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Translation. Just as this great narrowness of the blood vessels, particularly in a body of this kind, had perhaps been the beginning of all the diseases, so I do not doubt that the hardness of the pancreas, and still more that of the duodenum, was the cause of the vomiting. For whether that portion of the intestine is constricted by compression, as Riolan long ago observed, whom you will see cited here in the Sepulchretum by Théophile Bonet, or whether, because its coats are scirrhous, it is quite unable to contract, these opposite causes are followed by the same effect: since the contents about to descend from the stomach are either less readily received or less readily propelled onwards, most of them remain in the stomach, and there, either becoming corrupted or simply troublesome and oppressive through their delay, provoke vomiting. The distinguished Molinelli has also published a clear example of this. The same thing must happen when the pylorus is affected by defects of the same kind.

You have very many examples here in the Sepulchretum by Théophile Bonet, as in Observations XI and XVII and most of the others following almost as far as XXVI, and again in LVI, §13; in the Additions, in Observations I and VIII; and indeed elsewhere, as in Book I, Section IX, not only in Observation XXXIV but also, if you attend to those “upturnings”, in XXXIII. Among those which you will read in this Section VIII, when you come to Observation XXI, not very unlike another supplied by Johannes Bohn, and find there that vomiting of all food and finally death within ten days followed blockage of the pylorus by a small silver coin which had been swallowed, you will undoubtedly recall that much larger silver coin which the skilful surgeon du Luc successfully dislodged from that place and indeed out of the body. He did so with other aids, but especially with mercury: pressing it onwards by its gravitational weight and reducing it by amalgamation, as the chemists call it, when pains near the pylorus had already begun, with an urge to vomit (the printed laevi at this point is unclear).

The central inference is that different impairments of passage can produce the same vomiting. The author is Giovanni Battista Morgagni; the extract corresponds to Book III, Letter XXX, article 13 of The Seats and Causes of Diseases Investigated by Anatomy by Giovanni Battista Morgagni. The opening haec, “this”, points back to an anatomical case preceding the selected extract. The translation preserves the difference between the tentative claim fortasse, “perhaps”, about the narrow blood vessels and the stronger non dubito, “I do not doubt”, about the cause of vomiting. It does not convert either level of historical confidence into a present-day demonstrated diagnosis. ^{[ref] [ref]}

The two mechanisms are not contradictory observations. Compression can narrow the entrance to the duodenum; hard, poorly contracting intestinal coats can fail to propel their contents onwards. Both impede gastric emptying, allowing retained material to provoke vomiting. This is an early example of connecting clinical observation with pathological anatomy. Nevertheless, gross hardness, described as scirrhous, does not by itself supply a modern microscopic diagnosis of scirrhous carcinoma. The descriptive term scirrhous hardening is therefore kept distinct from that modern category. The separate assertion about the pancreas likewise cannot identify its precise disease from this extract alone.

The Sepulchretum by Théophile Bonet is an earlier compilation of anatomical observations. Its cited observation numbers are retained because they are part of the argument's trail of evidence, including the distinction between Section VIII and the additional cross-reference to Book I, Section IX. Subversiones literally means “upturnings”; in this context the reference concerns disturbances or upheavals of the stomach, not a political meaning. Ventriculus here is the stomach, not a cardiac heart ventricle. The printed word laevi near the end is grammatically unclear in its context; the translation gives the secure surrounding sense and does not silently assign it a patient's identity, an anatomical side, or a new causal claim. ^{[ref] [ref]}

The coin episode reports an attempted mechanical and chemical remedy, not a modern recommended treatment. In the text, mercury is supposed both to press the coin onwards through its gravitational weight and to reduce it by amalgamation with its silver. The report does not establish the contribution of each mechanism, the extent of the coin's alteration, or therapeutic safety. Its purported success should not be generalized from a historical anecdote. Modern toxicological information distinguishes the chemical forms of mercury and their routes of exposure: swallowed liquid metal is poorly absorbed, whereas vapour is readily absorbed and can cause serious harm. This distinction neither validates the historical intervention nor warrants the false correction that any swallowed metallic mercury must immediately produce systemic poisoning. ^[ref]

Modern investigation also separates obstruction from impaired movement. Endoscopy uses a flexible instrument with a camera to inspect the upper digestive passage for structural abnormalities; a gastric emptying scintigraphy test instead follows a meal containing a small radioactive tracer with an external camera. These examinations illustrate how the proposed impediment to passage can now be tested rather than inferred from vomiting alone. They are later developments, not techniques available to the author of this passage. ^[ref]

By 1867 the central change was from confidence in bloodletting as a general remedy to a disputed, increasingly restricted practice tested against clinical outcomes. Bloodletting includes opening a vein, local wet cupping, and the application of medicinal leeches. The history must explain both the theories that supported it and why clinical comparisons weakened that support.

Ancient explanations and qualifications. In the Hippocratic Corpus, disease could be explained through disturbances of bodily fluids. The four-fluid account underlying humorism named blood, humoral phlegm, yellow bile and black bile; restoring their proper mixture offered a rationale for evacuation. This was a historical explanatory system, not a modern description of blood composition. Nor was ancient practice uniformly indiscriminate. Aulus Cornelius Celsus describes bloodletting as a powerful intervention whose suitability depends on bodily strength and whether the condition represents excess rather than exhaustion. Galen likewise distinguishes whether evacuation is needed, whether it should be by venesection, and whether the patient can tolerate it; he discusses the site, quantity and repetition. Thus the ancient debate already included selection and restraint. ^{[ref] [ref] [ref]}

Medieval continuity and the instruments. The Canon of Medicine by Ibn Sina preserves a carefully qualified doctrine of venesection, including cases where removing good blood would leave harmful fluids behind. Its reasoning belongs to humorism; its distinctions should not be mistaken for verified modern indications. In late medieval Europe, bloodletting was also organized by calendars: a surviving Augsburg calendar for 1472 specifies supposedly favourable times according to the patient and the Moon. This documents an additional astrological framework, not evidence of therapeutic efficacy. ^{[ref] [ref]}

The material distinction between general and local removal mattered. Venesection opened a vein with a sharp instrument. Wet cupping combined superficial cuts in the skin with suction under a cup; Celsus describes bronze cups in which burning material reduced the enclosed air's pressure, and horn cups from which air was sucked through a small opening. Dry cupping did not include the cuts and therefore did not itself remove blood. Medicinal leeches provided another means of local removal. These instruments made depletion visibly demonstrable, but the visible removal of blood did not establish that a disease had been removed. ^[ref]

New physiology did not immediately settle treatment. William Harvey's 1628 account of blood circulation undermined the older picture of blood simply being supplied and consumed in the parts. His observations of venous valves and experiments with arm ligatures showed directional movement: filling below a ligature and the behaviour of compressed veins helped demonstrate return towards the heart. Nevertheless, a circulating blood supply could still be invoked to explain relief through depletion or redistribution. Establishing blood circulation and establishing the benefit of bloodletting were different questions. ^[ref]

In the early nineteenth century, François-Joseph-Victor Broussais's emphasis on local irritation and inflammation encouraged extensive use of medicinal leeches. This illustrates why changing theory could increase bloodletting: a local inflammatory explanation supplied a fresh reason to remove blood near the supposed seat of disease. The accompanying claims of efficacy still needed comparison with what happened under other treatments. ^[ref]

Comparative evidence weakened general claims. In 1835 Pierre Charles Alexandre Louis asked whether comparable patients with pneumonia did better when first subjected to bloodletting during days 1–4 than when first bled later. He explicitly considered age and other differences. This numerical method in medicine shifted attention from selected recoveries to outcomes in defined groups. His work restricted confidence in a large, general benefit; it should not be presented as a randomized controlled trial proving that every use was ineffective. In modern terms, these were observational studies: confounding by indication could make the earlier-treated group differ in severity, and surviving long enough to enter the later-treated group could introduce selection bias. Counting cases was an advance, but did not automatically remove these problems. ^[ref]

The dispute still alive in 1867. William Pulteney Alison defended earlier experience of benefit, while John Hughes Bennett opposed routine depletion and developed a restorative approach. One defence of the altered practice was the change-of-type theory of disease: formerly vigorous or “sthenic” inflammatory illness was said to have become weak or “asthenic”, so that measures once borne well were now inappropriate. The rival explanation was that understanding of pathology and the evidence about treatment had improved. Alison's 1856 argument and the contemporary 1858 review show that this was an active disagreement, not a completed unanimous rejection. ^{[ref] [ref]}

Bennett's 1864 discussion made the theoretical contrast explicit: an account centred on altered blood and vessels favoured depletion, whereas his account of tissue irritation and inflammatory exudation led him towards the opposite practice. That historical account of inflammation should itself be evaluated historically, rather than adopted as current pathology. The durable methodological lesson is that recovery after treatment is insufficient evidence of recovery because of it: acute disease may resolve naturally, as even the Latin extract acknowledges. Changes in theory, recognition of the patient's limited reserve, and comparative clinical observation together explain the retreat from routine bloodletting. ^[ref]

Present-day distinction. Contemporary venesection has specific indications: in haemochromatosis, removal of red blood cells helps reduce excess iron; in polycythaemia vera, it can reduce an excessive red blood cell burden. Those uses concern defined abnormalities, rather than correction of historical humorism or a general remedy for fever and inflammation. They are a modern explanatory coda, not knowledge attributed to the 1867 candidate. ^{[ref] [ref]}

Correlation of anatomical changes with disease and clinical observation. Gross findings and clinical symptoms do not, on their own, necessarily identify a modern microscopic mechanism.