Which did galen influence

He was fundamentally sincere in his belief that the truth in medicine required diligent application, and liberal education [4]. Not surprisingly Galen states that this was exemplified by himself but Hankinson believes he was capable of intellectual modesty and had the ability to change his mind. Perhaps, as Hankinson states, he saw himself as a man on a heroic mission to rescue medical science from its current poor state.

Galen had a detailed knowledge of earlier medical and philosophical writings, particularly Hippocrates, Aristotle and Plato [1]. Lack of philosophical training, especially in logic, physics the science of nature and ethics, was a criticism Galen frequently levelled against his opponents [18].

There were two main competing theories of bodily structure. A continuum theory was based on the idea of the four primary elements or qualities involving humours which Galen supported. The atomic theory supported the view that all matter consists of minute, discrete particles espoused by Asclepiades [1]. Galen was remorseless in his opposition to atomist theories which ultimately prevailed and scorned the Empirics.

He was very much linked with the Rationalists or Dogmatists [25]. Galen took from Aristotle teleological explanations in his writings and felt that the purpose of everything was predetermined. There was, of course, a certain popular appeal in the concept that the presumed function of an organ was because nature must have given it a purpose [6].

He understood the uncertainties and fears of the sick, as well as the interrelations of emotion and bodily symptoms, elaborating the four fundamental humours into four personality types. These terms, phlegmatic, sanguine, choleric and melancholic, are still in use today [6]. Galen wrote on the importance of trust, bedside manner, adequate explanation and the mastery of prognosis in the doctor—patient relationship [17].

Galen considered his development of pulse doctrine as his greatest contribution to diagnostic medicine with over 1, pages of text in 16 volumes [4]. There were four treatises, each consisting of four books with robust classification and description of pulse types together with the influence of innumerable internal and external factors [18]. Although Galen made large scale use of medications, he relied on tradition and experience with his pharmacological writings coming from the latter part of his life [9].

He often relied on polypharmacy, preparing his own prescriptions, and classified medications according to the humours and qualities of hot, cold, dry and moist [6]. Galen made extraordinary advances in anatomy which were not challenged until the time of Vesalius. His dissections were of animals, primarily pigs, dogs, goats, apes and sheep [18], which he then extrapolated to human anatomy resulting in some noteworthy errors. He described a wealth of accurate detail including the venous connection to the heart, the autonomous nature of the heartbeat and the demonstration that arteries contain blood, not air [26].

Galen was the first to describe the ureters with their function, as well as organising the bones of the skeleton with their muscle attachments [6]. Galen acknowledged his debt to the Alexandrian school, especially Herophilus [1] and Marinus, who he singles out as having resuscitated anatomy after it had fallen into neglect [8].

His public displays of anatomy in Rome were well executed and erudite, impressing medical colleagues as well as the public. Galen produced a completely systematized approach to anatomy and used anatomical knowledge as evidence of excellence in medical practice [8].

Nowhere is this shown more clearly than his neuroanatomical studies which, arguably, were the origins of the experimental neurosciences. Then you can show that the animal cries out when struck, but that it suddenly becomes silent after the nerves have been tied. The spectators are astonished. They think it wonderful that voice is destroyed when small nerves… are tied. Should the brain be compressed on both the two anterior ventricles, then the degree of stupor which overcomes the animal is slight.

Should it be compressed on the middle ventricle, then the stupor of the animal is heavier. And when one presses upon that ventricle which is found in the part of the brain lying at the nape of the neck, then the animal falls into a very heavy and pronounced stupor. This is what happens also when you cut into the cerebral ventricles, except that if you cut into these ventricles, the animal does not revert to its natural condition as it does when you press upon them.

Nevertheless it does sometimes do this if the incision should become united. This return to normal condition follows more easily, and more quickly, should the incision be made upon the two anterior ventricles.

But if the incision encounters the middle ventricle, then the return to the normal comes to pass less easily and speedily. And if the incision should have been imposed upon the fourth, that is the posterior ventricle, then the animal seldom returns to its natural condition. Although, nevertheless if the incision should be made into this fourth ventricle, provided that you did not make the cut very extensive, that you proceed quickly, and that in the compression of the wound, in some way or other, you employ a certain amount of haste, the animal will revert to its normal state, since the pressure on the wound is then temporary only — and indeed especially in those regions where no portion of the brain overlies the ventricle, but where the meninx only is found.

You then see how the animal blinks with its eyes, especially when you bring some object near to the eyes, even when you have exposed to view the posterior ventricle. Galen lauded the tradition of medical and scientific explanation dating back to Hippocrates, Plato and Aristotle.

He was a master rhetorician, combining the Platonic triad with the Aristotelian physic of four elements and humours, and produced the first coherent synthesis of structural and functional physiology. His achievements in anatomical science in antiquity are unequalled [8]. His explanations brought anatomy, logic and experience together [18]. There is no doubt he was a major force in medical thinking in his own time and a dominant influence for centuries after his death [1].

As Porter states, Gaelic medicine was monumental which Galen intended it should be. Perhaps his most timeless treatises are those where he emphasises the importance of philosophy in medicine and, even today, his writings could be taken as a model of how fundamental theoretical issues in medicine should be approached [1].

This remains of enduring relevance. Galen brought neuroanatomical knowledge and physiology together in his study of the brain and nerves using experimental methodology which arguably represent the zenith of neurological investigation in the ancient world. His description of experiments on the exposed animal and animal brain is remarkable and, in my view, depicts the origins of experimental neurosurgery. Johnston IJ. Galen on Diseases and Symptoms.

Cambridge: Cambridge University Press; Nutton V. The fortunes of Galen. Hankinson RJ, editors. In: The Cambridge Companion to Galen. New York: Cambridge University Press. John Caius and the manuscripts of Galen. Cambridge Philological Society.

Hankinson RJ. The Man and his Work. Hankinson, RJ, editors. In: The Cambridge Companion to Galen.. Galen on the Natural Facilities. Encyclopaedia Britannica, Inc. University of Chicago: William Benton. Medicine, Walton R, editors. This page is best viewed in an up-to-date web browser with style sheets CSS enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience.

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Galen c. World War One Centenary. Rather, teaching in these contexts—as in that of logical argument and knowledge acquisition—is a constant process of supervision and correction of errors. Above, we considered the role of logical demonstration. We should consider further the role of mathematics and geometry: Galen looks to these as providing a model of the possibility of certain knowledge, and a refutation of Skepticism. A key example is that of the building of a sundial: if one has done it correctly, the facts themselves—e.

So, Galen is optimistic about the attainability of reliable knowledge. Yet the examples of mathematics and geometry at the same time point to the most obvious challenge to this epistemological optimism. For, surely, the gulf between the level of certainty available in those areas and that and that possible in the study of the biological world, let alone in the medical examination of individual cases, is an enormous one.

In all such cases, it seems, a method proceeding from reliable empirical starting-points and applying sound logical method and where relevant training the perceptual senses may lead to secure knowledge. On the other hand, in clinical practice we make the transition from propositions of universal validity—the sort which Galen believes himself able to arrive at in the way seen above, through the application of logical method on the basis of evident starting-points—to the particular case; and Galen problematizes this difference between general or universal katholou and individual or particular idion Chiaradonna , van der Eijk Each individual case is different; moreover, the existence is acknowledged of empirical experiences which are not expressible in words Dig.

This suggests a conclusion of considerable epistemological interest, namely that there are individual phenomena which cannot be fully incorporated in the universal scientific account. Central to the understanding of clinical practice, too, is that we are here dealing with a system of symptoms or signs; and inference from signs cannot give one the same kind of secure knowledge that is available for propositions arrived at through demonstration. Galen here engages in what was already a complex and sophisticated area of discussion, drawing on both Hippocratic texts e.

As we have seen Galen, unlike the Empiricists, believes that the observation of bodily signs—a complex range, for the ancient doctor—enables the expert to make inferences about the underlying bodily state and causal conditions.

Galen remains confident about epistemic success in this area too; yet it is important to make the appropriate distinctions in relation to certainty and demonstrability. Galen claims that in his youth—partly in response to the confusion caused by mutually contradictory philosophical sects, all claiming certainty on unprovable issues—he nearly succumbed to the lures of Skepticism Lib.

The above possibility of certainty, as provided by mathematics and geometry, is what saved him. But an understanding of the limits of human knowledge is as important as the project of acquiring it in those areas where that is possible.

Galen is scathing about those who commit themselves rashly on insufficient evidence, and about philosophers who debate propositions on which demonstrative knowledge is impossible such as the existence and nature of the void outside the cosmos Aff. Yet the value of knowledge is not justified purely in pragmatic terms.

In Prop. This last category is in a sense the most interesting and Galenically distinctive. Perhaps, although it is not apparent from his dedicated—and highly polemical—discussions in Hipp. In spite of some strong apparently physicalist statements in this area, Galen consistently throughout the corpus denies that he knows the answer to this question Donini ; Singer 32—33 and Ch. The case is similar in response to the question, how information is transmitted into the embryo in the process of conception and foetal development.

But precisely who or what is responsible? How does the infant acquire, from birth or even before, the ability to perform all its innate functions? In an interestingly open-ended discussion in Foet. Galen explicitly states that, using theoretical reasoning in conjunction with empirical evidence, progress in knowledge is possible. He does, however, claim that progress in relation to the ancients is possible, and indeed that he has achieved it, in two chief senses.

One is that, for example in anatomy, he has made certain specific discoveries unknown to his predecessors; the other, more substantial in his presentation, is the project of giving solid demonstrative form to propositions which according to Galen were known to the ancients, but either stated by them without demonstration, or actually omitted from their writings Opt.

More specifically, Galen has an enormous explicit admiration for certain authors already regarded as classical in his time, most especially Hippocrates and Plato, and devotes lengthy texts to their exegesis. He is both influenced by previous authors and exercised to present his own views as consistent with a body of traditional thought. But his latter process is not a straightforward or uncritical one: different sets of authors are lined up as authority in different contexts; and authors highly respected in certain contexts become the object of fierce criticism in others.

On these issues see Lloyd ; Singer and , Ch. In practice, arguments from authority have considerable value for Galen, at least as a persuasive tool, in spite of his explicit denials of that authority status; and there are probably cultural reasons for his devotion to Plato and Hippocrates in particular. However, his claim not to be a slavish sectarian is borne out; and no one—not Aristotle, not Plato, not even Hippocrates—is exempt from criticism in particular contexts.

We have devoted considerable attention to the importance of logic for Galen in relation to the theory of demonstration and early intellectual training. Some account should also be given of his contribution to the broader theoretical study of logic, because—although not of similar relevance to epistemology or the theory of science—this contribution is, at least arguably, of considerable historical importance.

Certain caveats must be given at the outset. In an area of great technical complexity and interpretive difficulty, we can here attempt no more than the briefest summary of the main issues and points of discussion. In the context of Aristotelian syllogistic logic, meanwhile, there is some suggestion that he felt it necessary to posit a fourth figure in addition to the Aristotelian three. A final area of complexity and doubt concerns the relational syllogism, the introduction of which Galen claims as his innovation at Inst.

What seems clear is that Galen brought this new type of syllogism forward in response to what he perceived as inadequacies in both Aristotelian and Stoic logic; also that he believed it to be of particular relevance for proofs in geometry and mathematics. An example of a relational syllogism—from which such relevance is indeed clear—is:. Theo has twice as many possessions as Dio; but Philo has twice as many possessions as Theo; therefore, Philo has four times as many possessions as Dio.

One puzzling feature of relational syllogisms as presented by Galen is that he apparently sometimes does and sometimes does not mention the relevant axiom on which the syllogism depends, as part of the syllogism. What does seem clear is that Galen made a distinctive and in some ways influential and challenging contribution in this area, responding in an original way to both the Aristotelian and the Stoic logical tradition; and that even in the most abstract realm of logical analysis he retained a concern for the practical value of logic and its relatedness to things.

At the same time, where Galen gives an explicit listing of the number of different causes that may be used in such explanations, he refers explicitly to Plato and seems indebted to the Platonic tradition. In a passage of UP —the work which has the strongest Aristotelian echoes in this teleological sense—he gives a list of five causes, which seems closely related to one attested elsewhere in Platonist writing: final, efficient, material, instrumental, formal UP VI. On the other hand, the list comes in a dialectical context, and Galen is certainly not in general concerned to give accounts which mention all five.

Galen also makes use of a further set of causal categories, which are derived partly from the Stoic philosophical and partly from the medical tradition. Galen devoted two works explicitly to these causal concepts, CP and CC ; see further Hankinson b, a. The other two categories are of more significance.

Antecedent causes are conditions which raise the likelihood of an outcome in a body say, the occurrence of a disease ; these are typically external conditions, for example extreme ambient heat or moisture. But the presence of such causes does not guarantee the outcome; this will depend on internal differences in the constitution of the bodies in question, and in particular a preceding cause will be required to trigger the outcome.

Again, Galen uses this framework in an epistemologically optimistic way, highlighting the ability of the expert to predict or correctly analyse such an outcome, given sufficient understanding of all the relevant causal features. There is a strong emphasis on teleology in nature, and on the inadequacy of causal accounts that omit this. The major context for this is UP , a text explicitly inspired by Aristotle.

In this volume magnum opus, Galen goes through the parts of the body one by one, in each case giving an account which justifies the proposition of the purposive nature of the construction. Important, from the outset, is to insist upon the correct direction of causation: we have hands, etc. As so often in Galen, the polemical aim is of major importance for the formulation of the argument. The recurrent target is that group of thinkers who deny intelligence or purpose as an explanans, and omit it from their causal accounts.

Here Galen lumps together: a variety of ancient Atomist theorists; the followers of the Hellenistic medical author Erasistratus; and those of the more recent Asclepiades of Bithynia. All are accused of giving accounts which omit intelligence in the relevant sense, relying entirely on either spontaneous motions of bodies or mechanistic explanations of biological processes to explain the formation and maintenance of the complex processes of the human body.

There are further, distinctive features of the teleological account in UP. One is that—in a highly intriguing and individualistic discussion which however is not developed in any detail UP XI. Some features of the human body are to be explained not just in terms of its being better for them to be so, but in terms of their making the body more beautiful.

Examples are the male foreskin and the buttocks, both of which hide what would otherwise be unsightly, and the beard in men. The same chapter is also interesting for the explicit contrast it makes between intelligent design as Galen, in the post-Platonic Greek tradition, understands it, and intelligent design as understood in the Jewish tradition.

For Galen, the purpose of the divine Craftsman is, certainly, the most important cause, but the material cause must also be mentioned in a full account: matter represents the building-blocks used to realize the design, and in a sense provides a limitation to it. This, of course, is not religion in any conventional sense: rather, it is the fact that one has gained detailed, in-depth knowledge, both of anatomy and of the chreia of the parts revealed in anatomy—that is, of the close, detailed relationship between their their structure and their functional purpose—that enables one to celebrate the creator appropriately.

The question arises, both within the teleological analysis of UP , and much more broadly throughout the Galenic corpus, of the relationship between the different causes. For exploration of the issues see Singer b. To put it at its weakest, we may say that there are discussions of biological phenomena in which the teleological account appears to recede and an account in material terms seems to be all that is thought relevant. But it seems possible to go further.

Considering, in the context of this discussion of bodily mixture, what constitutes perfection in a human being, Galen states:. It seems that material causation is adequate in some areas, while design-based causation needs to be invoked at a higher level, in particular when one needs to explain animal and in particular human structures and their operations.

UP XI. Again, the result of such an analysis would seem to be that not all features of an animal can be equally part of a teleological account, or not part of it in the same sense. Certain things seem to happen spontaneously, or to follow unavoidably from the purposive cause, though not themselves intended. This leads us to a broader question. To what extent can lower-level, elemental, descriptions constitute full accounts of higher-level phenomena in the body?

And could a sufficiently full account of the balance of qualities—the most basic physical level—in a human body constitute an exhaustive account also i of its higher-level constituents, ii of the inception and iii of the nature of the diseases that befall the animal in that state, e.

The answer to the latter is complex, partly because of tendency for different conceptual areas to be discussed separately e. But the three subsections of this question may yield somewhat different answers. Humours, such as blood or bile, are in a sense uniform, although in a more detailed distinction of levels, they constitute a further layer, between elements and uniform parts, see Hipp.

In the pathological area it seems more difficult to see the relevance of the teleological cause. On the one hand, all properties discernible by the senses can be understood on the basis of the primary qualities that exist at the elemental level. The fact that we experience pain and sensation, whereas elemental bodies do not, shows that there has been a fundamental transformation in their nature, in the process of the composition of higher-level bodies from lower-level ones. In principle, then, we might think, the fact that hot, cold, wet and dry are the relevant explanatory terms at the lowest level would not necessarily mean that they are helpful terms at the highest level—that of everyday experience.

After all, we talk in perceptual terms of substances being sharp, acidic, bitter, etc. More than that: we might expect it to be the case that the use of these elemental terms was simply not helpful or relevant, precisely because of the Galenic theorization, just noted, of higher-level or secondary qualities as different in their nature from those elemental ones. Yet what is striking is that in spite of that theoretical apparatus, which would in principle mean that one might abandon talk in terms of hot, cold, wet and dry at higher levels of explanation—in particular, in the advanced medical realm of disease description and treatment—precisely these terms remain the central ones.

For Galen the fundamental constituents or elements stoicheia of physical bodies are the hot, the cold, the wet and the dry. Although he describes this difference as largely one of presentation, the alternative formulation in terms of the cosmic elements fire, earth, air, water is important for Galen, because it is central to his argument that the only coherent way in which a theory of elements in the body can be understood is in terms of the extremes of qualities; and, further, that since, e.

Although at times he uses the term stoicheia for both element-bodies and element-qualities, in his most detailed account, in HNH I. To summarize in an interpretively difficult area: Stoic theory has each element-body corresponding to the extreme of one element-quality fire to the hot, etc. On the other hand, it seems clear from certain passages in Hipp.

In the description of higher-level bodies—that of animals, in particular—one must invoke the concept of their form eidos. Again we have a Galenic version of an Aristotelian concept, with form understood as opposed to matter, on the one hand, and to the broader classificatory category, genos , on the other. The precise way in which form relates to matter, however, is complex and resists easy summation. We might rather point to a few contexts in which Galen invokes form in physical explanations.

In embryology, form represents the component of design in modern terms, of information which is transmitted to the embryo from the parents, as opposed to the matter out of which it is constructed. It thus becomes an explicit question problematized in different ways both in the early text Sem.

In the former text, for example, the process crucially involves the interaction of pneuma breath, containing the formal element and blood containing the appropriate matter ; and a distinction is made between ousia in the material sense and the power that moves and shapes it. In the account of the different physical composition of different animals and human beings in Temp.

This has a particular importance for accurate physical description, especially of the kind relevant for the doctor: it is by reference to this eidos that we meaningfully apply adjectives such as hot or cold to a body. It is not relevant whether they are hot or cold in some abstract sense, in relation to the whole cosmos, nor whether they possess those properties by comparison with members of a different eidos.

The coming-to-be of different physical substances in the world, as well as their various properties, is explained through the concept of mixture krasis. Every physical thing in the world, in particular the biological world, is composed from mixtures of the fundamental elements; they are thus appropriately described in terms of the predominance of one or more qualities hot, cold, etc.

Galen holds that higher-level properties come about through the alteration that may take place in this process of mixture; at the same time, the fundamental, low-level properties—hot, cold, wet and dry—which predominate in a given body remain powerful explanantia of its nature, at the macroscopic, perceptible level too; and this applies, for example, both to human bodies and to the various things they may eat and drink, including both food substances and drugs.

We should say a little more about the nature of mixture and change. As in many areas, Galen here tries to avoid some particular intricate and unanswerable metaphysical debates, while insisting on certain fixed points. One of the latter, as we have seen, is the four-element theory; another is the understanding of the physical world as a continuum, rather than as some set of bodies interspersed with void.