Galen: On the Natural Faculties

by Galen

We may expect, then, to detect the retentive faculty in the uterus more clearly in proportion to the longer duration of its activity as compared with that of the stomach. For, as we know, it takes nine months in most women for the foetus to attain maturity in the womb, this organ having its neck quite closed, and entirely surrounding the embryo together with the chorion. Further, it is the utility of the function which determines the closure of the os and the stay of the foetus in the uterus. For it is not casually nor without reason that Nature has made the uterus capable of contracting upon, and of retaining the embryo, but in order that the latter may arrive at a proper size. When, therefore, the object for which the uterus brought its retentive faculty into play has been fulfilled, it then stops this faculty and brings it back to a state of rest, and employs instead of it another faculty hitherto quiescent—the propulsive faculty. In this case again the quiescent and active states are both determined by utility; when this calls, there is activity; when it does not, there is rest.

Here, then, once more, we must observe well the Art [artistic tendency] of Nature—how she has not merely placed in each organ the capabilities of useful activities, but has also fore-ordained the times both of rest and movement. For when everything connected with the pregnancy proceeds properly, the eliminative faculty remains quiescent as though it did not exist, but if anything goes wrong in connection either with the chorion or any of the other membranes or with the foetus itself, and its completion is entirely despaired of, then the uterus no longer awaits the nine-months period, but the retentive faculty forthwith ceases and allows the heretofore inoperative faculty to come into action. Now it is that something is done—in fact, useful work effected—by the eliminative or propulsive faculty (for so it, too, has been called, receiving, like the rest, its names from the corresponding activities).

Further, our theory can, I think, demonstrate both together; for seeing that they succeed each other, and that the one keeps giving place to the other according as utility demands, it seems not unreasonable to accept a common demonstration also for both. Thus it is the work of the retentive faculty to make the uterus contract upon the foetus at every point, so that, naturally enough, when the midwives palpate it, the os is found to be closed, whilst the pregnant women themselves, during the first days—and particularly on that on which conception takes place—experience a sensation as if the uterus were moving and contracting upon itself. Now, if both of these things occur—if the os closes apart from inflammation or any other disease, and if this is accompanied by a feeling of movement in the uterus—then the women believe that they have received the semen which comes from the male, and that they are retaining it.

Now we are not inventing this for ourselves: one may say the statement is based on prolonged experience of those who occupy themselves with such matters. Thus Herophilus[308] does not hesitate to state in his writings that up to the time of labour the os uteri will not admit so much as the tip of a probe, that it no longer opens to the slightest degree if pregnancy has begun—that, in fact, it dilates more widely at the times of the menstrual flow. With him are in agreement all the others who have applied themselves to this subject; and particularly Hippocrates, who was the first of all physicians and philosophers to declare that the os uteri closes during pregnancy and inflammation, albeit in pregnancy it does not depart from its own nature, whilst in inflammation it becomes hard.

In the case of the opposite (the eliminative) faculty, the os opens, whilst the whole fundus approaches as near as possible to the os, expelling the embryo as it does so; and along with the fundus the contiguous parts—which form as it were a girdle round the whole organ—co-operate in the work; they squeeze upon the embryo and propel it bodily outwards. And, in many women who exercise such a faculty immoderately, violent pains cause forcible prolapse of the whole womb; here almost the same thing happens as frequently occurs in wrestling-bouts and struggles, when in our eagerness to overturn and throw others we are ourselves upset along with them; for similarly when the uterus is forcing the embryo forward it sometimes becomes entirely prolapsed, and particularly when the ligaments connecting it with the spine happen to be naturally lax.[309]

A wonderful device of Nature’s also is this—that, when the foetus is alive, the os uteri is closed with perfect accuracy, but if it dies, the os at once opens up to the extent which is necessary for the foetus to make its exit. The midwife, however, does not make the parturient woman get up at once and sit down on the [obstetric] chair, but she begins by palpating the os as it gradually dilates, and the first thing she says is that it has dilated “enough to admit the little finger,” then that “it is bigger now,” and as we make enquiries from time to time, she answers that the size of the dilatation is increasing. And when it is sufficient to allow of the transit of the foetus,[310] she then makes the patient get up from her bed and sit on the chair, and bids her make every effort to expel the child. Now, this additional work which the patient does of herself is no longer the work of the uterus but of the epigastric muscles, which also help us in defaecation and micturition.

[IV]

Thus the two faculties are clearly to be seen in the case of the uterus; in the case of the stomach they appear as follows:—Firstly in the condition of gurgling, which physicians are persuaded, and with reason, to be a symptom of weakness of the stomach; for sometimes when the very smallest quantity of food has been ingested this does not occur, owing to the fact that the stomach is contracting accurately upon the food and constricting it at every point; sometimes when the stomach is full the gurglings yet make themselves heard as though it were empty. For if it be in a natural condition, employing its contractile faculty in the ordinary way, then, even if its contents be very small, it grasps the whole of them and does not leave any empty space. When it is weak, however, being unable to lay hold of its contents accurately, it produces a certain amount of vacant space, and allows the liquid contents to flow about in different directions in accordance with its changes of shape, and so to produce gurglings.

Thus those who are troubled with this symptom expect, with good reason, that they will also be unable to digest adequately; proper digestion cannot take place in a weak stomach. In such people also, the mass of food may be plainly seen to remain an abnormally long time in the stomach, as would be natural if their digestion were slow. Indeed, the chief way in which these people will surprise one is in the length of time that not food alone but even fluids will remain in their stomachs. Now, the actual cause of this is not, as one would imagine, that the lower outlet of the stomach,[311] being fairly narrow, will allow nothing to pass before being reduced to a fine state of division. There are a great many people who frequently swallow large quantities of big fruit-stones; one person, who was holding a gold ring in his mouth, inadvertently swallowed it; another swallowed a coin, and various people have swallowed various hard and indigestible objects; yet all these people easily passed by the bowel what they had swallowed, without there being any subsequent symptoms. Now surely if narrowness of the gastric outlet were the cause of untriturated food remaining for an abnormally long time, none of these articles I have mentioned would ever have escaped. Furthermore, the fact that it is liquids which remain longest in these people’s stomachs is sufficient to put the idea of narrowness of the outlet out of court. For, supposing a rapid descent were dependent upon emulsification,[312] then soups, milk, and barley-emulsion[313] would at once pass along in every case. But as a matter of fact this is not so. For in people who are extremely asthenic it is just these fluids which remain undigested, which accumulate and produce gurglings, and which oppress and overload the stomach, whereas in strong persons not merely do none of these things happen, but even a large quantity of bread or meat passes rapidly down.

And it is not only because the stomach is distended and loaded and because the fluid runs from one part of it to another accompanied by gurglings—it is not only for these reasons that one would judge that there was an unduly long continuance of the food in it, in those people who are so disposed, but also from the vomiting. Thus, there are some who vomit up every particle of what they have eaten, not after three or four hours, but actually in the middle of the night, a lengthy period having elapsed since their meal.