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Galen himself, as a self-styled follower of Hippocrates, has strong
affinities with rationalism,
although his attitude towards the rival empiri-
cism is also far from critical. He praises empiricists for their systematic and
consistent approach to medical methodology.
The strength of this
method lies, according to Galen, in successful therapeutic practice.
He even goes so far as to argue that it is better for doctors to be empiricists
rather than follow a flawed rational method.
The theoretical understand-
ing of the constitution of the body, therefore, is clearly not absolutely
necessary for medical practice and, consequently, an experience-based
approach is an attractive alternative in principle.
Having said that, Galen himself identifies with the rationalist tradition.
The affinity to this tradition is evident in his methodology, as the theoret-
ical notion of demonstration is key for fashioning his own approach to the
study of the body.
The reason for that emerges in his discussions of
complex illnesses. When an illness is a matter of a single pathological
condition, either the rationalist or the empiricist method will do. When
more than one condition is present in a patient, an empiricist doctor will
be ill-equipped to determine the proper treatment and only rational
methods can offer a solution.
He also rebukes empiricists for their advice
to turn away from phusiologia and not try to understand human nature the
way philosophers do, going all the way to the primary elements by means
of reason.
Ultimately, Galen approves of the principles of both
argument that such figures as Menodotus and Heraclides of Tarentum might be examples of the
more moderate version of empiricism, admitting some usefulness of theory.
For example, in MM . (.K), he writes that empiricists discover by experience what ‘we’
find by indication, see also MM . (.K). He repeats the claim he made earlier in the treatise,
that both rationalists and empiricists have a way of figuring out what treatment would work,
although neither has a way to find everything in MM . (.K); see also MM . (.K)
for a similar claim in the context of pharmacology. Galen also criticizes both in On the Therapeutic
Method, although the general aim of his critique in both cases is specific practices rather than their
respective principal methods.
MM . (.K).
MM . (.K). See also Frede (: –).
Frede (: ). Galen’s own methods also place great importance on experience. On the
difference between the empiricist and Galenic use of experience, see van der Eijk (: ).
As the key treatise, On Demonstration, is not extant (though see Havrda ), this method has
been well studied on the basis of the other works that are extant; see, for example, Lloyd ();
Morison (: –) and Tieleman (, ).
MM . (.K). See also MM . (.K) for the same argument in a pharmacological
context. Another interesting case is diagnostics by taking into account customs of a patient in MM
. (.K). Here, Galen argues that experience of a patient can only tell an empiricist how a
certain practice affected the person so far, not what accumulated effects of that practice might be in
the future. Thus, the inability to calculate the effects of some practice by reason raises the possibility
of prescribing something harmful. See also Hankinson (: –) for a discussion of the same
kind of argument in Galen’s On Medical Experience.
MM . (.K): ἄχρι τῶν πρώτων στοιχείων ἀνιόντες τῷ λόγῳ.
Introduction
empiricism and rationalism, but he finds the methods of the latter to be
superior, while being acutely aware of the potential pitfalls of practicing
rationalism, that is, erroneous misapplications of reasoning.
Galen’s approach to the disagreement between the rationalists and the
empiricists she ds light on his ambivalent approach to phusiologia.Asthe
study of the nature of things, phusiologia is a distinctly rationalist under-
taking. Furthermore, it has a certain philosophical heritage, and Galen
uses the word in relation to specifi c philosophic al schools on some
occasions.
Phusiologia, therefore, has all the same advantages and short-
comings as any other rationalist undertaking in medicine: it can be
illuminating but it also entails the risk of reasoning errors. Galen is also
wary of the theoretical (or ‘philosophical’) discussions that venture off too
far from medical issues.
Despite all of these pitfalls, rationalism still
remains the preferable methodology becau se it has significant advanta ges
when applied well. The same could be said of phusiologia, because, despite
his hesitancy, Galen does not avoid it entirely. In fact, as Vivian Nutton
points out, ‘his practice as described in his own writings could easily be
viewed by outsiders as a typically Hippocratic “physiological” exposition
of the basic principles that govern the bodily universe. Galen fr equently
refers to mixtures, humours and so on to support conclusions reached by
observation, experiment or logic, or, at the very least, to exclude ideas of
others that he considered erroneous. ’
The reasons th at prevent him
from unilaterally advocating for ratio nalism are also, presumably, reflected
in his ambivalence towards phusiologia. The study of p husiologia, there-
fore, has some complications owing to the way Galen conceptualises this
area of study, but it does not follow that it cannot be done.
In this work, I use the term ‘physiology’ to refer to Galen’s examinations
of the body parts and their activities (ἐνεργεῖαι), following his use of the
term in the aformentioned passage of On the Formation of the Embryo.
In other words, ‘physiology’ here denotes the study of how the body parts
are constituted, what principles govern their activities, how those activities
contribute to the functioning of the body as a whole and, in some cases,
what the design of the body indicates about the construction of the world.
This physiology is neither comparable to the modern notion of ‘physi-
ology’ nor the exact equivalent of ancient phusiologia, but the area of study
that Galen thinks phusiologoi would be better off studying in any case.
It concerns the body parts and their activities, as well as the activities of
Nutton (b: ).
PHP .. de Lacy (.–K).
Nutton (b: ).
I. Empiricism, Rationalism and Phusiologia
different parts ‘working together’ in order to produce systems that main-
tain vitality.
This volume studies Galen’s contribution to this area with a bipartite
focus, which reflects his interests in both pluralising and unifying the body
and its functions. First, it focuses on the notion of parthood and the many
ways in which Galen divides up the body into parts. In doing so, he
conceptually takes the body apart, thus pluralising it. Second, it studies the
vital processes that these parts are responsible for, such as respiration or
nutrition. The full execution of these processes requires multi-organ
involvement and, thus, in his attempts to come up with a robust account
of these processes, Galen ‘puts the body back together’, unifying it. I use
this methodological cycle to frame the discussion in each of the chapters
and in the book overall.
I. Parts
The focus on diverse notions of parthood is another methodological pillar
of this study. There are many different ways of dividing the body and even
more ways of conceptualising these divisions. For example, the most
obvious is the division into large visible limbs, such as a hand, a leg, an
eye and so on.
This taxonomy, however, does not seem to play a major
role in Galen’s thought. In this work, I focus on those divisions into parts
that are more theory-laden and play some role in theorising human nature.
The discussion is especially centred around those parts whose ἐνεργεῖαι
Galen theorises most extensively. Before delving into a further discussion
of the different divisions of such parts, it is worthwhile to make a note
about the translation of this term. It can be translated as both ‘activities’
and ‘functions’. It has been pointed out that Galen’s ἐνεργεῖαι differ from
contemporary ‘functions’ and therefore ‘activities’ is a more suitable
option.
A lot of recent scholarship use the latter, and I adopt it in this
work as well. However, I also talk of the ‘functioning’ of physiological
I use the term ‘vitality’ to refer to the term ἡ ζωή. Galen uses it when describing vital processes and
the parts that carry them out; damage to, for example, respiration, constitutes the threat to ‘life
itself’ (αὐτην τὴνζωὴν), Ut. Resp. . ( Furley and Wilkie¼.K); see also MM .
(.K); UP . (., – Helmreich¼.K). A very similar use in Debru (: ).
See also Debru (: ) for the claim that Galen’s account of breathing ultimately involves
elements and preoccupations that do not exactly correspond to the modern areas of anatomy,
physiology or pathology.
UP . (., – Helmreich¼.K); Inaeq. Int. (.–K); Loc. Aff. .. Brunschön
(.K).
Furley and Wilkie (: ).
Introduction
systems and the body as a whole, and I argue that there is an ever-present
preoccupation with the functionalist understanding of parts and
their significance.
When it comes to grouping parts into different categories, the most
common taxonomy in Galen’s texts is the division of a body into structured
and homoeomerous parts.
This seemingly simple division is ubiquitous.
Apart from the Peripatetic influence (already discussed in scholarship),
I argue that Galen understands this division against a certain Hippocratic
background too. The frequency with which Galen uses it suggests that it is
significant, and the concluding part of this volume presents an argument
that this division is fundamental for a Galenic understanding of the human
body, and therefore it plays a role in most discussions.
On a few occasions, Galen also introduces what he calls the Hippocratic
division of a body into solids, fluids and pneumata.
This higher-order
division of parts not only plays a crucial role in pathology but also
encompasses the famous Galenic humoral theory, incorporating it into a
general account of human functioning. The upshot of this taxonomy is the
division of tissues into types, according to what could be called texture or
viscosity. The textural properties (themselves pre-determined by their
respective mixtures) determine how different types of tissues in a body
interact with each other, including the speed with which certain patho-
logical or therapeutic changes take place. This theory plays an especially
important explanatory role in Chapter .
A more generally applicable division of the body can also be found in
Galen’s description of diagnoses and treatments of fevers. Key to a suc-
cessful treatment of a fever is the preservation of the three central physio-
logical systems underpinned by the organs governing them: the brain, the
heart and the liver. Galen explains that the continuous functioning of these
parts ensures the maintenance of life and therefore their preservation ought
to be prioritised in medical treatments.
Thus, the fever conditions show
that these are the main parts of a human being for all (medical) intents and
purposes. These three systems, therefore, form the cornerstones of Galenic
physiology. They correspond to the tripartite soul system that Galen
See the list of passages in Chapter , note .
Trem. Palp. (.–K); see also Diff. Feb. (.K) and Caus. Puls. . (.–K).
Interestingly, a slightly different formulation can be found in MM . (.K), where the
three elements are pneumata, truly solid parts and fleshy parts. See Hipp. Epid. .. (., –
Littré); Flemming (: –) approaches ancient medical tradition in general as concerned with
these three kinds of substances.
MM . (.–K).
I. Parts
inherits from Plato. The physiological domains of the three souls are the
nervous system, the cardiac/pneumatic system and the vegetative system.
The activities of these systems are fundamentally different in nature. While
the nervous system is in charge of voluntary motion and perception, thus
enabling rational activities, the cardiac/pneumatic and the vegetative
systems are in charge of cardiac activities that maintain the innate heat
and nutritive activities underlying growth and healthy functioning respect-
ively. Together, they constitute a kind of unity that underpins the main-
tenance of vitality, so that serious damage to any one of these systems will
inevitably result in lethal damage to the others. Galen never explains
explicitly how these systems form such a closely intertwined and unified
common system. At the same time, the underlying unifying concepts,
assumptions and theoretical devices can emerge from a systematic study of
the relevant material in his oeuvre.
I. Chapter Descriptions
The chapters of this volume build on one another. The study starts with a
general discussion of the ways in which Galen divides up the body into
parts. The chapter analyses the conception of parthood by focusing on the
two claims that, when taken together, amount to a very idiosyncratic view.
First, Galen claims that the loss of a bone results in a complete loss of
voluntary motion in the limb. Second, he also claims that the loss of a
stomach is not vital and does not impede the ability of the body to be
nourished. Not all parts, therefore, are created equal. Having analysed
several of Galen’s divisions of parts, the chapter concludes that he theorises
parthood in relative terms, in reference to the functional role the part plays
in a bodily process. Furthermore, the organic functionality of the body is
tied to and determined by the three central systems: the nutritive, the
cardiac and the nervous. Their significance manifests itself via three
processes they govern: nutrition and growth, breathing, and voluntary
motion and perception, respectively. The following three chapters are
structured around answering the question of why and how each of these
processes constitute the vitality of the human body.
Chapter focuses on the domain of the vegetative soul, comprising
nutrition and growth. The vegetative capacities are the most fundamental,
but also the simplest activities that distinguish organic from inorganic life.
They are present not only in animals but also in plants. This chapter
examines the central vegetative system consisting of the liver, the veins and
their supporting organs, as well as the vegetative capacities present in all
Introduction
the tissues that are subservient to this system. The chapter not only
discusses the relationship between the central parts and capacities in the
rest of the body, but also examines the ways in which these capacities
manifest themselves, arguing they represent Galen’s attempts to grapple
with the notion of basic vitality, which in later terminology became known
as the organic life. The key problem is the extent of the capacities:
although their primary domain is nutrition and growth, they are also called
‘demiurgic’, a term with significant philosophical pedigree and implica-
tions, in an embryological context. The chapter delineates the scope of the
vegetative domain by examining the process of nutrition, Galen’s descrip-
tion of the vegetative capacities and his conceptualisation of ‘demiurgic’
acts.
If Chapter addresses the notion of the basic vitality, Chapter deals
with the cardiac system that underpins the more complex animal vitality.
The key process governed by the cardiac system is breathing, and the
chapter begins with a discussion of different types of breathing, as well as
the anatomy that underpins those types, before moving on to Galen’s
explanation of why deprivation of breath leads to death. Key to the process
of breathing is pneuma, and he distinguishes three types: the vital, which is
important for respiration, the psychic, which plays a role in perception,
and the natural pneuma, whose existence is uncertain. Given that the
account of breathing already covers the role of the vital pneuma, the
discussion moves on to the role of the other two types: the super-refined
psychic and the most turgid natural pneuma. The account of the latter is
elusive, but, I argue, Galen’s approach to the question of its existence
shows a tendency to adopt a pattern. The properties of the natural pneuma
are linked to the activities of the nutritive system, just like the properties of
the vital and the psychic pneumata are linked to the cardiac and the
nervous systems, respectively. In addition to discussing the three types of
pneuma and their activities, the chapter also introduces yet another
Galenic division of the body into solids, fluids and pneumata. This
division according to texture and movement of tissues offers an important
glimpse into how Galen conceives of the interaction between parts.
Moreover, the rapid alteration in the pneumatic tissues underpins the
physiological understanding of animal vitality.
Chapter is devoted to the final and, in a certain sense, most complex
physiological domain, the nervous system, in charge of three activities:
voluntary motion, pain and perception. Unlike the motion of the cardiac
and nutritive system, called motions ‘by nature’, the motion of this system
is voluntary. This physiological domain, thus, is the one that enables the
I. Chapter Descriptions
exercise of control, and the discussion in this chapter is focused on
delineating the extent and the nature of this control. Key to this control
is the role of nerves. Building his understanding against the background of
the discoveries of the Alexandrian Herophilus, Galen presents an extensive
discussion of the anatomy of nerves. His descriptions of the different types
of nerves are more elaborate than his discussions of veins and arteries, but
their typology shares similarities with pneumata. Most notably, sensory
nerves and the psychic pneuma, both of which play an important role in
perception, are much finer in texture than their counterparts responsible
for vital activities. Thus emerges one of the patterns that Galen uses to
classify body parts belonging to different systems.
Starting from the motor nerves responsible for voluntary motion, the
chapter examines the anatomy that enables these nerves to exercise control
over muscles and bones. I also argue that, in the context of the bodily
motions overall, the role of voluntary motion is relatively small.
Subsequently, I discuss Galen’s account of pain, arguing that the primary
phenomenon takes place in the tissues, and nerves simply enable the
sensation; the fundamental mechanism of this phenomenon is the same
as the one found in sense perception (covered in Section I.) and in the
internally directed sensation, such as hunger, discussed in Chapter .
Galen, thus, applies the same model of the perceptive capacity of nerves
to explain different phenomenon. The nervous tissues present a number of
problems when it comes to accounting for perception, but this chapter
especially focuses on the problem of the inherent sensitivity of the tissue.
In a rare critique of Herophilus, Galen rejects his finding of the inherent
sensitivity of the tissue, which, I argue, is important in explaining his
hesitation towards accepting more physicalist understanding of
psychic properties.
The final chapter is dedicated to the ways in which Galen unifies the
discrete parts and systems into a single unified entity, especially focusing
on the tripartition. The adoption of the Platonic tripartition is, at least in
one important way, puzzling. Originally, the tripartition of the souls
helped to explain the psychological conflict; Galen, however, is strongly
committed to the physiological tripartition, and, in fact, the discussions in
the previous chapters show that he does indeed make the three physio-
logical systems fairly discrete. But the body is also obviously a unified
entity, and this chapter explores Galen’s theorisation of the grounds of its
unity. Starting with anatomical unity, the chapter moves on to discuss the
material flux into and out of the body that the three central systems
control. Galen posits the persistence of identity through this material
Introduction
change with a reference to the form. The following discussion shows
Galen’s complex relationship with this notion. Like some of his contem-
porary Middle Platonists, Galen adopts the Stoic idea that the formal cause
is subordinate and instrumental to the cause from the maker, the efficient
and the final causes. The proper explanation, thus, lies not with the form
of the body but its design, especially the purpose of the design. Finally,
I argue the notion of a cohesive cause, which Galen uses to theorise such
processes as respiration and pulse, can account successfully for vitality,
giving an elegant way for unifying vital activities and the parts performing
them into a single unified whole.
The Conclusion summarises the findings by explaining the key motiv-
ations and claims behind the Galenic understanding of bodily unity.
I. Scholarship
There are still many areas in this expansive corpus that have never been
addressed in a long study, and the problem of the unity of Galenic
physiology is one of them. However, such theme and focus would not
be possible without building on the previous work on various aspects of
Galen’s physiology both in older monographs, such as C. R. S. Harris
() and E. Mendelsohn (), and in more recent works. In fact,
Galenic scholarship has expanded significantly in recent years. The treatise
On the Doctrines of Hippocrates and Plato in particular has received a lot of
scholarly attention, including monographs devoted to it (e.g., Tieleman
). More recent monographs on various anatomical, physiological and
psychological aspects of Galenic work include Stewart (), Rocca
(), Salas (b) and Devinant (). In addition to these, some
notable monographs investigated various literary and rhetorical aspects of
Galen’s work, including Mattern () and Petit () as well as Curtis
(). In addition to full monographs, edited volumes, both dedicated to
Galen specifically and those thematically broader, are important sources of
Galenic scholarship, including Hankinson (c), Thumiger and Singer
(), Petit (), Adamson, Hansberger and Wilberding (), Gill,
Whitmarsh and Wilkins (), Horstmanshoff, King and Zittel (),
and Bouras-Valliantos and Zipser ().
When it comes to works dedicated to Galenic physiology in particular,
aside from the more dated and somewhat controversial study of Rudoph
E. Siegel (–), the important studies tend to focus on a specific area
of physiology, for instance, the cardiac system and pneumatology in Debru
(). Some of the most prominent examinations of Galen’s thought in
I. Scholarship
recent years have also been done in the article form, for example, van der
Eijk () or Hankinson (). Galen’s understanding of human func-
tioning overall is also often discussed in works not specifically dedicated to
Galen, but to history of medicine more generally.
This monograph will
complement the current scholarship by offering a book-length study of the
unity of Galenic physiology in particular, focusing on its theorisation,
coherence and significance for Galenic understanding of human identity.
The problem of how Galen conceptualises unity is also the main
theme of Gill ( ), which focuses on psychology, presenting an
innovative reading of what the author ca lls the ‘high naturalism’ of the
Stoics and Galen.
The key argument is that Galen, despite his animos-
ity to the Stoics in such works as On the Doctrines of Hippocrates and
Plato, would have actually benefitted from adopting the Stoic
understanding of the single hēgemonikon instead of the Platonic
tripartition. Although this work does contain some physiological discus-
sions (e.g., embryology in Chapters and ), its main focus is on
psychology and related problems. The central topic of the present
volume is also the question of unity, although it primarily focuses on
those organs and systems that maintain vitality, such as nutrition,
respiration, voluntary motion by means of nerves, muscles and bones,
none of which feature prominently in Gill’s dis cussion. Given its focus,
this volume also does not address any significant problems in Galenic
psychology, covered by Gill and others,
with one relatively small
exception. The question on which psychology and physiology do overlap
is the tripartition of the soul and organ systems. This question is briefly
discussed in Chapter , but the overall discussion in the chapter puts an
emphasis on the physiological aspects of the tripartition, concentrating
on the interdependence of the organs rather than the psychological
activities they underpin. Thus, my enquiry into the physiological unity
runs parallel to Christopher Gill’s invest igation of the psychological
unity, and, hopefully, complements it.
For example, Cunningham (: –).
Gill (: –).
For an overview of the Galenic psychology and pertinent problems, see Singer (a: –, –);
Devinant () is a major recent study of psychological illness in Galen. See also Trompeter
(, ).
Introduction
I. The Problem of the Substance of the Soul
There is one more significant problem that studying the unity of parts
inevitably raises: the relationship between the psychic and the physical in
Galen. He is committed to the traditional Platonising view that the body is
an instrument of the soul,
which naturally raises the question of the
nature of the interaction between these two. Is the soul a corporeal entity
and this interaction is only a matter of a body affecting another body? If it
is incorporeal, then how can it have an effect on the body, a corporeal and
thus fundamentally different kind of entity?
The problem of the substance of the soul and the potential reducibility
of the psychic properties to the activities of the mixtures in the homo-
eomerous tissues is a well-known and widely discussed problem in Galenic
scholarship. A number of recent studies explored what either could be
called a kind of physicalism,
or the blurring of distinction between the
body and the soul,
or the ways in which mixtures account for certain
types of psychic content,
or how Galen makes no indication that
pathologies of the ‘soul’ amount to more than the imbalances of the
mixtures.
These studies, although concentrated on different topics, focus
on the same broad question, that is, whether the Galenic stance somehow
implies the conclusion that psychic capacities can be explained in terms of
the properties of tissues, which are produced by the mixture of the four
elements. Although, in many important ways, this volume builds on these
arguments, by and large it adopts a modest approach, taking Galen’s
Galen makes this claim when contrasting the ape body and the human body. The former resembles
the latter in the elements but not in the structure, because the structure is dictated by the soul
(which implies instrumentality: certain kind of soul requires a certain kind of body), see UP .
(., – Helmreich¼.–K) and UP . (., – Helmreich¼.K); see also QAM
(, –, Mu¨ ller¼.K). The ancient creationism that Galen is firmly committed to is
distinctly anthropocentric; this point is discussed extensively throughout Sedley (), especially
in the cases of Anaxagoras, Socrates, Aristotle and the Stoics.
The Stoic physics puts a special emphasis on this problem, laying the ground for a materialist
metaphysics that posits that all existing things are bodies; see, for example, Sextus Empiricus M
.¼SVF .¼LS B.
Gill (: –, , ), for example, suggests that Galen is leaning towards the Stoic style of
physicalism. He further argues that embracing fully this kind of physicalism would have made
Galen’s own position stronger and more coherent (–). See also the discussion of this point in
Chapter , note .
Das (: –).
As in Havrda (), although it is worth noting that such an interpretation is only applied to those
psychic properties that are underpinned by the activities of the vegetative and the spirited soul;
Havrda concludes that Galen did not make the same claim about the rational soul. See also
Vinkesteijn ().
Singer (: –).
I. The Problem of the Substance of the Soul