day bridges the second and third periods

Dean:

• Why are the latter seven-day periods slightly shorter?

Candidate:

• Two primary reasons:
  • Natural healing processes:
    • Slower at the beginning
    • Progressively faster towards the end
  • Disease Progression:
    • Initial seven-day period attenuates harmful bodily substances
    • Subsequent periods enable more efficient expulsion of these substances

Dean:

• Can the twenty-first day also be critical?

Candidate:

• Indeed, yes. When the disease’s underlying matter is particularly stubborn and resistant to the body’s natural healing processes, the crisis may extend to the twenty-first day. In such cases, all seven-day periods become essentially equivalent.
• Hippocrates noted critical moments on odd-numbered days, specifically:
  • 3, 7, 9, 11, 14, 17, 21
  • Particularly, sweats during fevers are considered beneficial on these days
• While the twentieth day is given prominence, the twenty-first is not entirely dismissed.

Indicatory Days

Dean:

• What are indicatory days?

Candidate:

• These are preparatory days that provide preliminary insights into the potential crisis within the three seven-day periods:
  • 4th day: Hints at the 7th day’s potential
  • 11th day: Suggests developments for the 14th day
  • 17th day: Indicates possibilities for the 20th day
• Their diagnostic power is limited; they merely offer glimpses into the potential crisis.

Dean:

• Is this pattern absolute?

Candidate:

• No. While generally consistent, external factors can disrupt this natural progression:
  • Physician’s potential misdiagnosis
  • Patient’s deviation from medical instructions
  • Unexpected internal or external influences

Interfalling Days

Dean:

• What are interfalling days?

Candidate:

• These are days that prematurely provoke bodily responses:
  • First seven-day period: 3rd and 5th days
  • Second period: 9th and 13th days
  • Third period: 19th day
• Characteristics:
  • Preparatory and indicatory
  • Odd-numbered days
  • Potentially dangerous
  • May cause incomplete or poorly managed purging

Vacant Days

Dean:

• What are vacant days?

Candidate:

• These are the days between critical moments:
  • 6th, 8th, 10th, 12th, 16th, and 18th days
  • Neither critical, indicatory, nor provocative
  • Any purging on these days is considered symptomatic rather than healing
• Notably, the 6th day is particularly significant:
  • Considered the most dangerous day
  • Described by Galen as a “tyrant”
  • Potentially precipitates severe complications or death
• Interestingly, some physicians refer to these as “medicinal days” because they represent the safest period for administering cathartic treatments without disrupting the body’s natural healing processes.

End

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