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fairly straightforward. It is simply a motion arising from the presence of the
motor nerves that transmit the impulse for a wilful action from the brain.
However, as a whole, a voluntary action can be a complex phenomenon.
This was made evident already Chapter , when discussing the complete
impediment of voluntary motion with the loss of a bone. The physio-
logical account of volition, in both humans and animals, furthermore,
requires the presence of muscle. Galen more than once states this quite
explicitly. For instance, in Book of On the Usefulness of Parts, dedicated
to the topic of the nerves, arteries and veins, he states the following:
πρὸςμὲνγὰρτὴν καθ’ ὁρμὴν κίνησιν ἐντοῖςζῴοις ἡ φύσις ἓν γένος
ὀργάνων κατεσκευάσατο τοὺς ὀνομαζομένους μύας. διό, καίτοι τῶν
νεύρων ἁπάντων ἑκατέρας ἐχόντων τὰς δυνάμεις, λέγω δ’ αἴσθησίν τε
καὶ κίνησιν, οὐδὲντῶν ἄλλων μορίων, ὅσα δέχεται νεῦρα, κινεῖται
προελομένων, ἀλλ’ αἰσθάνεται μόνον, οἷον τὸ δέρμα καὶ οἱὑμένες καὶ οἱ
χιτῶνες καὶἡἀρτηρία καὶἡφλὲψ ἔντερά τε καὶ μήτρα καὶ κύστις καὶ
γαστὴρκαὶ τὰ σύμπαντα σπλάγχνα καὶ τῶν ἀδένων τὸἕτερον εἶδος.
For voluntary motion Nature has constructed in animals one genus of
instruments, called muscles. Hence, although all nerves have both capacities
(I mean both sensation and motion), none of the other parts (whichsoever
receive nerves) are moved deliberately, but only feel, such parts, that is as
the skin, membranes, tunics, arteries and veins, intestines, the uterus, the
bladder, stomach, all the viscera, and the second kind of glands.
As the passage shows, presence of a nerve is not sufficient for voluntary
motion. A body part may have a nerve, but if it is not present in the
muscular tissue, that part will not be capable of voluntary movement.
Therefore, the brain, in spite of having access to the stomach via a nerve,
is hardly able to exercise control over it notwithstanding its ability to
receive sensory data from this organ of digestion. Muscle is, therefore, a
significant component of voluntary motion, although it is worth noting a
few counterexamples discussed in On Problematical Movements.
The treatise is concerned with cases in which the source of some
movement is unclear, for example, when a muscular motion occurs
unprompted by a deliberate decision. The most pertinent to the current
purposes is the opposite, a deliberate action that takes place without any
muscles. Galen mentions various examples, including people being able to
UP . (., – Helmreich¼.K), tr. May (: ), slightly altered.
See also PHP ..– de Lacy (.K) and Mot. Dub. .– (, –, Nutton).
Or, more importantly, the liver, which also has one nerve inserted into it, as the passage cited at the
beginning of this chapter indicates. Both cases are discussed below.
Perception and Voluntary Motion
vomit the wine they had just drunk voluntarily, but he discusses most
prominently the case of the tongue expanding beyond the jaw.
This
movement is problematic, because there is no muscle for extending the
tongue in such a manner.
Instead, it is explained by the large arteries in
the tongue that expand as they become filled with pneuma.
This is the
first step of the argument. The second – and the crucial – step is to explain
why this arterial activity corresponds to an act of volition.
The upshot of Galen’s explanation is a sympathetic action. He intro-
duces this account with the example of people observing sufferers from
ophthalmia and catching the illness themselves. The other examples
include people seeing someone yawning, stretching or urinating and
immediately feeling a desire to do the same, and children imitating adult
speech. The examples are also supported with a citation from Hippocrates’
On Humours.
Galen concludes that there is no reason to be surprised
that, apart from being movable by muscles, the tongue itself has some
power to recognise what the mind wants.
The solution bears some similarity to the case of a missing stomach
discussed in Chapter . Some actions can ta ke place without instrumen-
tal body parts if there are other body p arts that are able to perform
sufficiently similar activities. Just like the nutritive system can absorb
nutriment from liquids when the stomach is damaged and cannot crush
food, so in this case, the arteries, when filled with pneuma, can expand,
enabling the extension of the tongue beyond a jaw, even if no muscle is
present. The main difference is that the former is a pathological case and
the latter is not, which raises the following question. If the tongue can
move without muscles, why do we need muscles in other organs? Would
it not b e more elegant to skip them altogether? Presumably, muscles
provide a service that cannot always be replicated easily by sympathetic
reactions in other tissues.
This turns out to be the case if we consider ordinary limb motion,
which involves not only soft tissues but also bones and ligaments. Galen
has a teleological explanation for the role that these parts play in the
Mot. Dub. . (, – Nutton); in the case of vomiting, he concludes that it is predominantly
involuntary act brought about by natural capacities on a basis of an extensive anatomical discussion,
although it can occur voluntarily too, see Mot. Dub. .–. (, –, Nutton).
Mot. Dub. .– (, –, Nutton).
Mot. Dub. .– (, –, Nutton).
See Trompeter ().
All of these occur in a single dense passage, Mot. Dub. .– (, –, Nutton).
The kind of sumpatheia at work here seems to be part-to-part transmission of affection, rather than
part-to-whole transmission of ailment; see Holmes (: ) for this distinction.
. Voluntary and Involuntary Motion
process of voluntary motion in On the Usefulness of Parts. He states that
Nature is restricted by necessity in its design. Owing to this, neither
ligaments nor motor nerves can be used for voluntary motion by them-
selves. In the case of ligaments, this is because they are not attached to the
place that houses the hēgemonikon. More importantly, nerves cannot be
used for motion by themselves because their softness renders them incap-
able of transporting great weight. Therefore, they move a muscle, a harder
tissue, which in turn moves bones and ligaments, the hardest tissues in the
body. For this reason, when some part needs only to be attached, there is a
ligament; and when the part only needs sensation, there is only a nerve.
In cases where there is need for both, both are present: the nerve conveying
the signals from the hēgemonikon for motion and the ligament providing
the strength needed for such a motion.
The same model applies to bones.
In fact, later on in the treatise, Galen even remarks that damage done to
the bone can result in wholesale immobility.
The anatomy of voluntary
motion, then, consists of the nerve, the muscle, the ligament and the bone.
The order of items on this list represents two overlapping points: first, ‘the
chain of command’ in terms of the capacity for voluntary motion that is
sent down from the brain. Second, the texture change in the parts
involved: while softness in parts is required for the initial signal, the final
motion of the limb requires strength and hardness of parts, which is
achieved by means of the involvement of multiple parts with increasingly
harder textures.
Muscles play in important role as ‘intermediates’ in both transmission of
the capacity and the conversion of that signal into motion that requires
strength. There is, arguably, also another reason for the significance of
muscles, although it is not spelt out as explicitly. It concerns precision of
motion. The body is a fairly compact structure, with many parts governed
by different motions located in close proximity. In the case of respiration,
for example, it is quite important that the motions of the heart and the
thorax (containing the heart) are kept separate, so that an animal has some
control over respiration, which is generally involuntary (and it is, of course,
better for it to be so). The presence of muscles allows for the precise
control of the ribcage, without affecting arteries. The muscle, thus, is not
always crucial, yet often it is a fairly critical instrument for mediating
voluntary motion and establishing voluntary control over body parts.
UP . (. Helmreich¼.–K).
UP . (., – Helmreich¼.K); for the significance of the bone, see the discussion in
Chapter .
Perception and Voluntary Motion
The scheme of nerve-muscle-ligament/bone is mostly used to account
for the voluntary motion of the limbs, in which case it works well. The
heart, however, also seemingly meets all the criteria of an organ that is
subject to voluntary motion since it is a muscle containing a nerve,
and it
even has a bone, according to Galen’s understanding.
Interestingly, he
solves this problem by denying that the heart is a muscle in a fascinating
argument. In so doing, he also explains the role of the nerve inserted into
this organ and sheds some light on the interaction between the two central
physiological systems.
.. The Heart Is Not a Muscle
In the previous passages,
Galen claims that the heart, as well as arteries,
move involuntarily.
The more elaborate explanation of this view, includ-
ing corroborating proof, is found in the treatise On Anatomical Procedures.
Galen’s account is clearly polemical, and, although he does not state who
his opponents are, he offers a few clues.
He begins by noting that the similarity between the heart and muscu-
lar substances is an impression created by a careless glance.
The
differences, in fact, are numerous. The activities of each of these organs
attest to their differences, for the movement of the heart is involuntary
and ceaseless (ἀβούλητος ... καὶἄπαυστος)forthedurationofan
animal’s life . The activity of the muscles, meanwhile, is subjec t to the
animal’simpulses(ταῖς ὁρμαῖςτοῦ ζώου δουλεύουσα).
The activities,
as Galen not only states here but also i n other works,
are determined by
the substance. This entails an interesting consequence. If two parts
(μόρια) share the same substance, then they also have their ac tivity in
common, despite the f act that they are found in different animals.
Galen’s point is presumably that two pieces of muscle can be expected
Nerv. Diss. (.K).
Salas (: ff.).
To the modern eye, Galen might seem wrong, but the issue at stake is ultimately just a distinction
of the skeletal and the cardiac types of muscles, which was observed in antiquity. Debru (:
–) shows that this claim ought to be understood against three different uses of the term μῦς in
the Hippocratic corpus and argues that, ultimately, his argument is not innovative but rather built
on the understanding of the cardiac tissue developed in the Hellenistic period.
In UP . (., – Helmreich¼.K), for example, while describing the design of the
tongue, Galen suggests that its brilliance is evident from the fact that it is moved voluntarily, unlike
the arteries that move involuntarily (ἀβουλήτως).
Ousia is here presumably used in the Stoic sense of matter. Later on in the passage, Galen discusses
the differences in the ousia of these two organs, albeit in the sense of the Aristotelian essence.
AA . ( Garofalo¼.K).
See, for example, UP . (., – Helmreich¼.K).
. Voluntary and Involuntary Motion
to act in the same way owing to their substance being the same, despite
thefactthatonemightbepartofamouseandtheotherofahuman
being.
This part is very much in line with Galen establishing an
equivalence between humans a nd other animals for the sake of physio-
logical studies of motion, as discussed earlier. This, however, constitutes
only the first step in the longer ar gument.
As the argument progresses, it becomes clear that Galen’s main instru-
ment here is the contrapositive of his principle ‘activities depend on sub-
stances’, and ultimately, he is interested in the differences between organs of
a single body. First, he notes that the parts of an individual animal can have
different activities, listing various examples of internal organs. Their differ-
ences, it is suggested, are owing to their respective substances. He then
arrives at the conclusion that muscles do not have the same activity as the
heart. It follows that they are not composed of the same substance either.
In short, the argument consists in the following modus tollens:
if the
substances of two organs are the same, then their activities are the same.
But the activities of the muscles and the heart are not the same. Therefore,
their substances cannot be the same. In other words, the heart muscles are
composed of different substances from the other muscles.
This theoretical proof is then supported by the following empirical
observation.
When a heart and a piece of muscle are cooked and eaten,
they taste different. The same is true for other organs, including the
kidneys, the lungs, the liver and so on. Galen notes that they differ from
one another not only in taste but also touch, appearance, hardness,
softness, density and colour.
On the basis of this, Galen concludes that
doctors who maintain that the nerves effectively determine the activity of
the heart err insofar as they overlook the substance of the heart. The heart
is harder than any muscle and it differs in terms of its fibre, colour and
taste from other kinds of muscle, with reference to his comparison of
eating a cooked heart and cooked muscle.
See discussion in Salas (: –).
AA . ( Garofalo¼.K): διὰ τοῦτ’ οὖνοὐδ’ οἱ μύες ἔχουσι τῇ καρδίᾳ τὴναὐτὴν ἐνέργειαν,
ὅτι μηδὲ τὴνοὐσίαν.
See Inst. Log. . Kalbfleisch.
This is not to say that everything can be shown using both methodologies. A knowledgeable doctor
ought to know, for instance, which medicines were discovered through experience alone, through
reason alone and through both (MM . (.K)). See van der Eijk () for a seminal study
of the Galenic notion of qualified experience.
AA . ( Garofalo¼.–K).
AA . ( Garofalo¼.K), tr. Singer (: ): ἀλλά μοι δοκοῦσιν οὐδέποτε καρδίας
ἑψημένης φαγεῖν, ἢ πάντως ἔγνωσαν ἂν, ὁπόσον διαλλάττει τῶν σαρκῶν, εἰ μὴἄρα ἀγνοοῦσι καὶ
ταῦτα, ὡςαἱ σάρκες ἅπασαι μυῶνεἰσι μόρια. ‘I think they can never have eaten a cooked heart or
Perception and Voluntary Motion
The second error of these doctors concerns the nature of the nerves.
Here, the argument becomes less clear, with Galen beginning by
remarking that his opponents are wrong insofar as they maintain that
the brain is like nerves in all its parts (νομίζουσι τὸν ἐγκέφαλον ὅμοιον
αὐτοῖς κατὰ πάνθ’ ὑπάρχοντα τὰ μέρη), the only variation being the
softness of certain nerves. Let us call this the first claim. It comes across as a
point of disagreement, but in fact, these claims are all very much in line
with what Galen himself maintains, as evidenced by the discussion of the
anatomy of nerves up until this point.
It is more likely that the main
point of disagreement comes in the following sentence containing the
second claim. It states that, through certain nerves, the brain provides
sensation to the parts below, while, through the others, it sends signals for
voluntary motion. The upshot here is that Galen’s opponents strictly
separate the motor and sensory nerves. Taking this point to be the main
issue at stake fits the polemical context, since Galen is attacking the doctors
who state that the heart has no motor nerves, only sensory nerves.
Presumably, the position of these doctors is that the heart is a muscle
and the only thing that makes its activities different (the heart beats
ceaselessly and involuntarily, whereas muscles move by volition) is the
absence of a motor nerve and the presence of a sensory nerve instead. This
reading is further corroborated by Galen’s claim that it is reasonable
(εὔλογον) that all the nerves have both of these capacities. The only
difference is that the soft ones are more suited to sensation while the hard
ones are more suited to motion.
As an example, Galen names the third
and sixth pairs of cranial nerves, which branch out both into muscles and
other parts (μόρια). The sixth nerve-pair branches off into the heart, lungs
and stomach, as well as the muscles of the larynx.
Finally, Galen adds that if the heart were a muscle and only lacked
motor nerves, which would render it mobile like the other muscles, then it
could neither move by volition nor receive pulsation, which must have
some cause. Galen’s point is apt: if the heart is like any other muscle, then
it must follow the same pattern of activity. In other muscles, motor nerves
they would surely have known how much it differs from flesh, unless, of course, they do not even
know that all kinds of the flesh are kinds of muscle.’
He states that the brain and the nerve share the same kind of tissue in Form. Foet. , – Nickel
(.K). See the later discussion.
AA . ( Garofalo¼.K): ὅσοι δὲ διὰ τοῦτό φασι τὴν καρδίαν οὐκ ἔχειν τοῖς μυσὶ τὴναὐτὴν
ἐνέργειαν, ὅτι νεύρων οὐ μετέσχηκε κινητικῶν, ἀλλ’, ὡς ἐκεῖνοι νομίζουσιν, αἰσθητικῶν, ἀθρόα
πολλὰ κατὰ τὸν λόγον ἁμαρτάνουσι.
This point is consistent with the description of the differences between the soft and firm nerves in
On the Usefulness of Parts, as outlined in the section on the anatomy of nerves.
. Voluntary and Involuntary Motion
are the causes of voluntary motion. Therefore, if the heart has no motor
nerve, then it should not be able to move. The motion of the heart has to
be derived either from the nerves or else it is inherent in the organ. Since it
cannot come from the nerves, it must be inherent. Definitive evidence that
the heart has its own motion (and, to this end, does not require nerves)
consists in the fact that it continues to move for a while after it is removed
from the thorax.
This means, then, that the cardiac motion is independ-
ent of the nervous system. Indeed, as far as its motion is concerned, it can
function without it.
One might be left questioning the purpose of the nerve that is found in
the heart. Presumably, Galen agrees that this nerve is, to all intents and
purposes, sensory. Just like the liver discussed previously, the heart lacks
muscle. The brain, therefore, lacks the instrument for its voluntary
movement (especially true considering that the tissue of the heart is harder
than a normal muscle; possibly too hard for a soft nerve to move).
Consequently, while the brain may receive sensory data from the heart,
it is not able to exercise direct control over it. This has some interesting
consequences for understanding the scope of the nervous system. Its role as
an instrument of conscious control is greatly restricted by anatomical
considerations, mainly by the presence or absence of appropriate instru-
ments, especially muscles. The scope of the control that the nervous
system has over the body can be aptly illustrated when considered in
context of all the motions that the body is capable of.
.. Different Types of Movement
As well as involuntary motion, which is produced by the cardiac-
respiratory system,
Galen describes various other kinds of bodily motions
of the human being. An arm, for example, has a natural tendency to move
downwards without any psychic intervention.
The brain itself also
moves, as he notes when comparing it to the spinal medulla.
The
pathology of nerves also presents an interesting case. Galen explains
convulsions as arising from the depletion of the nerve parts (τῶν
νευρωδῶν μορίων).
Even nerves, then, can move in an involuntary
way in pathological contexts.
AA . ( Garofalo¼.K). See also the anecdote in PHP .. de Lacy (.K), which
describes a dissected heart leaping from the doctor’s fingers thanks to its violent palpitations.
See UP . (.– Helmreich¼.–K).
UP . (., – Helmreich¼.–K).
UP . (., Helmreich¼.K).
MM . (.K).
Perception and Voluntary Motion
Bearing this in mind, the role of voluntary motion (viz. the motion
deriving from the nervous system) is not as dominant as one might expect
within human physiology more broadly. In the grand overview of the body
as a whole, the voluntary motion enabled by the motor nerves is only one
type of many types of vital bodily motions. Notably, it exercises little
control on the internal processes of the body. Having said it, it is also
worth noting that it would be quite incorrect to say that the voluntary
motion is on par with downward motions of arms, pathological convul-
sions and so on. First, these motions are accidental, rather than essential.
A part is identifiable as an arm, for example, not because it falls downward,
but because it can be used for gripping, holding and similar.
The motion
deriving from the mass of the part (or its pathological state) bears little
explanatory power about the nature of that part.
The second (and related) point is that the essential feature of voluntary
motion is its regulatory role. In short, the significance of this motion lies in
its explanatory power rather than in its predominance. It plays a significant
role in respiration, a process concerned with the regulation of the body in
reference to its external environment: the intake and output of the air.
More importantly, the role of the voluntary motion is significant, since it
manifests the activity of the hēgemonikon in reference to a person’s environ-
ment. The activities of the nervous system enable navigation of the outside
world not only via voluntary motion but also through sensory perception.
In fact, it could be argued that just as nutritive and cardiac systems regulate
their respective material fluxes (nutriment and air), so the nervous system
regulates its inputs and outputs: sensation and voluntary motion. The rest
of this chapter is dedicated to Galen’s bipartite account of its inputs:
inwardly directed pain and outwardly directed sense perception, arguing
that the significance of the kind of control that the nervous system is
capable of becomes quite clear in these cases.
. Pain and Nerves
Galen’s claim that pain is an activity of the nervous system may seem
strikingly insightful, given that this fact has been established by modern
life sciences too.
This, however, would be too hasty. An entire section is
The first book On the Usefulness of Parts is dedicated to the design of the hand, with a strong
emphasis on the brilliant design enabling its many activities. See also Trem. Palp. (.K) for the
claim that the ‘natural’ downwards motion occurs when no voluntary power is present, for example,
when an arm is paralysed. The downward motion is therefore not a proper motion of the part.
See Ochs () for an extensive study of the history of nerve functions.
. Pain and Nerves
dedicated to the nerves in On My Own Opinions, including an argument
against unidentified doctors who maintain that nerves are more sensitive
than flesh. It seems likely that, in this case, Galen’s opponents are not
identified because the view at stake is simply commonplace among phys-
icians rather than being a doctrine of some particular medical school.
He explains what medical phenomenon motivates ‘many doctors’ and
why that view is wrong. He argues that the nerves are no more sensitive
than ordinary flesh.
He begins by stating that the foremost sensitive body part is where the
hēgemonikon is located, whence the nerves connect to the rest of the body.
Every part of the body to which nervous impulses flow is thereby rendered
sensitive (αἰσθητικός). The capacity running through the nerves
causes
the nerves to be sensitive but, importantly, no more sensitive than any
flesh. Galen provides a proof of this based on what can be seen through
vivisection. Having exposed both the nerve and flesh, he finds that an
animal complains more following the stimulation of the latter, while
stimulating the former does not agitate the animal to the same extent.
Subsequently, Galen explains the reason why many doctors suppose
that the nerves are more sensitive than ordinary flesh. It is owing to their
connection to the hēgemonikon, as well as the dangers attending nerve
inflammation. Although Galen does not explain this position very clearly,
it seems that the sensitivity of the nerves is here inferred from a therapeutic
phenomenon. The inflammation of the nerves is a more dangerous condi-
tion than the inflammation of the flesh since it affects offshoots of the
hēgemonikon. Thus, nerves must be more sensitive than flesh. Dissection
reveals that this conclusion is erroneous, according to Galen, owing to the
fact that the condition of a patient does not worsen when an inflamed
nerve is severed. He also recounts cases in which doctors did sever the
nerve only to find that their patient had not realised this. In other cases,
the surgeon accidentally severed the nerve during venesection, but this did
not result in the patient experiencing more pain.
Galen’s commitment to
the view that fl esh is as sensitive as nerves raises two questions. First, what
is the nature of the phenomenon of pain? Second, how can nerves be less
sensitive to pain than flesh while having the sensibility for pain as one of
their three activities?
One might claim that, although Galen names pain as one of the three
activities of the nervous system in On the Usefulness of Parts, he does not do
The word for ‘channel’ here is ὀχετός, not the Herophilean πόρος.
Prop. Plac. . ( Lami Garofalo).
Prop. Plac. . ( Lami Garofalo).
Perception and Voluntary Motion
so consistently. However, for the sake of charity, it is important to note
that this inconsistency is probably owing to the vague relationship between
the sensation of pain and sense perception (that is to say, sensation) in
general. Thus, it would not be unreasonable, in certain contexts, to
subsume pain under the category of ‘sensation’ since it is, after all, one
form of sensation. The question regarding whether (and how) pain differs
from sensation in general is the third and final issue to be considered in
this section.
.. The Causes of Pain
Galen mentions pain and palliative care regularly in various medical texts,
building on the preceding tradition.
However, unlike the description of
voluntary motion, which is always said to be lost when the nerve is ligated,
his descriptions of the origins of pain are not consistent. He names various
causes of pain, so much so that different treatises come across as pro-
pounding disparate accounts. For instance, in his commentary on
Hippocrates’ On the Nature of Man, Galen states that both pain and health
are caused by the four humours: pain arises when one of the humours is
either present to excess, or deficient or is separated in the body and not
combined with the others.
In Book of On the Therapeutic Method, Galen provides a different
and extensive account of pain and its aetiology. Ultimately, there are two
primary origins of pain. It occurs either by the dissolution of unity or on
account of change.
Galen proceeds to remark that change that produces
pain cannot be gradual but sudden,
adding that this type of pain must
originate from dyskrasia. He notes that he is not talking about external
injuries here.
The following exposition of causes provides a clear picture
of how the dissolution of continuity can occur internally:
καὶ πρῶτόν γε θεασώμεθα τίνος εἶναι χρὴ φύσεως ὃ διαιρήσει τὴν
συνέχειαν. ἀναγκαῖον οὖν ἤτοι ῥῆξιν ἢ θλάσιν ἢ διάβρωσιν εἶναι τὴν
διάθεσιν ἐντῷ διαιρεῖσθαι τὸ συνεχές. ἀλλ᾿ἡμὲν ῥῆξις ἐκ τάσεώς τινος, ἡ
An extensive discussion of the dependence on the earlier tradition in King ().
HNH . (.K); see also . (.K).
It is also worth noting that Galen says that it is not necessary to know whether pain is produced
owing to the loss of continuity or change in order to discover what will cure it. It is sufficient to be
aware that what rapidly heats or cools produces pain in bodies that are capable of sensation (MM
. (.K)).
MM . (.K): ἀναγκαῖον ἀθρόαν τε ἅμα καὶ βιαίαν γίνεσθαι τὴν μεταβολήν, εἰ μέλλει τις
ὀδύνη γενήσεσθαι.
MM . (.K).
. Pain and Nerves