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The Medical Institutions that I wish to discuss have not yet been written about by anyone, it seems to me; yet I believe nevertheless they could be written about today by a learned Doctor; and to the extent that they are employed in connection with the art that is to be learned, practiced, and advanced, they would be as a torch brought into a dark place.
It is evident that the human body is a Machine disposed by its author or inventor towards certain functions. And thus to write medicine is nothing other than to prescribe a method to a Mechanic --such as the precepts that are typically given to the custodians of those hydraulic machines by means of which water is dispensed throughout an entire city-- by which he will thus be able to conserve the Machine that has been entrusted to him in faith, in order that it should always operate correctly,
In any Machine one may observe both its functions or ends, as well as its manner of operating or the means by which the author of the machine achieved its end. And therefore we should take care not to imagine a machine that well fulfils these functions, yet in such a way that the precepts of this imaginary machine that is to be conserved should differ from the laws of a true machine. Wherefore it is not surprising that we have certain new philosophers who have thought the most ingenious things about Human beings, but fewer who have brought their thoughts to bear on the advancement of Medicine, since they have sketched out their man more from the intellect than from experience.
The primary function of a human being is perception, and the secondary function (which exists thanks to the first) is the ordering [procuratio] of perception. It is in fact in the advancement of these functions that the advancement of human perfection consists. And anything that is helpful to perception or to the ability to attend to perceptions is agreeable; anything that impedes them is disagreeable.
Perception occurs thanks to the organs of sense; the ordering of perceptions or action thanks to the organs of motion. Both should be conserved in continual operation or in the operation at an instant [operandi promtitudine ??] that is brought about now by the removal of impediments, now by the increase of facilitating conditions. And the greatest increase is nutrition itself, in so far as [the body's] particles cannot be conserved in number, but continually vanish.
The manner by which sensation is brought about can therefore be described through a separate consideration than the manner by which Motion, or the procuring of sensation, is brought about; it is useful to this assumption that the object and the organs be equally disposed to sensing; just as if there were in a human being no faculty of procuring for himself any perceptions, as, when someone is sleeping deeply, he has perceptions, but does not procure them for himself. From here it can be explained in what way perceptions excite in us the desire to procure other perceptions, and the manner described, by which we are thus able to dispose the organs of sense as well as the objects in such a way that a certain perception arises in us. All of these things can be understood, and if nutrition is not yet understood, neither indeed do these things depend on it. Thus we see at length in those who are burdened by atrophy, or who do not take their meals, sense and motion nevertheless endure for a sufficient length of time. Finally therefore it is by this very method that the organs of nutrition may be explained as a thing necessary not so much to present as to future functions. As for the organs of generation, they can be considered among the organs of motion by which an agreeable perception is procured; thus nature brings it about that the action of generation in animals be conjoined with the greatest pleasure.
In truth with our Medicine more can be gained concerning Nutrition than voluntary Motion, and more concerning this Motion than the functions of Sense; and a machine may be imagined that is capable of Nutrition but that lacks animal sense and motion, as it is easier to explain in what way we are nourished than in what way we perceive and act. Indeed, from aliments those very parts are even generated which we require for the functions of the sensitive soul. It will be preferable to inquire first into those parts that are seen by a certain reason to be held in common even with plants, than into those that are proper to animals.
And the Method is Analytic for as long as we are investigating the media or organs of any given function and the mode of their operating; and therefore we come to acquaintance with the body through its parts, by which, when completed, we will come to Synthesis, and we will describe all of the parts coordinated into one, and the first Motor of motion and the liquid and solid instruments, and their connection, and altogether the entire economy of the animal; particularly with this very analysis, which inquires into the organs and their function, we shall discern that often the very same organ is devoted to several functions, just as in Machines the wisdom of their maker shines through most of all when many effects are brought about by few things.
Considering this Synthesis, we discern that now and in antiquity it has been wisely observed that all of the parts of our body can be distinguished into what contains, what is contained, and what constitutes the [impertum], and accordingly the Veins, Humors, and Spirits, and hence our Body, are a Hydraulico-Pneumatico-Pyrobolic Machine. Now in the vessels humors are contained, but at the same time the humors of a diffuse Spirit --which is like the rays of the sun or a flame or indeed like lighted gunpowder, or like other explosions of the sort we note in fermentations and reactions (all these indeed return by the same vessel, so that of course the agitated ether is able to reconstitute itself), penetrate, agitate, and impel all the vessels.
That in our bodies there is Spirit --that is, an insensible Matter set in rapid motion-- is demonstrated from that very great motion not so much of the circulated blood, but of the members, whose motion provides enough force for us to be able to suddenly lift great weights. This cannot be attributed to the structure of the machine, for machines raising greater weights by means of forces, raise [them] slowly, while animals do it quite swiftly, from which it follows that they have a great force in them. It is manifest moreover that the members do not have a visible principle of motion; indeed it is clear that the extravesicular liquors in motion can be stopped by a motion that is not yet sensible, from which it follows that the Motor in our bodies is insensible. There is moreover a certain continuous fluid diffused throughout the whole body, from which it can be understood, that all things that are in contact with any given part of our bodies can easily be sensed. Once this spirit is set into a great internal Motion, moreover, it does not lose force, but nor does it bring it about or communicate it to another, unless heavier bodies should float into contact with it, or should resist it, whereupon it will have a great force upon them; and when it is restrained from every side by an equal pressure, if perchance an outlet towards somewhere else becomes available, it expends all of its force towards that place, from where it extends in such a way that by a slight exertion we should exercise enough force as to be useful not so much for bringing about force in us, but for determining it. Another thing that is useful to the Spirit is aliment, as oil is useful to the flame; air, or respiration, is also useful; in the next place moreover the exit of the things that it dissipates is useful, nor is it of importance that the blood of some animals is not warm to our touch, for indeed we are not able to detect all luminous things, nor all warm effervescent things, by sense. And autophosphorum, when air is withdrawn, is able for a small amount of time to give off light, until it should be able to respire again.
It is not at all doubtful, therefore, that our life consists as it in a sort of flame, which is found not so much in the heart as in the entire body [in omni membro]. That we should be the less astonished, it must be learned in what way the flame or the spirit functions as the motor in all bodies, in what way from the forces that it exerts there arise fermentations and other reactions or battles, in what way the spirit, set in an appropriate motion, conserves the water [in the body] in a fluid [state], when to be sure water freezes when agitated less intensely by its ambient surroundings [??]. In this very way our Spirit is agitated by the ambient aether, by which it is imparted in all directions through fine passages. Similarly moreover the spirit easily conserves its motion, for on account of the divisibility of impediments the opposition [objectum] of one part does not impede the motion of the other parts, whence it arises that soon motion is restored to this same impeded part by the lifting of the impediment.
Whenever the Motion of this Spirituous Matter is perturbed, there arises in the liquid a certain Ebullition whose species are fermentation, when one body is admitted, and reaction, when two opposing bodies are mixed. In this way it is necessary that the number of Ebullitions in our bodies be great, now arising when diverse humors are mixed among themselves, now when new aliments or new air are mixed into the contents that are already there.
I should suppose therefore that a certain reaction arises when bile is mixed into the blood, for both the blood outside of the vessels as well, now, as the blood that has coagulated and is turning black, as a result of some little drops of bile infused in the cold blood, a certain amount of blood that is fluid and rubescent returns once again. And indeed the blood is like oil, and the bile like sulphur; sulphurs moreover, are easily loosed from corresponding oils, above all when alkalis are added (there is moreover in bile, just as in blood, a volatile alkali or urinous salt). As it is plausible that new aliments react with the blood confected from prior elements (for those things react the most that have a contrariety together with a certain likeness, how much more [illegible] and, with a little bit of bile already in the jejunum the [impraegnata] thence at length enter into the blood.
It is not useful initially to investigate the origin of the blood; indeed it suffices that both the blood and its motion be communicated from the mother; the respiration of the mother moreover is also beneficial to the infant; the blood is moved in the heart, veins, and arteries; it is dispersed in the arteries from the heart to the extremities [membra], it returns in the veins from the extremities to the heart, percolates in the liver, whereby bile is deposited that is dilated from the gall bladder into the jejunum through its own duct, where it corrupts the chyle coming from the stomach, and with it returns to the blood in the subclavial veins.
The blood in the extremities deposits lymph, which in turn moves in its own vessels, which are called 'lymphatic'. It comes with the blood in the arteries from the heart, but does not return to the heart with the blood through the veins. A part of the lymph serves for nutrition, the rest moves through the lymphatic vessels. The lymphatic vessels pass through the glandules, or as it were the nodes or shallow basins, in which the percolated lymph is transformed and acquires a new nature. Among these the pancreases [sic] are unique --that is, the glandules gathered together out of many simple (or clotted) [glandules]; in the pancreas the subacidic lymph, which is called pancreatic juice, is produced; it is more easily transformed by air than is usual for other lymph. Saliva is also a peculiar sort of lymph, which undoubtedly contributes much to digestion in the stomach. The seminal vessels also extend to this point, [and] the semen is partly from the lymph and partly from the blood. Now the blood deposits both urine and blood in the kidneys, into which lymph is in turn mixed in the testes. It appears that the Cerebrum and the Medulla are a certain stagnant, condensed lymph. It is certain that bones are perforated by various vessels; it remains to be seen whether arteries or veins deposit something there, and whether the lymphatic vessels convey lymph there and bring it back thence.
As lymph is, by its own juice, [a sort of] nutrition, it is well known that lymph is intended by nature [?], and through heterogeneous deposits, its sulphur, and a continuous passage through the heart, the blood is by degrees, as if consumed by a flame, converted into lymph. For as much lymph, freed up from the sulphur, is deposited in the extremities [refrigeratus] as sulphur is lost by burning when passing through the heart and propulsed through the arteries. The blood moreover, which hitherto was charged with sulphur and fairly mobile, is now returned to the heart through the veins.
The blood deposited with the lymph dispersed throughout the flesh into these subtle vessels, is dissipated by the sweat in that place from which these vessels, afterwards cooled once again, suck the new material from the blood into themselves; that is they purge the blood. …
All medicines operate either after the manner of Aliments or of poisons. The former by degrees and insensibly, the latter by a great and sudden force. Thus they are not to be tried unless we require immediate aid.
The Method of treating Illnesses is twofold. One method is Analytic, in view of symptoms; the other is Synthetic, in view of causes. It is to be examined whether all symptoms are simple illnesses; functions are indeed always harmed, but since, when one function is harmed, it harms several others along with it, often there can be a single cause of multiple symptoms. The method of treating by symptoms is infinite, should we wish to enumerate all of their combinations. There are certain signs of a good constitution, and of a bad one, which cannot be called symptoms, such as color, urine, what is pleasing and what is injurious; synthesis is to be delivered after having subjected the specimen to analyses; or to the Method of general healing, which is related to pathological synthesis as algebra is to the Elements of Geometry.
De scribendis novis Medicinae Elementis (1680-1)
Institutiones Medicas, quales ego desidero, nondum a quoquam scriptas arbitror; et puto tamen facile scribi hodie posse a Medico docto; tantumque earum usum fore, et ad discendam artem, et ad exercendam et ad promovendam, quantus est facis illatae in locum tenebrosum.
Constat humanum corpus esse Machinam ad certas quasdam functiones ab autore sive inventore suo comparatam. Itaque Medicinam scribere nihil aliud est, quam alicui Mechanico methodum praescribere, qua Machinam suae fidei concreditam ita conservare possit, ut semper rite operetur, qualia praecepta dari solent custodi Machinarum illarum hydraulicarum quibus aqua per totam aliquam urbem dispensatur.
In omni Machina spectandae sunt tum functiones eius, sive finis, tum modus operandi, sive quibus mediis autor machinae suum finem sit consecutus. Itaque cavere debemus, ne machinam fingamus quae forte praestet easdem functiones, sed tamen non iisdem modis, non[?] praecepta illius machinae imaginariae conservandae a verae machinae legibus diversa essent. Unde mirum non est novos quosdam philosophos quorum ingeniosissima de Homine cogitata habemus, parum ad rem Medicam augendam attulisse, quia hominem ex ingenio potius quam experentia delineavere.
Functio hominis primaria est perceptio, at secundaria (quae prioris gratia est,) perceptionis est procuratio. In harum functionum augmento consistit humanae quoque perfectionis augmentum. Et illud omne quod perceptionem aut perceptionis procurandae facultatem juvat, id gratum est; quod contra impedit ingratum.
Perceptionis gratia sunt organa sensuum; procurandae perceptionis sive actionis gratia sunt organa Motus. Ambo debent conservari in continua operatione aut operandi promtitudine quod fit tum remotione impedientium, tum additione convenientium; et potissima additio, est ipsa nutritio; quoniam eaedem numero particulae conservari non possunt, sed continue avolant.
Potest ergo describi modus quo fit sensio separata consideratione modi quo fit Motus, seu sensionis procuratio; ponendo scilicet objectum et organa jam prout ad sentiendum opus est, disposita esse; perinde ac si nulla in homine esset facultas procurandae sibi perceptionis alicuius, quemadmodum et is qui profunde dormit, perceptiones habet, sed sibi non procurat. Deinde exponi posset quomodo perceptiones excitent in nobis voluptatem procurandi alias perceptiones, describendusque est modus, quo tam organa sensuum quam objecta ita disponere possumus ut aliqua nostra perceptio oriatur. Et haec quidem omnia intelligi possunt, etsi nondum intelligatur nutritio, neque enim ab ea pendent. Ita videmus aliquando in his qui atrophia laborant, aut cibum non capiunt, sensum tamen et motum satis adhuc diu durare. Postremum ergo hac quidem methodo foret ut organa nutritionis exponantur tanquam rei, non ad praesentes sed tantum ad futuras functiones necessariae. Quod vero attinet ad organa generationis, ea referri possunt ad organa motus quibus procuratur perceptio grata, ita enim natura constituit, ut in animalibus actio generandi cum maxima voluptate conjuncta sit.
Verum cum Medicina nostra magis circa Nutritionis quam Motus voluntarii, et magis circa huius Motus quam circa Sensus functiones occupetur, et fingi possit Machina Nutritionis capax, at sensus motusque animalis expers, facilius etiam explicetur, quomodo alamur, quam [quo]modo percipiamus atque agamus; denique ex alimentis eae quoque partes generentur, quibus ad animae sensitivae functiones indigemus, satius erit in ea prius inquirere, quae plantis quoque aliqua ratione communia videntur, quam quae sunt propria animalis.
Atque haec quidem Analytica est Methodus, dum cuiuslibet functionis media sive organa et horum operandi modum investigamus; atque ita in corporis notitiam per partes venimus[,] quibus absolutis redibimus ad Synthesin, omniaque ad unum coordinata, et primum Motorem motusque instrumenta liquida et solida, horumque connexionem, et omnino totam animalis oeconomiam describemus, praesertim cum hac ipsa analysi in organa cuiusque functionis inquirendo deprehenderimus, idem saepe organon pluribus functionibus inservire, prorsus quemadmodum in Machinis eo maxime ingenium autoris elucet, si multa paucis efficiantur.
Hanc Synthesin ut delineemus considerandum est, quod sapienter jam et veteres observavere, omnes corporis nostri partes posse distingui in continentia, contenta, et impertum facientia, nempe Vasa, Humores, et Spiritus, ac proinde Corpus nostrum esse Machinam Hydraulico-Pneumatico-Pyrobolicam. In vasis enim contineri Humores, sed per vasa pariter et humores diffundi Spiritus, qui instar radiorum solis aut flammae aut etiam pulveriis pyrii incensi, aliorumve displosorum, qualia in fermentationibus et reactionibus notamus (cuncta enim haec eodem redeunt, ut scilicet aether turbatus se restituere coneter) omnia penetrant, agitant[,] impellunt.
Spiritus esse in corpore nostro, id est Materiam insensibilem in celeri motu constitutam demonstratur ex ipso motu sane magno non tantum sanguinis circulati, sed et membrorum, cuius motus tanta vis est ut magna pondera subito elevare possimus[,] quod non potest tribui structurae machinae, nam machinae maiora viribus pondera elevantes, tarde elevant, cum animalia id satis promte faciant, unde sequitur magnam in iis vim inesse. Manifestum est autem membra principium motus visibile non habere, liquores etiam extravasatos a motu cessare nondum licet sensibiliter mutatos, unde sequitur Motorem in corpore nostro esse insensibilem. Eundem autem esse unum aliquod continuum fluidum per totum corpus diffusum, ex eo intelligi potest, quod omnia quae in quacunque parte corporis nostri contingunt, facile sentimus. Is autem Spiritus semel in magno Motu intestino constitutus vim non amittit, sed tamen nec exercet sive alteri communicat nisi corpora crassiora ei innatent, sive ei occurrant, tunc enim magnam in ea vim facit, et cum undique coerceatur aequali nisu, si forte exitus alicubi detur illuc totam suam vim impendit, unde patet quodmodo tam levi negotio tantam vim exerceamus, qui non excitare vim in nobis, sed tantum eam determinare opus est. Caeterum Spiritui opus est alimento, ut flammae opus est oleo; aëre quoque seu respiratione[,] deinde etiam exitu eorum quae dissipat, nec refert quod nonomnium animalium sanguis nostro tactu calidus est, ita enim scimus nec omnia lucida, nec omnia effervescentia calida sensu deprehendi. Et autophosphorum aere negato paulatim lucere desinere donec iterum respirare possit. Vita ergo nostra haud dubie velut in flamma quadam consistit, quae non tantum in corde sed et in omni membro reperitur. Quod quominus miremur, sciendum est huiusmodi flammam seu spiritum motorem in omnibus corporibus reperiri, et ex vi quam exercet oriri fermentationes aliasque reactiones seu pugnas, hunc spiritum in debito motu constitutum, aquam fluidam serrvare, cum vero remissius ab ambientibus agitatur aquam glaciari. Eodem modo et Spiritus noster ab ambienti aethere agitationem habet, cum quo undique per tenues aditus communicat. Idem spiritus etiam motum facile servat, nam ob divisibilitatem impedimentum uni parti objectum reliquarum partium motum non impedit, unde fit ut mox illi ipsi parti impeditae sublato impedimento motus reddatur.
Quotiescunque Motus huius Spirituosae Materiae perturbatur oritur in liquido Ebullitio quaedam cuius species sunt fermentatio cum unum est corpus adsensum, et reactio cum duo corpora pugnantia miscentur. Huiusmodi autem Ebullitionum in corpore nostro necesse est magnum esse numerum, tum quando diversi humores inter se, tum quando nova alimenta aut novus aer prioribus contentis miscentur.
Crediderim itaque cum bilis miscetur sanguini oriri quandam reactionem, nam et [sang]uis extravasatus et iam coagulatus et nigrescents [gut]tulis aliquot bilis immissis etiam in frigido, fluidus [iter]um nonnihil et rubeus redditur. Est enim sanguis instar olei, at bilis instar sulphuris, sulphura autem ab oleis respondentibus, inprimis si alcalia accedant, (est enim in bile pariter et sanguine alcali volatile sive sal urinosum) facile solvuntur. [Cum] alimenta recentia [cum san]guine ex prioribus alimentis confecto pugnare credibile sit, [(pugnant] enim maxime quae contrarietatem [habent] cum quadam cognatione) quanto magis fl‡ et, cum bile paulo ante in jejuno [impr]aegnata inde demum sanguinem ingrediantur.
Originem sanguinis initio investigare [non] opus est, sufficit enim a matre [vel]uti communicari, et sanguinem [et] ejus motum; respirationem autem matris [in]fanti quoque prodesse[;] sanguis movetur [in co]rde, venis et arteriis; in arteriis a corde ad membra mittitur, [in] venis a membris ad cor redit[,] percolatur [in] hepate ubi deponitur bilis, quae ex vesicula fellea per ductum proprium in intestinum jejunum dilata, ibi chylum [e] stomacho venientem inficit; et cum eo [sa]nguini in venis subclaviis redditur.
Sanguis in extremis [de]ponit lympham, ea deinde per propria vasa movetur quae lymphatica vocant. Venit cum sanguine in arteriis [a] corde, sed non cum sanguine per venas redit ad cor. Pars lymphae servit nutritioni, reliquam [vasis] lymphaticis movetur. Vasa lymphatica transeunt per glandulas, tanquam nodos, sive pelves, in quibus percolata lympha alteratur, novamque naturam acquirit. Ex his singulares sunt pancreas, quod est glandula ex pluribus simplicibus (seu conglobatis) conglomerata[;] in pancreate lympha subacida fit, quam vocant succum pancreaticum, ea facilius aëre mutatur quam alias lympha solet. Est et saliva peculiare lymphae genus, quod digestioni in stomacho multum haud dubie conducit. Huc pertinent & vasa seminalia[,] semen partim est ex lympha partim ex sanguine. Nam sanguis partim urinam partim materiam seminalem in renibus deponit, cui deinde lympha in testibus miscetur. Videtur Cerebrum et Medulla esse lympha quaedam stagnans, inspissata, certum est ossa a vasis variis perforari, videndum an arteriae vel venae illic aliquid deponant, et an vasa lymphatica illuc afferant lympham, atque inde referant.
Cum lympha sit proprio succo nutritio, patet lympham a natura intendi, et sanguinem depositis heterogeneis ac sulphure suo continua per cor trajectione ut a flamma consumto paulatim in lympham converti. Nam quantum sulphuris in corde transiens et per arteriam propulsus deflagratione amisit, tantum lymphae a sulphur liberatae in extremis refrigeratus deponit. Sanguis autem, qui adhuc sulphure impraegnatus at satis mobilis est, per venas ad cor refertur.
Sanguis cum lympha in subtilia illa vasa per carnem dispersa delatus, illic sudore dissipatur, unde haec vasa pos[t] iterum refrigerata, novam sibi ex san[guine] materiam sugunt; id est sanguinem purgant. Quae causa est, cur sudor[es] sint propemodum panaceae, vimque [suam] late extendant, et prope soli in fl‡ morbis usum praebeant. Sanguis ipse ea quae motum eius liberu[m] versus extrema rejicit, quae cum fl‡ non reperiunt, sanguis continuam sp[onta]neam purgationem sui non pofl‡ donenc in extremis illis vasulis sta[gnat]. Materia sudore vel insensibili [tran]spiratione auferatur, quo novae deponendae fiat locus. Itaque part[im] attractione partim impulsu fit, ut san[guis] et lympha sudore purgentur. Attractionem sane[e] hic intelligo, cuius origo est a quodam in[iti]ali impulsu. Cum sudorem pfl‡ possimus solum calorem internum, id e[st] vim motoris nostri augendo, manifestu[m] est sudorem moderatum nec[essari]o prodesse tanquam effectum virtutis fl‡.
Medicamenta omnia operantur vel instar Alimentorum vel instar venenorum. Illa paulatim & insensibilit[er,] haec magna et subita vi. Itaque non probanda nisi cum promto auxilio indigemus.
Duplex Methodus tractandi Morbos, una Analytica per symptomata, altera Synthetica per causas. Considerandum est, omnia symptomata esse morbos quosdam simplices, semper enim sunt laesae function[es,] sed quia una functio laesa facit plures [alias] collaedi, hinc saepe causa plurium symptomatum unica haberi potest. Si laesio functionis non sit perceptilis per se non appellatur symptoma. Methodus tractandi per symptomata, infinita esset si omnes eorum combinationes enumerare vellemus. Sunt quaedam signa bonae malaeque constitutionis, quae symptomata dici non possunt, ut color, urina, juvantia et laedentia; vera tradenda est analysis, seu ars tum in signa inquirendi, tum ex signis concludendi morbum. Tradenda est synthesis post subjicendum specimen analyseos; seu Methodi medendi generalis, quae habet se ad synthesin pathologicam ut algebra ad Elementa Geometriae.
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