Hellenistic biological sciencesR.J.KankinsonThe five centuries that separate Aristotle’s death in 322 BC from Galen’sascendancy in Rome in the latter part of the second century AD were fertileones for the biological sciences, in particular medicine. Nor is the periodsolely of interest to historians of science—for the methodological debatescharacteristic of the life sciences of the time shadow, and in some casesforeshadow, those which raged between the contemporary Sceptical andDogmatic schools. If our knowledge of the medicine of the period isnecessarily circumscribed by the fragmentary nature of almost all of oursources, and if the project of reconstructing the science is consequently allthe more difficult, the enterprise is none the less a rich, fascinating, andexciting one.
EMPIRICISM AND AETIOLOGYWhen Aristotle died, scientific theories, their nature and status, had alreadybeen the subject of intense debate for at least a century. The moretheoretical of the Hippocratic doctors, such as the authors of
On Regimen1.2 (who analysed human physiology in terms of fire and water) and
Nature of Man (who introduced the theory of the four humours: blood,phlegm, black and yellow bile), took issue with their empirically-mindedcolleagues, notably the writer of
On Ancient Medicine, who eschewed sucharcana, championing instead the cause of explanations grounded inexperience. That debate revolved around the issue of what science properlyinvestigates, and what sorts of explanation it should produce. Should it dealin grand theoretical structures, postulating hidden entities in terms ofwhich the course of ordinary observable events is to be determined (and, forthe practising physician, altered)? Or must it rather simply concentrate onestablishing a secure body of data concerning which phenomena areobserved to go along with which others? What, crucially, is the analysisand role of the notion of cause in science?These questions were posed with unprecedented sharpness in Aristotle’stheoretical works on science, most particularly in
Posterior Analytics and
Parts of Animals 1.Aristotle stressed that science must start from anempirical base (
Parts of Animals 1.1, 639b3 ff., 640a14 ff.; althoughprecisely how it should do so is obscure:
Posterior Analytics 2.19); but itmust also aspire to final exhibition in the form of a complete and rigorousdeductive structure, whose theorems can be seen to flow from itsfundamental axioms and definitions. Science’s explanatory force resides inthat dependency: a fact is explained when it is shown to follow as adeductive consequence of some causally prior and more basic facts aboutthe domain in question (
Posterior Analytics 1.2; cf. 113, 2 16–17).Aristotelian science seeks to make patent the total structure of reality, andis thus strongly realist in conception. The axioms are not merely arbitrarypostulates: they are the bedrock foundational facts upon which everythingelse depends. Yet such realisms are, of course, notoriously prone toepistemological attack; and Aristotelian realism was no exception. It is onething to assert that science ought to have some such form; quite another toexplain how we can know when we have actually arrived at it. Suchdifficulties form the core of the empiricist, and later the sceptical,onslaughts upon the scientific pretensions of those they called theDogmatists.
DIOCLES OF CARYSTUSLet us begin, however, with Diocles of Carystus:Those who think that one should state a cause in every case do notappear to understand first that it is not always necessary to do sofrom a practical point of view, and second that many things which existare somehow by their nature akin to principles, so that they cannotbe given a causal account. Furthermore, they sometimes err inassuming what is unknown, disputed, and implausible, thinking thatthey have adequately given the cause. You should disregard peoplewho aetiologize in this manner, and who think that one should statecauses for everything; you should rather rely upon things which havebeen excogitated over a long period on the basis of experience
[empeiria]; and you should seek a cause f or contingent things whenthat is likely to make what you say about them more understandableand more believable.(Diocles, in Galen,
On the Powers of Foodstuffs VI, 455–6 Kühn [10.10])<sup>1</sup>Diocles was a doctor. His dates are controversial, but he is very likely ayounger contemporary of Aristotle: and that text has unmistakableAristotelian echoes, so much so that Jaeger [10.55] was moved to makeDiocles a more or less orthodox Aristotelian. However, this is clearly anexaggeration: although Diocles agrees with Aristotle that not everythingrequires causal explanation, his reasons are not Aristotle’s.Aristotle took genuine first principles to be indemonstrable—that is whatit
is to be a first principle (
Posterior Analytics 1 2;
Metaphysics 4 3).Diocles however says only that some things are akin to first principles—hedoes not say that they
are. Moreover, anticipating a familiar Sceptical trope(the Fourth Mode of Agrippa: Sextus Empiricus,
Outlines of Pyrrhonism(hereafter
PH) 1 168, 173–4), he notes that theorists frequently merelyassume, without argument or justification, some hypothetical startingpointfor their systems in spite of its being a matter of controversy. Thephysician should offer explanatory accounts only where they arepedagogically helpful, basing his actual practice firmly on
empeiria.Indeed, Diocles does not even insist that such accounts be true—theyfunction simply as useful heuristic and persuasive tools.Diocles was concerned to combat what he took to be an overly simplifiedview of the powers of particular foodstuffs:those who think that things which possess similar juices [? humours]or smells or degrees of heat or anything else of this sort have identicalpowers
[dunameis] are mistaken, for one may point to many cases inwhich dissimilar things arise from things which are similar in theseways.(
ibid., Fragment 112 Wellmann)One rather needs to realize that ‘their nature as a whole is the cause’ oftheir particular powers. Diocles does not, then, reject theory or the offeringof
aitiologiai, causal accounts; and he is happy to recognize the existence ofpowers or faculties (quite what this involves will be of paramountimportance in what follows). But he opposes what he takes to be the toonaive and typological view adopted by some of his opponents (in this caseprobably Pleistarchus), a position which is at least compatible with thedescription of him (by Celsus:
On Medicine Proem 8) as a Hippocratic.
HEROPHILUSThis tentative attitude towards causal explanation was shared by the greatAlexandrian physician, anatomist, and physiological theorist Herophilus ofChalcedon (fl.
c. 260 BC). Herophilus was perhaps the first Greek doctorto practise systematic anatomical researches upon human beings basedupon dissection (the evidence is collected in von Staden [10.15—hereafterVS] ch. VI, T 60–129; see also 139–53), although he was not the firstsystematic dissector. That honour, like so many others, belongs toAristotle: and Herophilus was perhaps indebted to Aristotle in otherrespects as well.A methodological injunction of his is preserved, in slightly different forms,in two sources:let the
phainomena be said [
legesthai: perhaps ‘be stated’] first [
prôta:perhaps ‘to be primary’], even if they are not first.(Herophilus T 50a VS; cf. T 50b VS: the bracketed words point to theinterpretative problems).<sup>2</sup>This text has been compared (VS p.118) to the methodological proem to
Parts of Animals (1.1, 639b3–11), where Aristotle asks whether thenatural scientist should ape the mathematical astronomers by first studyingthe
phainomena and only then going on to state their causes. At 640a14–15 he answers his own question affirmatively; and our passage apparentlyechoes this (particularly if ‘
legesthai’ is translated as ‘be stated’). IfHerophilus really intends to recall Aristotle, then it is significant that hisdictum makes no mention of causes or causal explanation (although as itstands it leaves room for such explanations). Rather (on what is, onbalance, the most plausible interpretation) Herophilus urges us to treat thephenomena as being of primary importance, even if they may not (in thegenuine metaphysical order of things) be really basic. Whatever else may betrue, we need to start from the apparent facts, and only then (if at all)proceed to discover their underlying causes. This has an obvious Diocleanring; and it appears too that Herophilus is offering a more circumspectversion of Anaxagoras’s celebrated dictum: ‘the
phainomena are a glimpseof the non-evident
(ta adêla)’ (Fragment 21a).This is empiricism with a small ‘e’: science must start from the
phainomena: these are what need, in the famous Greek slogan, to be saved(cf. Lloyd [10.57]), and which science, ideally, tries to explain.Other texts attest to Herophilus’s reliance on experience,
empeiria:We find, however, that this Herophilus concedes no small importanceto experience, nay indeed, to speak the truth, he makes experience allimportant(T 52 VS)and he is said (T 53 VS) to have given an account of pulse-rhythm based onobservation and experience, rather than abstract rational theorizing.On the other hand, he did not reject theory altogether; indeed in theimmediately preceding passage (T 147 VS), Galen says that he ‘surpassedthe great majority of the ancients, not only in breadth of knowledge but inintellect’, citing as an example his ‘rational account’
(logos) of the arterialpulse. In fact, the historian Polybius went so far as to stigmatize the‘Herophileans’ (although not directly Herophilus himself) for relyingpurely on theory, and hence being about as much practical use as a pilotwho navigated from a book (T 56 VS). And while that charge is clearlyunjustified if levelled against Herophilus himself, none the less it is clearthat he was perfectly prepared to countenance theoretical speculation ofthe type that was to become anathema to the medical Empiricists (seebelow, p. 33), whose stance Polybius represents.What, then, was the relation for Herophilus between theory andexperience? This question is peculiarly difficult to answer, and not onlybecause of the fragmentary nature of our evidence; for that evidence,although incomplete, appears to ascribe to Herophilus two quite distinctand on the face of it incompatible attitudes. Let us approach them,however, by way of a brief treatment of Herophilus’s anatomicalachievements.Only three actual citations from his
On Anatomy survive (60–2 VS); buta wealth of testimonia attests to his comprehensiveness and to his influencein the field of general human anatomy. He gave a far more completeaccount of the structure of the brain than any of his predecessors (T 75–9VS; cf. [10.15] 155–9), distinguishing its main ventricles, discovering the‘calamus scriptorius’, and bequeathing to his modern successors the nameand description of the ‘torcular Herophili’.<sup>3</sup> His dissections of the eye wereof a calibre and detail quite unparalleled by any of his forebears (T 82–9VS): he was the first to distinguish the four membranes of the eye, as well asisolating the optic nerve. Indeed he is usually (and justifiably) credited withthe discovery of the functions of the nerves in general (Solmsen [10.69]; it
is disputed whether he or Erasistratus was the first to distinguish betweenmotor and sensory nerves: T 81 VS).Herophilus applied himself, then, to dissective anatomy withunprecedented vigour and attention to detail. However, hedoes not think that anatomical descriptions of the type which saythat ‘this part has its natural origin in that’ can produce any generalpreconception relevant to theoretical knowledge…; for the faculties
[dunameis] which control us are discovered from other
phainomena,and not simply from inspection of the part itself.(T 57 VS)It’s no good basing your account of the functioning of the body simply onits apparent structure, presumably because (and this was to be a Galeniccommonplace: see Furley and Wilkie [10.5] Introduction IV; Hankinson[10.45]) such structures, considered simply as inert constructions, tell younothing about how they actually work. Thus we need to examine ‘other
phainomena’, in this case presumably the observable effects of cutting orligating the connections between them in a living animal (again as Galenwas to do: see below, p. 349).At this point we may introduce another controversy. Herophilus and hisrough contemporary Erasistratus were both associated in anancient tradition with the deliberate vivisection of live human beings. Themost detailed (although by no means the only) evidence comes fromCelsus:So it is necessary [sc. according to Rationalist doctors] to dissect thebodies of the dead in order to examine their viscera and intestines.And they say that Herophilus and Erasistratus did this in the best wayby far, by cutting open criminals provided by kings from prison, andinspecting, while they were still alive, those parts which nature hadpreviously hidden as to their position, colour, shape, size,arrangement, hardness, softness, smoothness, connection, and theprojections and concavities of each, and whether anything is insertedinto something else and whether anything receives into itself a partfrom some other.(T 63a VS: cf. T 63b–7)This story has often been questioned, although not with good cause; andthere is no reason not to accept it. Celsus does not say that Herophilus (andErasistratus) vivisected in order more directly to investigate functions assuch—but it is a highly plausible conjecture, since only by suchexperimentation on live creatures could the difference between motor andsensory nerves be discovered.And equally obviously it is only in living creatures that faculties
(dunameis) in this sense can be detected. T 57 VS cautions against toostraightforward and unreflective a set of mechanical assumptions regardingthe causal relations that hold between the parts of the body: merelyobserving that one is inserted into another is not enough to determinewhether the two are causally related, and if so how and in what direction.Such inferences can only be made on the basis of the observation of thestructures at work. Herophilus apparently posited four faculties of livingcreatures (131 VS), one of which was the vital faculty (T 164 VS)—but ourevidence for these is exiguous in the extreme.The ‘vital faculty’ may be that which is transmitted through the coats ofthe arteries (in Herophilus’s view) to produce the pulse (which was ofsupreme importance in Herophilean diagnostics; he invented a water-clockfor more accurate time-keeping: T 182 VS; cf. VS pp. 282–4); and if he didindeed distinguish motor and sensory nerves, that would provide aphysiological basis for two more faculties (with thought as the fourth?)—but this is conjectural.At all events, Herophilus seems to have started with a conceptualanalysis of what it is that animals (perhaps particularly humans) standardlydo—and then to have proceeded, on the basis of anatomical investigation,to try and isolate the media via which these faculties were transmitted. Butas to precisely what the faculties consisted in, he perhaps maintained aprudent reserve.This brings us to the issue of Herophilean scepticism. On the basis of thefollowing reports in Galen’s
On Antecedent Causes (hereafterCP),<sup>4</sup> Kudlien [10.56] saw Herophilus as an important figure in the historyof Greek scepticism:Some people say that nothing exists as a cause of anything, whileothers, like the Empiricists, dispute whether or not there is a cause,and still others, like Herophilus, accept it on a hypothetical basis, andothers again—whose leader he [sc. Erasistratus]<sup>5</sup> was—rejected,among the causes, the antecedent…causes as not very plausible.(T 58 VS)What, then, does Herophilus say? ‘Whether or not there is a cause, isby nature undiscoverable; but in my opinion6 I believe I am chilled,warmed, and filled with food and drink.’(Herophilus T 59a VS)Presumably, to accept causes on a hypothetical basis7 is to accord them amerely provisional status: we may make causal ascriptions on the basis ofthe phenomena, but the phenomena do entail them—and hence we cannever know for certain that our causal hypotheses are correct (this isreminiscent of, but more sophisticated than, Diocles’ position). ThusHerophilus anticipates the second mode of Aenesidemus against theaetiologists (Sextus,
PH 1 180–1). This picture derives modest support fromT 59a, provided that we understand ablatives of agency (for example ‘bythe wind’, ‘by the sun’) with ‘chilled’ and ‘heated’ to square them with therepletion example. Herophilus then does not doubt that he is being(phenomenally speaking) chilled, heated, or filled up—but he cannot becertain that the sun (or whatever) is responsible for it (hence the cause is‘undiscoverable by nature’: although it is worth noting that Celsus reportsthat he held that all diseases have their causes in the humours:
OnMedicine Proem 14). That coherent and moderately sophisticated attitudein regard to causal ascriptions represents, I think, an improvement onAristotle’s theory of science.Thus the sceptical Herophilus seems to be a chimaera. Yet elsewhere inthe same passage, Galen accuses Herophilus of lacking the courage of hisconvictions:Having expressed doubt about every cause with many strongarguments, he is himself subsequently detected using them, by saying‘it seems this way to everyone’.(T 59a VS)This suggests that Herophilus offered an antithetical set of considerations,both for and against causes, in a manner reminiscent of the Pyrrhonists (cf.Sextus,
PH 3 13–30), where the majority opinion that causes exist isweighed against contrary abstract argument. Indeed immediately afterwardsGalen presents as Herophilean three general arguments against the veryconceivability of causes which were later to find a natural homein Pyrrhonism (they are rehearsed by Sextus:
Adversus Mathematicos (M) 9210–36). The arguments are similar in form, so one example will suffice:(1) If there are causes, then either (a) bodies cause bodies, or (b)incorporeals cause incorporeals, or (c) bodies cause incorporeals, or(d) incorporeals cause bodies;but(2) neither (a), nor (b), nor (c), nor (d);so(3) there are no causes.That argument is sceptical both in form and content; and from it ‘he drewthe inference that nothing is the cause of anything’.It is not clear what to make of these passages, but they are not obviouslycompatible with the earlier causal hypotheticalism—indeed, they seemclearly in conflict with it. It is one thing to have epistemological doubtsabout our access to the causal facts of the matter, quite another to impugntheir very metaphysical coherence. I confess I can see no very satisfactorysolution to this problem; but perhaps if we stress the fact that it is bynature (or perhaps ‘in their nature’) that causes are undiscoverable, wemight attempt one along the following lines. The difficult, perhapsimpossible, metaphysics of causation undermines any purely rationalisticattempt to create an aetiology: hence we can never give a satisfactoryaccount of what causal powers and causal transmission really are. On theother hand, empirical experience and investigation provide us with clearexamples of causal correlation—and we need no grand metaphysical theoryin order to investigate and establish them. It is perhaps no accident thatHerophilus talks neutrally of the ‘powers’
(dunameis) of the body: these areuncontroversial, empirically determined place-holders for whatever arcane,hidden facts in fact underlie them.
ERASISTRATUSHerophilus’s great contemporary (and accomplice in the charge of humanvivisection), Erasistratus, probably also lived and worked for some at leastof his life in Alexandria.<sup>8</sup> He too was an innovative theorist in anatomy(the differentiation between motor and sensory nerves is also attributed tohim: Fragment 39 Garofalo [10.6]—hereafter G), and in physiology, wherehe introduced the theory of
triplokia, the triple plaiting of three basic typesof vessel (nerve, artery and vein), which he held to be the fundamentalelements of all bodily tissue (Fragments 86–90 G. See further G, pp. 32–3).Our main source for Erasistratus is Galen; and he is generally hostile tohim (although he is much sharper with Erasistratus’s latter-day followers),pouring scorn on his rejection of ‘natural faculties’ of attraction, repulsion,and excretion (with which Galen chose to account for the functions of thebodily organs) in favour of the principle of
horror vacui as the agent ofinternal movements of material in bodies (Fragments 93–6 G).<sup>9</sup> But behindGalen’s polemic we may discern an Erasistratean attempt to reduce thephysical mechanisms needed to explain metabolism and generalphysiological functioning to the bare minimum required to explain thoseprocesses—and if Galen is sometimes justified in his particular criticisms, wemay none the less applaud Erasistratus’s reductionist zeal. Indeed we maybest proceed by following the outlines of Galen’s rebuttal of theErasistratean position.Erasistratus is lambasted by Galen for his anti-teleological belief thatsome organs (including the spleen and the omentum) fulfilled no function atall (
On the Natural Faculties II 33, 91, 132, 134; Fragment 81 G). YetErasistratus was not opposed to teleological explanation as such—in fact,he considered it to be the proper business of the philosopher (Fragment 114G; Fragment 83 G; cf. Fragments 77–8 G; and G pp. 45–6); his attitudeseems rather to be closer to that of Aristotle,<sup>10</sup> for whom some structuresof the body are not susceptible of direct teleological explanation. But forall that, and in spite of the relative exiguousness (and partiality) of thesources, an Erasistratus committed as far as possible to the explanation ofbiological functioning on mechanistic principles emerges with reasonableclarity. Erasistratus further rejected the humoural theory of humanconstitution (Fragment 92 G), for which once more Galen takes him totask. But even Galen is not always hostile to him, admiring his diagnosticacumen;<sup>11</sup> and Erasistratus was held in the highest regard in antiquity.From our point of view, Erasistratus’s most significant doctrines concerncauses. First of all (from a practical perspective) he held that all fevers arecaused by inflammations, which are in turn caused by transfusion
(paremptôsis) of blood from the veins (where it naturally belongs) to thearteries, where its presence is, for Erasistratus, pathological (Fragment 109G).The most important Erasistratean claim, however, concerns the status ofwhat came to be known as antecedent causes
(aitia prokatarktika),<sup>12</sup> theexternal factors responsible (in some medical theories, Galen’s included)for triggering the already-existing disposition of the patient into illness. Thebulk of Galen’s
On Antecedent Causes is devoted to refuting Erasistratus’scausal ‘sophisms’, by which he seeks to remove
aitia prokatarktika fromthe causal lists. Antecedent causes of disease include, standardly, suchitems as overheating, refrigeration, overwork, over-indulgence in food,drink, or sex, and the like. Such factors may not affect all equally—butnone the less (so at least Galen thinks) they are pathogenically relevant.This is precisely what Erasistratus denies. His greatest mistake inpathology, according to Galen’s view, was to deny the importance ofexternal heating and chilling upon the human body, which are (Galenholds) of great pathogenic moment; yet Erasistratus holds them responsibleonly for surface alterations in animals’ conditions, having no effect on theirinternal dispositions (Fragment 75 G).But Erasistratus’s rejection of such antecedent causes is theoreticallymotivated. He contends that heat and cold cannot be the causes of illness,since they are not invariably followed by it, and do not persist at the time ofthe illness:<sup>13</sup>In this way sophists find reasons for their arguments that attempt toshow that, even if on some occasion these things [i.e. antecedent heat,cold, etc.] harm weak bodies, not even then can they properly becalled causes. For if indeed they do act because of their own internalnature, and this action derives from themselves, then they must beseen to have an effect at all times.(Galen,
CP i 9–10)Later, Galen quotes from Erasistratus directly:Most people, both now and in the past, have sought the causes offevers, trying to ascertain and learn from the sick whether the illnesshas its origin in being chilled or exhausted or repletion, or some othercause of this kind; but this kind of inquiry into into the causes ofdiseases yields results neither true nor useful. For if cold were a causeof fever, then those who have been chilled the more should suffer thegreater fever. But this is not what happens: rather there are some whohave faced extreme danger from freezing, and who when rescuedhave remained unaffected by fever…. [And] many people whoexperience far worse exhaustion and repletion than that whichcoincides with fever in some others yet escape the illness.(Erasistratus,
CP viii 102–3; cf. xi 141–4; xiii 166–8)Similar arguments were, unsurprisingly, deployed by the Sceptics (Sextus,
M9 242–3). This argument has the effect of radically restricting the class ofitems allowable as causes: in effect, it stipulates that all causes must be
aitiasunektika, containing causes. The notion of containing causes originatedwith the Stoic idea that every existent object required some internal tensileforce to account for its persistence, that force being labelled its
aitionsunektikon. But the concept was soon redeployed by the doctors to covernot merely the persistence of objects, but the necessary and sufficientconditions of events and processes. Sextus defines
aitia sunektika as ‘thosein the presence of which the effect is present, and with the removal ofwhich it is removed, and with the lessening of which it is lessened’ (Sextus,
PH 315).Thus, containing causes are strongly functionally-correlated with theireffects (Sextus’s example is of the relation between a noose andstrangulation: the tighter the noose, the greater the strangulation).In this way Erasistratus seeks to deny the status of cause to anythingwhich does not meet these stringent requirements. It is however anothermatter whether he need be committed by this thesis concerning the properapplication of the term ‘cause’ to the view that no item, unless constantlyconjoined with some other, can have any causal relevance to it. Galensometimes tries to pin this on Erasistratus—but it is by no means apparentthat Erasistratus need accept this consequence. In fact Erasistratus allowsthat over-eating and exhaustion are implicated in the triggering of disease,although he apparently refused to grant them the title of causes.<sup>14</sup>The crucial component in the Erasistratean pathology of fever was
plêthôra. Plêthôra is vascular congestion caused by an influx of undigestedfood into the veins (Fragment 161 G). If the digestive system cannot copewith the excess of nutriment, and if evacuation does not take place byother means, the undigested food enters the veins, compressing the bloodand forcing it through the valves
(anastomôseis) between the veins andarteries (which normally contain only
pneuma), causing inflammation andfever (Fragment 198 G). However,
plêthôra can be treated before diseaseitself sets in; but once
paremptôsis takes place, disease is unavoidable. Evenso, these inflammations can be reduced by encouraging the blood to flowback through the
anastomôseis into the veins.Galen is concerned to emphasize the fact that external antecedent causesare causally relevant to that patient’s subsequent condition. Erasistratusasks why, of a thousand people who attend the theatre on a hot afternoon(and hence who are exposed to the same external conditions) only four getoverheated, and of these only one develops a full-blown fever: and infersthat antecedent heating cannot be a cause of illness. Galen replies that it isnot the
sole cause (which fact accounts for the differential response to it;some people are more constitutionally susceptible than others). But evenso, how can something no longer present be the cause of anything? Theoverheating occurs,
ex hypothesi, several hours before the actual onset ofthe illness.Erasistratus thus adopts two distinct theses:(1) nothing can be a cause unless it is actually producing its effect;and(2) nothing can be a cause unless it invariably produces its effect.Effectively, Galen rejects both of them, rightly: but Erasistratus’s positionis not negligible, and it requires a certain sophistication in causal analysisto rebut it.Erasistratus held that x was a genuine cause of y only if x at leastinitiated a sequence which was such that, other things being equal, y wasbound to result. Thus he treats
paremptôsis as being responsible for thefever, even though the disease can still be alleviated by the appropriateinterventions, since if left to run its own course, disease inevitably results.
Plêthôra, on the other hand, cannot be a genuine (i.e. proximate) cause,although Erasistratus allows its causal relevance. However, he clearlyrejects the notion that anything prior to the
plêthôra can be a cause, on thebasis of thesis (2).
THE EMPIRICISTSThus the theoretical contributions of the Alexandrians bring into centrestagethe preoccupation with the analysis and classification (as well as theepistemic justification) of the causal relation that was to characterize laterGreek philosophy and science. Central to this debate were the doctors ofthe medical sect known as the Empiricists. Empiricism had a long history.The founding of the school is usually attributed to Philinus (fl. 250 BC) andSerapion (fl. 225 BC), although, following the ancient penchant forcreating long and prestigious intellectual pedigrees, some Empiricists tracedtheir ancestry back to the fifth-century Sicilian doctor Acro.Serapion was connected with Herophilus; and it is plausible to seeEmpiricism proper as an outgrowth of the epistemological and explanatorycaution which we have seen evinced by Herophilus. But the Empiricists goa good deal further. Their method simply consists in the observation andrecording of phenomenal concurrences of events: therapies (bothappropriate and inappropriate) are indicated by the past course of events.If I see that pomegranates are efficacious in one case of diarrhoea, I shall bemoved to try them on another—and if that turns out well I shall be well onthe way to forming what the Empiricists called an experience, an
empeiria.Crucial to this is personal observation,
autopsia, although the initialdiscoveries are held to be the result of luck:The Empiricists say that the art comes about as follows: one hasobserved many affections in people. Of these some are spontaneous,both in the sick and the healthy (for example nose-bleeds, sweating, ordiarrhoea, or something similar which brings harm or benefit), eventhough one cannot see what it was that produced the effect. In othercases, the cause is obvious, although they too occur as a result ofchance, not choice. Thus it just so happened that someone fell, or washit or wounded in some other way, and that there followed a flow ofblood, or that somebody who was sick satisfied his appetites bydrinking cold water or wine, or whatever, each of which had either aharmful or beneficial effect. The first kind of beneficial or harmfuleffect they call ‘natural’, the second ‘chance’. But in both cases theycalled the first observation of such an event an accident, choosingthis name because one happens upon these things not by design. Theaccidental type of experience, then, is roughly like this. Theextemporary kind, however, is characterized by the fact that wedeliberately come to try something, led either by dreams or bysomething else to form an opinion as to what should be done. Butthere is further a third kind of experience, the imitative…wheresomething which has proved to be beneficial…is tried out again forthe same disease. This sort of experience has contributed the most totheir art. For when they have imitated, not just two or three but verymany times, what has turned out beneficial in the past, and whenthey discover that it has, for the most part, the same effect in the caseof the same diseases, they call such a memory a theorem, and think itto be credible and to form part of the art. But when they hadcollected many such theorems, the whole collection formed the art ofmedicine. …Such collections came to be called
autopsia by them…[which] consists in a certain kind of memory of what one has oftenperceived to happen in the same way. But they also called the samething
empeiria. History, however, they called the report of an
autopsia.(Galen,
On Sects (SI) 2, 2–3 Helmreich: trans. after Frede)<sup>15</sup>That sketch of the Empirical method prompts several questions which willbe taken up in the next section. But its general outline is clear enough.What the Empiricists are reacting against is the tendency of thetheoretically-minded physicians (whom they compendiously lump togetheras the ‘Dogmatists’ or ‘Rationalists’) to explain both disease and therapy interms of hidden internal conditions of the body which they must infer onthe basis of the
phainomena, the appearances. For the Empiricists all thatthere is are the appearances, and the theorems that are built up as a resultof them.Thus the debate between Rationalists (among whom are standardlyenrolled Diocles, Herophilus, Erasistratus, and Asclepiades) andEmpiricists turns, among other things, on the possibility of our havingepistemic access to a purely theoretical domain; and in turn it forms part ofthe central Hellenistic debate among the philosophers about the nature andacceptability of certain types of sign-inference. Here is not the place to domore than sketch that debate (reproduced most fully in Sextus:
PH 2 97–133;
M 8 141–299); but crucial to it is the classification of different waysin which something may be non-evident
(adêlon):Of matters, then, according to the Dogmatists, some are (a) preevident,some (b) non-evident; and of the non-evident, some are (i)totally non-evident, some (ii) temporarily non-evident, and some (iii)naturally non-evident. Pre-evident are those which come to ourknowledge from themselves, e.g. that it is day; totally non-evident arethose which are not of a nature to fall under our knowledge, such asthat the number of the stars is even; temporarily non-evidentare those which, although they possess an evident nature, are nownot evident to us because of certain external circumstances, as the cityof Athens is to me now; while the naturally non-evident are thosewhich do not possess a nature such as to be evident to us, such as thetheoretical pores.(Sextus,
PH 2 97–8)Things in category (a) are unproblematic—likewise no one claims to beable to have any sort of access to the items under (b i). Moreover, all alikeagree that the contents of (b ii) are accessible, by way of ‘commemorativesigns’: I see smoke on the horizon, although I cannot now see any fire; butknowing that there’s no smoke without fire, I infer that there must be a firethere, temporarily hidden from me. What distinguishes the Sceptic or theEmpiricist from the Dogmatist is their attitudes towards category (b iii).The Dogmatists hold that we can legitimately infer purely theoreticalentities: in the paradigm case of such an inference (which will be ofimportance in the next section), the fact of sweating is an indicative sign(as they called them) of the existence of invisible pores in the skin. It is thelatter type of reasoning (or
analogismos, as they call it) that the Empiricistsreject. The important difference between it and the smoke-fire case is that,in the latter, we may simply perceptually verify the inference; but in thecase of (b iii), no direct perceptual confirmation can, by definition, beforthcoming. In a manner significantly reminiscent of the philosophicalSceptics, Empiricists chide Dogmatists for the rashness of their theorizing,for the way it outruns its evidential base. The only things they will alloware the Humean concatenations of evident events that make up the generaltheorems to be used in commemorative sign-inference—and even that is, inprinciple, defeasible.The Dogmatists treat the indicative sign as being ‘an antecedentproposition in a sound conditional, which is revelatory of the consequent’(Sextus,
PH 2 101). The Empiricists, like the Sceptics, urge that there canbe no such uniquely revelatory conditionals: there is in principle alwaysmore than one way to account for the evident facts (cf. The Eight Modes ofAenesidemus against the Aetiologists: Sextus,
PH 1 180–5); and in in anycase the Dogmatists are unable to agree among themselves as to what their‘signs’ are signs of:In the case of fever patients, flushing and prominence of the vesselsand a moist skin and increased temperature and quickening of thepulse and all the other signs…do not appear alike to all; but toHerophilus, for example, they seem to be definite signs of good blood,to Erasistratus of the transference of the blood from the veins to thearteries,<sup>16</sup> and to Asclepiades of the lodgement of theoretical particlesin the theoretical interstices.(Sextus,
M 8 219–20; cf. 189)And, again in obvious tandem with Pyrrhonian scepticism, the Empiricistspoint to the endemic and irresoluble disputes among the Dogmatists asproof that their ‘signs’ are nothing of the sort (
SI 5, 11–12 Helmreich).Moreover, there is no need for such theorizing: everything necessary tomedical science can be discovered on the basis of experience. Thus theEmpiricist accumulates collections of instances in which certain thingsfollow upon certain others. This collection is an
empeiria; and if it is bigenough, it will constitute a general theorem. It is worth noting that, for theEmpiricists, the relations that hold between the items in such theorems donot have to be universal and affirmative. They outlined a five-fold typologyof connection and disjunction according to whether things were seen to gotogether always, for the most part, half the time, rarely, or never: all ofthese are valuable in determining which therapies are, and which are not,appropriate.None the less, some Empiricists did allow another way in whichtherapies could be obtained, their ‘transition to the similar’
(hê touhomoiou metabasis). Transition is a form of analogical reasoning, to beused in cases ofdiseases which had not been encountered previously, or which wereknown, but for which there was no ready supply of medicines provenby experience. Hence they turned transition to the similar into ameans for finding remedies. By its means they transfer the sameremedy from one ailment to another and from one affected place toanother, and they move from a previously discovered remedy to onesimilar to it.(Galen,
SI 2, 3–4 Helmreich)Similar ailments may yield to similar medicines; and what works on onepart of the body may well work on another similar part. Transition, then,amounts to a method of discovery, but not yet to discovery itself,prior to testing. But as soon as you put what is expected to the test, itis already as credible (if the test is positive) as if it had been observedmany times.(ibid. 4)Thus transition does not itself generate theorems; but it suggests likelytestable candidates for them—and the Empiricists have a high degree ofconfidence in successfully tested transitional solutions.Even so, they are at pains to point out the distinctions between thislimited acceptance of inference and the opposing position of theDogmatists:Logical [i.e. Dogmatic] transition based on the nature of things layshold of knowledge by means of indication
[endeixis].<sup>17</sup> But theEmpirical variety relies on what is discovered by experience, notbecause it is persuasive or plausible that the similar shouldbe productive of something similar, or require similar things, orundergo similar things; it is not on the basis of this, or anything elseof this sort, that they think it justifiable to make the transition, but onthe basis of the fact that they have discovered by experience thatthings behave this way.(Galen,
Subfiguratio Empirica 9, 70 Deichgräber)Thus transition for the Empiricists is not, supposedly, grounded in anyconviction that its past successes render it objectively probable that theprocedure will deliver useful results; rather the Empiricist simply actsdirectly on the basis of past experience. It is plausible to assimilate theirposition here (as elsewhere) to that of Hume—we can provide no rationalbasis for our reliance on the procedures involved: but we are simplyconstrained by nature to behave in such a way.But even so, transition was a source of internal controversy within theEmpiricist school itself. This probably arose in the course of the debateswith the Rationalists, in response to the latters’ accusations that the basicEmpirical practice of
autopsia supplemented by
historia<sup>18</sup> is fatallycircumscribed: it is simply not rich enough to discover the whole art ofmedicine on its own (Galen, for example, claims that the cupping-glasscould never have been discovered by Empiricist extemporaneousness alone:
On the Affected Parts VIII 154). Thus, as a result of the on-going debatebetween the medical schools on the nature of allowable inference(paralleled of course in the great philosophical debates), some Empiricistscome to relax their original epistemological hard line:the question has been raised whether Serapion too believed thattransition to the similar is a third constitutive part of medicine as awhole. Menodotus taught that it was not, but that the Empiricist onlymakes use of transition, it not being the same thing to make use ofsomething and to treat it as a part. Cassius the Pyrrhonian even triesto show that the Empiricist does not even make use of transition of thissort…. Theodas did better in saying that transition constitutedreasonable experience. Others still have held that transition is morelike a tool.(
Subfiguratio Empirica 4, 49–50 Deichgräber)Galen’s caution about Serapion shows that by his day little was known forsure about the early history of Empiricism. Menodotus was the leadingEmpiricist of the middle of the second century AD (and hence the author ofthe Empiricism Galen is familiar with). The intriguing Cassius probablyflourished in the middle of the first century BC; and just as Aenesidemusabandoned an Academy gone soft and Stoic in epistemology to refoundPyrrhonism, so too Cassius reacted against the increasingly watered-downnature of Empiricist epistemology in order to rediscover its pristineoriginality.These debates, then, concern the acceptability of certain types ofreasoning, and what attitude the Empiricist should take to them.Effectively, Menodotus refuses to enshrine transition as a proper part ofthe Empiricist method of discovery. He allows that Empiricists do, in thecourse of their practice, make use of such manoeuvres: but it is one thing toemploy a procedure, quite another to endorse it.However one interprets the complex and shadowy history ofEmpiricism, it is clear that the more the Empiricists are prepared to allowsome form of reasoning (and perhaps hence of rational justification) intotheir practice, the harder it becomes to distinguish them from theirDogmatic opponents: and indeed Galen, true to his syncretist tendencies,discerned a convergence between the practices of the better Empiricists andthe more reputable Dogmatists. None the less, there will remain for eventhe most relaxed Empiricism a sharp distinction between what entities (andhence what types of explanation) each school will allow. The Dogmatistwill happily admit theoretical entities into his structures, and will use themin both physiological and therapeutic explanations: the
phainomena areindications
(endeixeis) of the hidden conditions of the body which areultimately causally responsible for its funtioning well or ill. By contrast, theonly indications the Empiricists allow are those afforded bycommemorative sign-inference, or
epilogismos, direct psychologicalsuggestions of therapies that have proved appropriate in similar conditionsin the past; and they will countenance no theory at all involving things bynature non-evident. A corollary of this is that all explanation for theEmpiricists will be epistemic in form: an Empiricist physician can explainwhy he adopts a certain course of action, in the sense of saying whatprompts him to do so—but he will have no views whatsoever on themetaphysical reasons (if any) why it should be effective.Of a piece with this rejection of theory is the Empiricists’ refusal to haveanything to do with anatomy, which they consider to be, for the most part,entirely useless (see Galen,
On Anatomical Procedures II 288–90). Theyattacked the Alexandrian practice of vivisection as being not only cruel butalso pointless (Celsus,
On Medicine Pr. 74–5; cf. 23–6, and Ts. 63b–c VS),since what if anything a physician needed to know was how the bodyfunctioned under normal circumstances—but there is nothing normalabout a body undergoing vivisection.<sup>19</sup>But if the Empiricists will have nothing to do with hidden causes andconditions, it appears that they are none the less prepared to admitantecedent causes,
aitia prokatarktika: for these are indeed evident events,and hence can be put into suitable Humean correlations with furtherevident outcomes. Thus when Galen seeks, in
SI, to offer a brief,thumbnail characterization of the differences between the major schools, heallows that the Empiricists (unlike the Methodists, for instance: see below,pp. 340–2) will admit antecedent causes into their account of the generalset of circumstances, surrounding the illness or
sundromê (
SI 8, 18–20Helmreich). Yet on the other hand Galen also reports (
CP xiii 162) that theEmpiricists refuse either to affirm or deny the existence of antecedentcauses. This apparent contradiction is, I think, easily resolved. What theEmpiricists refuse to allow is any theory of causal interaction—hence theywill have nothing to do with the Dogmatists’ theoretical accounts of howantecedent causes of the sort embraced by Galen and rejected byErasistratus can have the effects they apparently do. But that does notmean that they cannot treat them, in sound Empiricist fashion, as signsthat produce expectations of future occurrences. Why then call themcauses? Simply, the Empiricists (like the Pyrrhonists) do not botherthemselves with terminological disputes. Thus there is no real inconsistencyin the positions ascribed to them by Galen.<sup>20</sup>
ASCLEPIADESThe last section situated the development of Empiricism within the contextof their long-running dispute with their Dogmatist opponents thatparalleled the contemporary epistemological debates of the philosophicalschools. A key figure in that debate is Asclepiades of Bithynia (fl.
c. 125 BC).Galen’s early text,
On Medical Experience, rehearses a debate between aDogmatist and an Empiricist: the debate is fictional, but the bulk of theDogmatic polemic is ascribable to Asclepiades (Menodotus lies behind theEmpiricist reply). Asclepiades made a great reputation for himself in Rome,not least because of the pleasantness of the treatments he prescribed (a factwhich earned him the scorn of Pliny:
Natural History 26 12–15). But hewas not merely a panderer to public tastes: he elaborated a theory ofdisease in which the main pathogenic factor was the lodgement in andblockage of invisible pores in the body of invisible corpuscles (this featurehas often led people to assume that Asclepiades was an atomist of sorts: asVallance [10.70] demonstrates, that conclusion is unfounded andpremature). Moreover, as far as we can tell (the evidence is fragmentaryand very difficult to assess) he accounted for motions of fluids within thebody (and perhaps outside it) on the principle of ‘movement towards therarefied’
(pros to leptomeres phora), a modification of Erasistratus’s
horrorvacui.<sup>21</sup> Galen takes him to task both for this and for his abandonment ofteleology (for example
On the Function of Parts III 464–71), and considershim to be in the same case as Epicurus (
On the Natural Faculties II 30–57).But most important from our point of view is his attack on Empiricism.Pliny takes him to task for being a medical parvenu, insufficiently versed in
autopsia and
empeiria (
Natural History 26 12); but it is clear from Galen’s
On Medical Experience that he was an implacable foe of Empiricism. Firstof all, he attacks the Empiricists’ right simply to help themselves to a pretheoreticalnotion of similarity, a notion he takes it that they require inorder to ground their theorems. Diseases are infinitely variable: we requiretheory in order to determine what counts as relevant similarity betweenone condition and another, and what does not—but that is precisely whatthe Empiricists eschew (
On Medical Experience 3–4, 88–90 Walzer):What is more manifold than disease? How does one discover that adisease is the same as another in all its characteristics? Is it by thenumber of the symptoms, or by their strength and power?(
On Medical Experience 4, 89 Walzer)And mere hearsay of the sort afforded by Empiricist
historia cannotconfirm that it is precisely the same condition that is being experienced(ibid.).Moreover, even if this is allowed, how can the Empiricistspretheoretically narrow down sufficiently the indefinitely many distinctevents and factors that surround each individual case in order to makethem empirically tractable? Why, in default of theory, should one beconcerned about what patients ate, whether they overworked, wereoverheated, drank too much or had too much sex, rather than where theylived, what they had been reading and what types of clothes they wore(ibid. 6, 91–2)? The Empiricists thus require theory to sort out the relevantfrom the irrelevant, otherwise their syndromes will be too large to becontained even in a library (ibid. 7, 94).Finally, even if all these difficulties can be resolved, what is it that makesthe Empiricists’ ‘experience’ ‘technical’, i.e. constitutive of the art ofmedicine? For a single instance of observed connection is not enough:They themselves also say that what has been observed but once doesnot amount to anything technical; so what is observed very manytimes is composed of many things each of which is non-technical. Theargument could also be presented as follows…: what has beenobserved once is non-technical; hence the same is true of what hasbeen observed very many times.(ibid. 7, 94 Walzer)Finally Asclepiades asks: ‘how many times is many?’ Does the Empiricisthave an account of how frequently some conjunction needs to be observedbefore it becomes theorematic, some account ‘grounded in the nature ofthings’ (ibid. 95–6)? If so, then he is a theorist of natures
malgré lui. But ifnot, the Empirical ‘art’ is irremediably vague and without foundation.Moreover, it is vulnerable to a soritical objection: how can the addition ofone single instance (which the Empiricists allow is, on its own, evidentiallyinadequate) make the difference between having and lacking theorematicstatus (ibid. 96–7)?The Empiricists’ reply, in essence, is that the Dogmatists’ demands hereare misplaced. They, from their own avowedly theoretical standpoint,may think it necessary to provide an account of how many instancesvalidate a particular theorem; but the Empiricist is under no suchobligation. He allows that different cases provide for different degrees of(subjective) confirmation, but that is a fact about his own psychology,having nothing necessarily to do with the way things really are. All theEmpiricist does is describe a practice, in strictly psychological,associationist terms. Like Hume, he may be able to point to the mechanismswhich operate in particular cases to generate certain degrees of confidenceor expectation: but equally like him he will not produce any metaphysicaljustification of those attitudes. Thus as regards the sorites (ibid. 16–18,114–20), the Empiricist will not say how many times makes many. Theanswer to the question will vary from individual to individual and case tocase, since it is, at bottom, a matter of individual psychology rather thanlogic. Building up an experience is not a matter of inference—rather, afterobserving a certain number of particular cases, the Empiricist simply seesthat they exhibit a general pattern. Now, that pattern may ultimately proveto be misleading and chimerical (then it will be abandoned or modified inthe light of further experience): but past experience gives us (once moresubjective) grounds for hoping that it will not do so. Experience, then, doesnot license belief—it merely causes it. That position is, I think, coherent. Itmay not, for a variety of reasons, be satisfying, especially to anAsclepiadean Dogmatist—but mere dissatisfaction with it cannot show it tobe untenable.
ATHENAEUS OF ATTALEIA AND THE PRECEDING CAUSEWe noted above the crucial distinction insisted upon by Galen and othersbetween antecedent and containing causes. That distinction is a venerableone (traces of it are to be found in the Hippocratics); but the terminology ofantecedent and containing is usually ascribed to the Stoics. In a famousimage, Chrysippus compared the relation of external stimulus and internaldisposition in the case of human action to the rolling of a cylinder: itrequires a shove to get it going, but thereafter contains to roll
‘suapte vi etnatura’ (Cicero,
On Fate 49). The antecedent shove is necessary (althoughnot sufficient) for the initial movement—however, the movement continuesafter the shove has stopped, under its own steam, as it were: for that, thenature of the cylinder is a sufficient, containing cause. Chrysippus’sinterests were in showing how human beings could be part of a fullydeterministic causal nexus, in which their actions are conditioned by anineluctable fate (defined as the interrelations of antecedent causes), and yetstill be fit objects for moral appraisal: we can be praised and blamed forwhat we do because, after the initial stimulus, it is our dispositionalstructures (and our assent to the various presented impressions) thataccount for our actions.It is often assumed that a third type of cause, the preceding
(proêgoumenon) cause is also to be attributed to the Stoics, although this isfar from clear (no text unequivocally so ascribes it). The distinctionbetween antecedent and preceding causes is to be found in Galen, althoughhe does not invariably avail himself of it. Roughly speaking, however, thepreceding cause is an internal dispositional state which is roused intoactuality by the impact of the antecedent cause, thus setting in train what isnow the containing cause of the condition in question. An antecedent
(prokatarktikon) cause is evident, open to inspection, while a preceding
(proêgoumenon) cause is not: it is an internal state of affairs. Frede ([10.26] 242) remarks that such a distinction would have been at home inChrysippean psychology; but the rolling drum passage does not apparentlyadvert to it,<sup>22</sup> and it is not found elsewhere in surviving Stoic discussions ofpsychology and action. In fact, the distinction may well be medical inorigin, and due to Athenaeus of Attaleia.<sup>23</sup>Athenaeus (fl. ?
c. 100 BC) founded the Pneumatist school of medicine,which accounted for proper and improper physiological functioning interms of the states of the various internal types
of pneuma, or dynamicgaseous fluid, in the body. What matters for us, however, is not thestructure of his general physiology, but rather the causal taxonomy Galenattributes to him in
On Containing Causes 2 (
=CMG Supp. Or. II, 134.3–19). Galen explicitly says that Athenaeus was responsible for the tripartitedivision into antecedent, preceding and containing causes, where precedingcauses are the internally conditioned effects of external antecedent causes,but are not yet themselves containing causes of the illness. This account issupported by Pseudo-Galen,
Medical Definitions XIX 392; and one mayreadily see how such a distinction might commend itself to medicaltheorists. If this is right, then, an important refinement in Hellenistic causaltheory is owed not to the philosophers but to the doctors—and this is byno means the only such instance of philosophically important innovationsbeing made in the medical schools.
THE METHODISTSThe origins of the Methodist school of medicine, which arose early in thefirst century AD, are obscure, but it seems to have been developed out ofAsclepiadean corpuscularian physiology, first by Themison of Laodicea atthe end of the first century BC (who is generally thought not himself tohave been a Methodist), and completed by his pupil Thessalus, acontemporary of Nero.They held that there were two fundamental ways in which the parts ofthe body could become out of balance: they could either be too loose (andhence promote too free a flow of the bodily fluids) or too costive (with theopposite effect). In line with this magnificently simple pathology, theyrejected the patient’s causal history as being therapeutically irrelevant,claiming that the indication
[endeixis] as to what is beneficial, deriveddirectly from the affections themselves, is enough for them, and noteven these taken as specific particulars, but taking them to becommon and universal. Thus they also call these affections whichpervade all particulars ‘communalities’…which they call restrictionand relaxation, and they say that each disease is either constricted,relaxed, or a mixture of the two.(Galen,
SI 6, 12–13 Helmreich)The physician’s only task is to recognize the existence of these pathologicalstates, which, on the Methodists’ own account, he should be able tomanage without difficulty after a little practice (medicine could be learnedin six months, so they claimed), since these ‘communalities’ are notinferred, theoretical entities, but are in fact perfectly evident. Thus theMethodists reject antecedent causes, even in the sense in which theEmpiricists accept them. In an instructive passage (ibid. 8, 18–19) Galencompares the attitudes of Empiricists and Methodists to the case of a manbitten by a rabid dog. For the former, the dog’s condition will be relevant(mad dogs’ bites having been observed to be far more serious than others);for the Methodists, however, all that matters is the wound itself—and thatof course has nothing to do with the condition of the dog (Dogmatists willof course go further than the Empiricists, trying to specify how the dog’scondition can have had the devastating effect on someone’s internalconstitution).Indeed Sextus commends the Methodists for being closer to thePyrrhonians than the Empiricists are, sincethe Methodist speaks of ‘communality’ and ‘pervade’ and the like in anon-committal way. Thus also he uses the term ‘indication’undogmatically to denote the guidance derived from the apparentaffections or symptoms, both natural and unnatural, for the discoveryof the apparently appropriate remedies.(Sextus,
PH 1 240)And the Methodist, like the Sceptic, is driven by the ‘compulsion of theaffections’ to apply countervailing remedies.Moreover, it seems from Sextus’s account that Methodism, unlikeEmpiricism, does not even rely on the memory. One does not, apparently,need to develop an understanding of the communalities on the basis of longexperience; rather one simply sees them. And while the Methodists admitindication of sorts (cf. Galen,
SI 6, 14 Helmreich), it involves no inferencesof hidden conditions. In fact, the fifth-century AD medical writer CaeliusAurelianus<sup>24</sup> preserves a Methodist argument against sign-inference:Thessalus and his sect…argue thus: if there were sure and inevitablesigns of future events, such as the onset of phrenitis, allwho manifested them would necessarily develop phrenitis. But someof those who show these symptoms do not develop phrenitis.(Caelius Aurelianus,
On Acute Diseases 1 22)Moreover, Caelius continues:every sign is understood in relation to what is signified, since signsbelong in the category of relations. But can anything be called a signif the thing signified is not only not present now, but in some casesnever will be?(ibid. 1 29)This parallels Erasistratus’s claims about causes; and it is vulnerable to thesame objections. But even so, there is surely something to the anti-Dogmatic doctors’ claims that the endemic dispute among the Dogmatistsabout the relative significance of pathological signs at the very leastcompromises their claims to expertise.
GALENThus, by the beginning of the Imperial period, there were three majorcompeting groups of doctors in the Greco-Roman world, of which oneclass, the Dogmatists, includes a wide variety of different theoreticalstandpoints united only by a common belief in the importance of inferenceto the hidden, internal conditions of the body, and of producing theoreticalaetiologies for diseases. Moroever, as we have seen, Empiricism was not amonolithic orthodoxy—it came in different strengths, and evolved overtime. Equally even Methodism, whose hard-line early position wassketched above, came to soften some of its rough edges over time. Soranusof Ephesus (fl. early second century AD), whose
Gynaecology survives,allowed himself a good deal of doctrinal leeway. He was prepared to talk,against the original Thessalian orthodoxy, of causes and aetiology, andwould sometimes speculate on patients’ internal conditions.This is the world upon which Galen was to make such a deep and lastingimpression. Born into a well-to-do family in Pergamon in AD 129, Galenwas first broadly educated in philosophy (at the feet of some of the majorfigures of the day), and then equally well schooled in Dogmatist medicineand anatomy. For all that, Galen never underestimated the value ofempiricism: indeed his main contribution to medical theory andmethodology was his largely successful attempt to supersede and renderredundant the dispute between the schools by showing just what each ofthem had to offer to a synthetic medical method.But, for all his eclecticism, Galen was no mere indiscriminate plundererof the various previous traditions. Rather his aim is, in line with thegeneral tendency of the emerging Middle Platonist orthodoxy of the time,syncretic: he seeks to show how the best elements of the various schoolscan not only be combined to form a coherent whole—they are, in a deepsense, equivalent. And we can trace this drive both in medicine andphilosophy. Galen sought both to show how successful Empiricist andDogmatist practice could converge into a theoretically unified whole, andto demonstrate the fundamental agreement between at least the reputablephilosophical schools on all important issues of metaphysics andepistemology. But it should be stressed that this is no anodynecompendiousness—Galen is implacably hostile to Methodism (at least in itsoriginal Thessalian form), and he frequently lambasts representatives ofvarious Dogmatic schools, including Herophilus, Erasistratus, andAsclepiades for their perceived theoretical shortcomings (we have alreadybriefly noted some of these broadsides). Equally, he regularly attacksChrysippus and other Stoics for what he sees as their lack of logicalacumen, and insufficiency of rigour in argument. Sceptics in particularreceive short shrift from him (although, significantly, he reveals that as ayoung man he was seduced by Scepticism’s siren song, rejecting it onlyafter discovering the a priori certainties of geometrical demonstration:
OnHis Own Books XIX 49).And Galen is consistent in his expressed view that the pinnacle of allwisdom is to be sought in Plato in philosophy and Hippocrates inmedicine. Indeed, his monumental
On the Doctrines of Hippocrates andPlato (
PHP: V 181–805) is devoted to demonstrating the substantialagreement on all major points between his two great authorities (this is theclearest measure of Galen’s syncretism). Thus both of them (he contends)support a divided soul, whose rational faculty is located, contra Aristotleand the Stoics, in the brain, while emotion and desire find their seats in heartand liver respectively. Even so, Galen will not follow Plato slavishly—herefuses to commit himself one way or the other on questions such as theeternity of the world or the soul’s immortality, holding that such‘philosophical’ questions are beyond the reach of human knowledge; and ingeneral he will not treat any of his predecessors’ work, no matter howexalted, as holy writ.In fact, he considers his principal debt to the great ancients to be one ofmethod rather than substance: they pointed the way both to the discoveryand justification of true science, and it is the duty of all who follow in theirfootsteps to carry that programme to completion. Of course their task hasbeen rendered immeasurably harder by the proliferation of sophists andcharlatans whose only concern is with a quick and easy reputation at theultimate expense of their duped clientele, a fact which Galen harps uponthroughout his works. A passage of
On the Natural Faculties is worthquoting at length:Although the statements of the ancients on these matters wereaccurate, they did not support their case with logicaldemonstration; of course they did not suspect that there could besophists so shameless as to contradict plain facts. Of the moderns,some have been taken in by their sophisms, while others who havetried to argue against them lack, for the most part, the ability of theancients. For these reasons I have tried to construct my arguments onthe lines the ancients would have adopted if they were around to takeissue with those who seek to overturn the finest achievements of thescience. That I will achieve but little success, however, I realise. For Ifind that very many things which were conclusively demonstrated bythe ancients are unintelligible to most people because of theirignorance, or perhaps because of their unwillingness to come tounderstanding, which is due to idleness. And even if they have arrivedat any knowledge, they have not properly examined the issue. It isessential that anyone who wants to understand anything better thanthe ordinary run of humanity must far outshine them, both in naturalendowment, and in the quality of their early training. As a lad hemust develop an almost erotic passion for the truth, so that day andnight, like someone possessed, he will not let up in his desire to learnwhat was propounded by the most illustrious of the ancients. Andwhen he has learnt these things, he must spend a great deal of timetesting and justifying them, seeing what accords with the observablefacts and what does not; and on the basis of this he will accept somedoctrines and reject others.(Galen,
On the Natural Faculties II 178–80)That passage encapsulates many of Galen’s obsessions: with the necessityfor rigorous and lengthy training allied to innate ability (a combination heclearly felt himself to have been blessed with); the importance of logic ingeneral and demonstration in particular to the construction of medicalscience; the need empirically to test and confirm the results of any theorybefore accepting it (time and again Galen castigates his theoreticalopponents for failing either to see or to admit that their theories clash withthe evidence); and the moral degeneracy and inadequacy of the vastmajority of his contemporary opponents. These themes are ubiquitous inGalen—and they are of course highly rhetorically coloured. But that factalone should not cause us to dismiss his claims out of hand. Let us finally,then, see what they amounted to in a variety of different areas.First of all training and logic. These things go together, Galen thinks—itis because of people’s lamentable logical shortcomings that they are unableto see through the fallacies of the medical charlatans (Galen’s principal,although by no means exclusive, targets here are Methodists andErasistrateans) that surround them. Only by understanding logicalconsequence, and being able to expose equivocation and other similarsources of fallacy (
PHP V 795–7), will the young hopeful be able to exposethe sophistries of the medical degenerates (among which Galen classes, forexample, Erasistratus’s arguments against antecedent causation).Indeed the tiro doctor should acquaint himself with both Aristoteliancategorical and Stoic hypothetical syllogistic (in his syncretic manner,Galen thinks them to be but two sides of the same basic coin) in order tobe able to recognize and to construct valid arguments, and to expose theinvalid. Indeed, Galen wrote voluminously on logic (his fifteen-book
OnDemonstration is lost), of which only a short handbook, the
Introductionto Logic,<sup>25</sup> survives. The
Introduction briefly outlines the Aristotelian andStoic systems, before pointing out that neither is equipped to handle thesort of relational inference to be found in mathematics and elsewhere, forwhich he proposes the development of a third type of argument, therelational syllogism, arguments which have their validity ‘in virtue of anaxiom’ (
Introduction 16–18). Galen’s actual treatment of the logic ofrelations is limited and naive: but he deserves the credit for having seenclearly (and uniquely among the ancients) the syntactic inadequacies of thetraditional logics.But logic was not merely useful as a destructive weapon for rooting outbad argument. The proper model for science, Galen thinks, is Aristotelian,along the lines laid out in
Posterior Analytics (upon which Galen wrotecommentaries, now lost). Galen insists that all science, medicine included,is axiomatic in structure, proceeding from basic, indubitable axioms viasecure principles of inference to the theorematic derived truths. The axiomswill include logical laws (such as that of the excluded middle); but alsocomprehended are principles of mathematics (‘equals subtracted fromequals leave equals’), and various metaphysical principles such as ‘nothingoccurs causelessly’, ‘nothing comes to be from nothing’, and ‘nothing iscompletely annihilated’. These axioms are described as being ‘evident tothe understanding’, and anyone who rejects them is simply not worthy offurther consideration.But in addition to the class of things evident to the understanding, thereis a set of items which are equally evident to perception. Galen has no truckwith scepticism, accusing sceptics of bad faith and of subverting human life(
On Distinguishing Pulses VIII 782–6;
On the Best Method of Teaching I40–52). In fact, Galen thinks, it turns out upon analysis that even theAcademics agreed with the undeniability of things perceptually evident, anagreement they obscured by their insistence upon talking about the‘persuasive’ (
pithanon) as opposed to the true (
PHP V 777–8). Galen nodoubt minimizes the genuine differences that existed between the Stoic andAcademic epistemologies (he considers the Stoic criterion of the catalepticimpression to amount to no more than the common-sense view that whatis evident to perception is true); but equally it is worth pointing out that,by the end of the two-centuries-long debate between the schools, someothers (notably Antiochus and Aenesidemus, from their differentperspectives) could see little difference either. Galen is surely right to stressthe fact of pragmatic convergence between them.And just as he stresses the convergence of practice between the goodEmpiricist and the competent Dogmatist (above, p. 336) in the realm ofprescription and therapy, so here in epistemology his bent towardssyncretism manifests itself. At the end of the day, when all the dust hassettled, everyone who is not hopelessly ensnared in sophistry and illusionwill agree that the senses, in good condition and uncorrupted by disease,are criteria of truth: for we have nothing else to go on; and in any case,nature could not have provided us with such ‘natural criteria’ if they werenot, for the most part at least, reliable (
PHP V 725–6). That, admittedlybrief, attempt to justify his epistemological optimism serves as a convenientbridge into what is in many ways the most important feature of Galen’snatural philosophy: his teleology.Galen attributes his teleology, as so much else, to the example of Plato(of the
Timaeus) and Hippocrates:even if you are one of those who through ignorance of Nature’s worksaccuse her of lack of skill, I think you will repent with shame andchange your view for the better, agreeing with Hippocrates who iscontinually singing the praises of Nature’s righteousness and theforesight she displays in the creation of animals.(
On the Usefulness of the Parts (UP) III 235)A page or so later, he invites the reader to choose between two choruses:that surrounding Plato and Hippocrates, which exalts the purposivenessand foresight of Nature in arranging things in animals’ bodies for the best;and the other, which denies Nature’s skill and claims that many things arecreated by her to no purpose.The invocation of Hippocrates is a trifle strained; and while Plato in the
Timaeus clearly outlines a natural teleology, and one which does indeed inimportant respects anticipate Galen’s own, it is clear that, insofar as thedetailed working-out of his teleological conception of nature is concerned,it is the Aristotle of
Parts of Animals to whom he is most indebted. But ifthe detail is Aristotelian (although Galen claims to expand upon andadvance Aristotle’s position), the form of the teleology is indeed Platonic:for Galen, unlike Aristotle, attributes the teleological structure of nature toa divine artificer, whose praises he sings contantly throughout
UP, andwhom he calls, in conscious recollection of the
Timaeus, the Demiurge.Thus there is no doubt on which side of the great ancient debate betweenteleology and mechanism Galen will find himself: he is particularly harshon those who (such as Epicurus and Asclepiades) wilfully refuse, as he seesit, to recognize the providential form of Nature. His reason for ascribingnature’s purposive structure to a Demiurge is a simple and familiar one (itis to be found also in the Stoics, and appealed to the young Aristotle:Cicero,
Nature of the Gods 2 95): if one compares the construction of thenatural world with the work of any human artisan, one will immediatelyrecognize a basic similarity in design, although the former by far outshinesthe latter in beauty, functionality, economy, and goodness (
UP III 238–9;IV 346–66). Thus if it is absurd to suppose that any human artefact mighthave come about by chance and undesigned, how much more so in the caseof the natural world. That version of the Argument from Design iscurrently out of favour; but it is so only because we possess far moresophisticated conceptual resources (in the form of cybernetics, andDarwinian notions of natural selection) with which to explain howunplanned, mechanically produced structures can none the less mimicdesign. The ancient mechanists, lacking such resources, were woefullyinadequately equipped to offer any such account.<sup>26</sup>It is from this perspective that he takes Asclepiades to task in aninstructive passage from
UP (III 464–71), in which he endorses theAristotelian system of Four Causes (although he assimilates the FormalCause to the Platonic paradigm, and elsewhere in his works makes noreference to it), with the Middle Platonist addition of the InstrumentalCause, that with which something is brought about (cf.
CP vi 54–67).Asclepiades held that the ‘venous arteries’ (i.e. the pulmonary veins)became thin (unlike other arteries) because of their hard work; Galen holds,conversely, that they were made that way in order to be able to work hard.Thus Asclepiades gets the primary direction of explanation the wrong wayround, because he fails to allow for purposiveness in nature; and he fails tosee ‘that the arteries of the lung are venous and the veins arterial because itis better so’ (
UP III 469). They are made thin by the Artificer in order thatthey may perform the function they are supposed to; their thinness is amere instrumental cause, ‘the most insignificant of all, and which I believeanyone versed in the philosophical method would not call a proper causeat all, but one that is contingent or consequential, like a counterfeit drachma’(ibid. 466; moreover the whole debate is vitiated by the fact that the ancients,lacking a circulatory account of the vascular system, mistook thepulmonary artery for a vein and vice versa).Elsewhere (
CP vi 67), Galen says that the final and efficient causes are themost important, followed by the instrumental and material; but Galen doesnot underestimate the importance of the latter—it is precisely by appealingto material factors that he can circumvent Erasistratus’s ‘sophism’ againstantecedent causes. Thus he appropriates three at least of Aristotle’scanonical tetrad; the efficient and material causes are readily furtherassimilable to the Stoics’ active and passive principles (cf. Sextus,
PH 3 1–2),and the Stoics too invoked purpose and design, the final cause. Moreover,Galen takes advantage of the conceptual distinctions made by the Stoics inphilosophy and people such as Athenaeus in the medical tradition (seeabove, p. 340) in order to refine the notion of an efficient cause. Theresulting structure gives him an explanatory model of great power andflexibility.It remains to consider Galen’s attitude towards the relations betweentheory and practice, reason and experience. We have already seen Galen’sown report of how the dispute between the Dogmatists and the Empiricistsplayed itself out in terms of an increasing convergence between thepractices of at least the more reputable representatives of each tendency.Galen himself, in his own voice, underlines the need to appeal both toreason and to experience in order to arrive at a coherent and empiricallyadequate medical theory. On the one hand, he denies that the pureEmpiricism of Cassius could ever have arrived either at complex remediesor at the discovery of such useful tools as the cupping-glass. On the otherhand, theory without experience is blind: only by repeated testing ofexpected theoretical outcomes at the tribunal of experience
(peira) can atheory be validated.This is, of course, of a piece with his view that some things are evident tosense-perception; but unlike the Empiricists, Galen does not think that
peira can be relied upon to deliver the candidates for theorematic statusthat are to be the subject of empirical testing—that is the role of theory, or
logos. That is,
peira is necessary for testing the results of logicaldeductions, but is on its own insufficient to discover the whole truth ofscience—in modern parlance, it functions in the context of justification,not that of discovery (cf. Galen,
On Hippocrates’ ‘Nature of Man’ XV 152–3). At MM X 29, he puts it slightly differently:
logos serves to demonstratethe soundness of causal explanations,
while peira assesses the results;moreover,
logos and peira should be kept strictly separated and notconfused, although any not thoroughly versed in the demonstrative methodshould restrict themselves
to peira (ibid. 30–2). But even though theEmpiricist may discover some therapies by his own method, his practice isfatally restricted—he lacks the means to progress logically from one item toanother (ibid. 486; cf. 608, 628, 901).<sup>27</sup>Furthermore, Galen is implacably opposed to the Empiricist line thatanatomy is pointless: on the contrary, it is a vital tool in the discovery of thefacts of connection and disconnection among the parts of the body thatenable the competent theorist to deduce the functional relations that holdwithin it from facts of its structure.<sup>28</sup> In his treatise,
On AnatomicalProcedures (AA) he writes:anatomical study has one application for the scientist who lovesknowledge for its own sake, another for him who values it only todemonstrate that Nature does nothing in vain, a third for one whoprovides himself from anatomy with data for investigating a physicalor mental function, and a fourth for the practitioner who has toremove splinters and missiles efficiently, to excise parts properly, orto treat wounds, fistulae and abscesses.(
AA II 286)Thus anatomy has a variety of uses, theoretical and practical—but Galen isadamant that the sort of knowledge gained by the ‘adventitious anatomy’that the Empiricists allow is insufficient for the purpose (
AA II 288–9; cf.224) ‘Adventitious anatomy’ is the chance observation of corpses on abattlefield, or of skeletons exposed by flooding in a graveyard, as by Galenhimself (ibid. 221); and this underscores the fact that, by Galen’s time,practising anatomists were in a much worse case than their Alexandrianpredecessors. It had, in fact, become socially impossible even to investigatecorpses on purpose; and the bulk of Galen’s research was carried out onmonkeys, pigs, goats and other animals (ibid. 222–4). In order for this tobe productive, he had to rely on a theory of animal homology whichoccasionally led him astray—but for the most part, the fruits of thisresearch were impressive and original.One of his most remarkable results was the demonstration of thefunction of the recurrent laryngeal nerve in voice-production (
AA II 675–81) upon experimental animals, in the course of a precise and brilliantsequence of experiments on neural sections in the spinal column, in whichGalen showed how a ligature at a variety of different points variouslyaffected the animal’s abilities to move and to produce sounds. Theseexperiments are important not least for the fact that they
are experiments.It is often alleged that the ancients were innocent of anything that might becalled ‘the experimental method’ in science and there is something to thatclaim. Although ancient science abounds with reports of observations fromthe Hippocratics onwards, there is at least in the classical period scantevidence of anything we might recognize as experimental design: thedeliberate manipulation of selected variables in artificial conditions inorder to determine their various relations.But Erasistratus at least performed a recognizable experiment, by placinga bird in a sealed container, and weighing it before and after feeding, alongwith its droppings, in order to show that some of its body-weight had beenlost by invisible emanations; and Galen in several places reportsexperiments he claims to have carried out. They are not, it must beadmitted, uniformly well designed and performed. In
On the Use ofBreathing IV 504–5, he says that a boy was able to survive an entire daywith an ox-bladder over his nose and mouth to prevent him frombreathing; while in two places (IV 73 and II 645–8) he describes anexperiment involving severing an artery and inserting a thin tube linkingthe severed parts. Galen claims,
contra Erasistratus (whom he accuses ofnot having observed the phenomena), that the portion of the artery distalto the incision will exhibit no pulse, thereby proving that the faculty ofpulsation is carried in the arterial walls, and does not result from thepumping of the blood itself. But as Harvey, who repeated the experiment,observed, it is extremely difficult to effect such a severance and junctionneatly, and in any case, the relative absence of pulsation distal to the cutcan be explained on other grounds consistent with the pulse’s being causedby the blood-flow.<sup>29</sup> But whatever the particular shortcomings ofconception and execution, it is clear that by Galen’s time appeal toartificially created experimental circumstances in order to support ordisconfirm a theory was an established part of scientific procedure. Thereis a theoretical motivation for this: this is part of the
peira which tests andconfirms the discoveries of
logos.This methodology can be seen at work in
On the Doctrines ofHippocrates and Plato in Galen’s rebuttal of the Stoic (and Aristotelian)doctrine that reason was located in the heart rather than in the brain. Hebegins by distinguishing, in Aristotelian fashion, between properly scientificpremisses, which are ‘found in the very essence of the matter underconsideration…we should first state the essence and definition of the thingunder consideration, and then use it as a standard’ (
PHP V 219), and thosewhich are ‘superfluous and irrelevant; and this is how a premiss that isscientific differs from one that is either rhetorical or sophistical’ (V 220).We begin, then, with conceptual analysis:The governing part of the soul, as even [the Stoics] allow, is thesource of sensation and drive. Therefore the demonstration that theheart is the location of the governing part must not start from anyother premisses than that it initiates every voluntary motion in theother parts of the animal’s body, and every sensation is referred to it.(
PHP V 219–20)But to determine that the heart really is the centre of voluntary controldemands empirical data:What can this be shown from…apart from anatomy? For if itsupplies the power of sensation and movement to all parts of thebody, then it is necessary that there be some vessel growing out of itto perform this service.(
PHP V 220)This vessel can be isolated on the basis of anatomical experiment: hence theimportance of the neural sections, which determine both what mediates thepsychic power (here as elsewhere Galen speaks in studiedly neutral terms),and its direction of flow. By tracing the neural canals backwards to theirsource we can establish that they originate from the brain, and hence thatit is the brain and not the heart from which voluntary motion arises and towhich sensation is referred. The argument is not innocent of certaincontrovertible causal assumptions, but it is typical of Galen’s willingness tomarry abstract argument to empirical investigation.<sup>30</sup>Finally, a word about the notion of a power or faculty
(dunamis). Wehave already noted Herophilus’s deployment of the concept (see above, p.325). Galen frequently speaks of powers: and where he does so it isprecisely in order to avoid too rash a set of claims regarding the actualphysical status of things. Thus he disavows knowledge of the substance ofthe soul (cf.
On the Formation of Foetuses IV 700–2); but he thinks itspowers can perfectly well be investigated.In
On the Natural Faculties he is concerned with enumerating andspecifying the function of various faculties that he discerns at work in thehuman body: thus, for instance, the kidneys possess (so he supposes) thefaculty of attracting urine (II 57–64, 74, etc.). Quite how they do so isanother matter; but that they do so is, Galen thinks, clear simply from theinadequacy of purely mechanical theories such as those of Erasistratus andAsclepiades to explain how the various bodily fluids get separated out andconveyed to their various proper places.And whatever the empirical and theoretical shortcomings of thisconcept, at least in these cases there is something attractive both about thecaution with which Galen essays his theorizing here, and, congruently, withthe weight he seeks to place upon the empirical facts. Theories, for him,must be empirically driven and answerable to the tribunal of experience.Galen thus represents the culmination of the development we havediscerned throughout the period of this study.
ABBREVIATIONSAA Galen,
Anatomical ProceduresCP Galen,
On Antecedent CausesDL Diogenes Laertius,
Lives of the PhilosophersG Garofalo [10.6],
ErasistratusMM Galen,
De methodo medendiPH Sextus Empiricus,
Outlines of PyrrhonismPHP Galen,
On the Doctrines of Hippocrates and PlatoSI Galen,
On SectsUP Galen,
On the Usefulness of the PartsNOTES1 Even where later and better texts of Galen’s work are available (as they are inthis case: Corpus Medicorum Graecorum V. 4.2), I generally refer to theedition of Kühn [10.10], since the later texts are (for the most part) keyed toit. Exceptions are noted where they occur.2 The sense of this lapidary fragment is disputed: see von Staden [10.15] andHankinson, review of this in
Phronesis 35 (1990). VS (125) translates ‘let theappearances be described first even if they are not primary’: but that readingrequires us to take the two occurrences of the word
‘prôta’ in completelydistinct senses, even thought there is no indication to that effect.3 This structure, the confluence of the four major cranial sinuses, is morecommon and more visible in animals than in humans, a fact which, alongwith his erroneous but influential ascription of a
rete mirabile to humans (T121 VS), has encouraged some to doubt whether Herophilus ever did in factdissect humans; but on the whole the evidence suggests that he did: see p.325.4 See Hankinson [10.49] for an edition, translation and commentary of thistext; it survives in a mediaeval Latin translation made by the Italian scholarNiccolò da Reggio.5 Galen clearly refers here to Erasistratus, who was mentioned by name in theprevious sentence (and who is the principal target of
CP), and not toHerophilus, as von Staden suggests: [10.15] 136. See Hankinson [10.49] adloc.6 Niccolò’s Latin reads: ‘quid igitur ait? “causa vero, utrum sit vel non, naturaquidem non est invenibile, existimatione autem puto infrigidari, estuari, ciboet potibus repleri”.’Von Staden renders
‘existimatione’ as though it stands for
‘exhupotheseôs’; but Niccolò’s
‘ex suppositione’ of T 58 VS clearly translates
‘exhupotheseôs’: and he was careful to render technical terms unambiguously.Thus
‘doxêi’ or the like seems more probable (so Bardong in his‘Rückübersetzung’: CMG Supp. II, p. 53), yielding my translation. VonStaden’s sense is undeniably attractive, and perhaps the text should beemended; but as the text stands it recalls the Pyrrhonist Timon of Phlius’remark that ‘I do not claim honey is sweet; but I agree it seems so’ (DiogenesLaertius
Lives of the Philosophers 9 105 (hereafter DL)); which perhapsargues against emendation.7 Von Staden misleadingly compares the Aristotelian doctrine of hypotheticalnecessity (
Physics 2:9;
Parts of Animals 1:1) with Herophilus’ causalhypotheticalism—but there are no significant similarities between them; seeHankinson in
Phronesis 1990, 209, n. 30.8 This is a matter of dispute: see Fraser [10.25] and Lloyd [10.58] for opposingviews.9 On the Erasistratean principle of
horror vacui, see Garofalo [10.6] 33–5; andVallance [10.70] especially ch. 2.10 This may not be accidental: Erasistratus is said to have studied withTheophrastus in the Lyceum (DL 5.57; cf. Fragment 7 G).11 In particular his celebrated diagnosis of love-sickness by a method Galenhimself repeated: he took the woman’s pulse, and reeled off an apparentlyrandom list of names. When the woman’s pulse suddenly quickened, Galeninferred that she was enamoured of the man he had just mentioned:
OnPrognosis XIV 630–5; cf. Nutton [10.66] 195–6.12 For the history of the development of the concept, see Frede [10.26];Hankinson [10.37], [10.38] and [10.49]13 See
CP ii 9–10; vi 46; viii 96–114; Hankinson [10.49].14 Garofalo ([10.6] 30) thinks that Erasistratus called them ‘origins
(archai)’ ofdisease: Fragment 162 G; 223 G; but it seems rather that Erasistratusreserved the term
archê for the condition of
plêthôra consequent upon them:see further below. On these issues in general, see [10.6] 29–31.15 I here depart from my usual practice, and refer to
SI by way of Helmreich,1893, since Frede’s English [10.4] is keyed only to that text.16 This is the famous
paremptôsis of Erasistratean pathology (although Sextususes the term
‘metaptôsis’): for Erasistratus, all fever was consequent uponinflammation caused by blood being forced through the
anastomôseisbetween the veins (in which in normal circumstances the blood resides) to thearteries, where it has no business being.17 ‘Indication’ here is equivalent to indicative sign-inference.18
Historia did not, for the Empiricists, involve an uncritical acceptance of allreceived testimony: on the contrary, they elaborated a complex andsophisticated system of assessment of the relative value of different testimony(according to how far it cohered with other parts of the art alreadydiscovered, and on the basis of the past reliability of the source in question).19 On the Empiricist attitude to anatomy, see Hankinson [10.50].20 For more on this, see Hankinson [10.38]; and on the nature of antecedentcauses in general, Hankinson [10.37].21 See Vallance [10.70] ch. 2, for a careful analysis of the (principally Galenic)evidence, and a reconstruction of the theory.22 However, this turns on tricky issues in the interpretation of Cicero’s Latinrendering of technical Greek terminology: see Sedley [10.68] and Hankinson,forthcoming [10.52].23 See Hankinson [10.37].24 Caelius’s two treatises,
On Acute Diseases and
On Chronic Diseases, areLatin adaptations of lost original works of the second-century MethodistSoranus of Ephesus.25 Not discovered until 1841, and hence not edited by Kühn; see Kalbfleisch [10.9].26 I discuss this in Hankinson [10.41], and [10.43].27 On all these issues, see further Barnes [10.19].28 On the relation of structure and function in Galen, see Furley and Wilkie [10.5] and Hankinson [10.42].29 See Furley and Wilkie [10.5] 51–3.30 See also Galen’s criticism of the Stoic argument against the view that themind is located in the brain from the fact that voice passes through thewindpipe (
PHP V 241).
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