Cutting Words - Polemical Dimensions of Galen's Anatomical Experiments (Studies in Ancient Medicine) 9004439188, 9789004439184

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Cutting Words: Polemical Dimensions of Galen’s Anatomical Experiments

Studies in Ancient Medicine Managing editor Philip J. van der Eijk (Humboldt-Universitä t zu Berlin)

Editors Ann Ellis Hanson (Yale University) Brooke Holmes (Princeton University) Orly Lewis (The Hebrew University of Jerusalem) John Scarborough (University of Wisconsin-Madison) Joseph Ziegler (University of Haifa)

volume 55

The titles published in this series are listed at brill.com/sam

Cutting Words Polemical Dimensions of Galen’s Anatomical Experiments By

Luis Alejandro Salas

leiden | boston

Cover illustration: Bidloo, Govard (1649–1713): Ontleding des menschelyken lichaams Amsterdam, 1690. (dutch language edition of Anatomia humani corporis, 1685). Gerard de Lairesse (drawings), Abraham Blooteling, Pieter Stevens van Gunst (engravers). Courtesy of the U.S. National Library of Medicine. Library of Congress Cataloging-in-Publication Data Names: Salas, Luis Alejandro, author. Title: Cutting words : polemical dimensions of Galen’s anatomical experiments / by Luis Alejandro Salas. Description: Leiden ; Boston : Brill, 2020. | Series: Studies in ancient medicine, 0925-1421 ; volume 55 | Includes bibliographical references and index. Identifiers: lccn 2020043145 (print) | lccn 2020043146 (ebook) | isbn 9789004439184 (hardback) | isbn 9789004443860 (ebook) Subjects: lcsh: Galen–Influence. | Galen–Criticism, Textual. | Medicine, Greek and Roman. | Anatomy–History. | Vivisection–History. | Human experiments in medicine–History. Classification: lcc pa3997 .s25 2020 (print) | lcc pa3997 (ebook) | ddc 610.92–dc23 lc record available at https://lccn.loc.gov/2020043145 lc ebook record available at https://lccn.loc.gov/2020043146

Typeface for the Latin, Greek, and Cyrillic scripts: “Brill”. See and download: brill.com/brill‑typeface. issn 0925-1421 isbn 978-90-04-43918-4 (hardback) isbn 978-90-04-44386-0 (e-book)

Copyright 2020 by Luis Alejandro Salas. Published by Koninklijke Brill nv, Leiden, The Netherlands. Koninklijke Brill nv incorporates the imprints Brill, Brill Hes & De Graaf, Brill Nijhoff, Brill Rodopi, Brill Sense, Hotei Publishing, mentis Verlag, Verlag Ferdinand Schöningh and Wilhelm Fink Verlag. Koninklijke Brill nv reserves the right to protect this publication against unauthorized use. Requests for re-use and/or translations must be addressed to Koninklijke Brill nv via brill.com or copyright.com. This book is printed on acid-free paper and produced in a sustainable manner.

Contents Acknowledgements Abbreviations ix

vii

Introduction 1 1 Experiment and Experimental Writing 16 1 A World of Text 17 2 Demonstration: Instruction and Display 27 3 The Physical Spaces of Public and Private Medical Performances 4 Public and Private Demonstrations in Writing 44 5 Antiquarianism and Galen’s Doxographical Polemics 50 2 Galen and Agonistic Anatomical Demonstration 56 1 Credentialing and the Medical Marketplace 59 2 Rome and the Centrality of Public Display 68 3 Anatomical Procedures 73 4 Agonism and Invasive Anatomical Display 78 5 Prepared Extemporaneity 81 6 The Intercostal Nerves 88 7 Galen’s Experiments on the Ureters and Ureterovesical Valves 8 The Implicit Contest with Alexander 99 3 Magnification and the Elephant 103 1 Magnification and Analogy 105 2 Analogy, Classification, and the Ancient Anatomical Tradition 3 Elephants 119 4 Aristotle, Teleology, and the Elephant’s Trunk 121 5 Teleology, Humoralism, and the Elephant’s Gallbladder 129 6 Analogy and Teleology 133 7 Aristotle and Surrogate Targets 138

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4 Fighting with the Heart of a Beast: Galen’s Use of the Elephant’s Cardiac Anatomy against Cardiocentrists 144 1 The Os Cordis 145 2 The Agōn over the Heart 147 3 Galen’s Engagement with Aristotle 153 4 Galen’s Teleology and Cardiac Structure 158

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5 It Is Difficult Not to Write Anatomy: Galen on Erasistratus and the Arteries 169 1 Maryllus the Mime-Writer and the Value of Anatomical Experience 173 2 Claims of Knowledge and Refutations of Ignorance 175 3 Compulsion of the Truth and the Anatomy of Deception 176 4 A Polemic in Four Parts 181 6 Galen and the Experiment on the Femoral Artery 196 1 The Femoral Artery Experiment 201 2 Capacities and Their Explanatory Powers 205 3 Galen on the Simultaneous Movement of the Arteries 212 4 Arterial Breathing and Pulmonary Respiration 214 5 The Movement of the Blood 219 6 Irrigation of the Body 221 7 The Motile Properties of Blood and Pneuma 223 8 The Femoral Artery Experiment in Its Galenic Context 225 7 Drawing Blood: Galen’s Use of the Arterial Experiment against Erasistratus 227 1 Praxagoras and Some Rough Beginnings 229 2 Pneuma 233 3 Herophilus and an Emerging Tradition 238 4 The Simultaneous Action of Arterial and Cardiac Movement 241 5 Transpiration and the Arteries’ Attraction of Material from All Around 242 6 Erasistratus and Mechanism 249 7 Erasistratus and Void 252 8 Erasistratus, the Bird, and the Bear 257 9 Erasistratus and the Femoral Artery Experiment 261 8 De Galeni corporis fabrica: Writing Galen and the Greek Past in Vesalius’ Fabrica 265 1 Books and Book Production 267 2 Vesalius’ Appropriation of Galen’s Polemical Strategies 270 Conclusion

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Bibliography 289 General Index 310 Index Locorum 313

Acknowledgements In many ways, this book is a response to my first encounter with Galen’s On Prognosis and its abbreviated account of his experiment on the recurrent laryngeal nerve. I only later came to read Anatomical Procedures, in order to gain a better understanding of the demonstration. I was struck then, as I am still, by the complexity of Galen’s experimental writing—its vivid personal narratives, combative eruptions, and the sophisticated theoretical disputes roiling beneath their surface. I have been fortunate to have had the time and institutional support with which to complete this book. Its writing would not have been possible without the scholarly community available to me as a graduate student in the Joint Program in Ancient Philosophy at the University of Texas at Austin. The faculty of the Department of Classics at Washington University in St. Louis, my new home, have been model colleagues. I am deeply grateful to them for fostering an atmosphere of scholarly collegiality, and most especially for allowing me uninterrupted and precious time in which to write while on leave. More recently, my research has been made possible in part through a Loeb Classical Library Foundation Faculty Fellowship for the year of 2018–2019. I was also awarded a Center for Humanities Faculty Fellowship for the spring term of 2019 by Washington University. I would like to thank the staff of the Center for Humanities for providing me a friendly space in which to conduct my research. Robert Feibel and Elisabeth Brander of the Bernard Becker Medical Library at Washington University kindly allowed me to consult the library’s copies of both the 1543 and 1555 editions of Vesalius’ Fabrica, as well as the Giuntine edition of Galen’s collected works. The questions at the heart of the book are the product of a great many conversations with Lesley Dean-Jones and Jim Hankinson about Galen, in particular what sorts of things he counted as evidence for medical knowledge claims. It was under their supervision that I wrote the dissertation on which this book heavily draws. Lesley Dean-Jones has been a constant source of critical insight and commentary. Her encouragement and support have been singularly meaningful to me. To Jim Hankinson I owe, among other things, my initial interest in Galen. I have benefited tremendously from his incisive comments on my work, and from countless evenings discussing ancient philosophy and medicine. Numerous other friends and colleagues have been generous of their time and attention to my work. At one time or another Eric Brown, Carl Craver, Ignacio Infante, Nate Jones, Tom Keeline, Rebecca Messbarger, Tim Moore, Ben Morison, Caroline Petit, Julie Singer, Zoe Stamatopoulou, and Kate Wilson have

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all commented on sections of this book in written or oral form. Julius Rocca has been generous with his support of my research. I also wish to thank Daryn Lehoux, Mariska Leunissen, and Ralph Rosen for their comments on an earlier draft of the manuscript, as well as the Center for Humanities at Washington University for arranging the workshop in which they did so. I owe special thanks to Marquis Berrey, who has read and discussed nearly every word of the book with me. It is my great fortune to have his intellectual camaraderie. I also owe a great deal to Philip van der Eijk and Brill’s anonymous reader for their comments on my work, which have been meticulous and invariably helpful. Remaining mistakes are of course mine alone. It has been a pleasure to work with Giulia Moriconi, Cas Van den Hof, and the editorial staff at Brill. A section of chapter four has been published previously as Salas (2014); I am grateful to the editors of Greek, Roman, and Byzantine Studies and Duke University Press for permission to republish a very lightly edited version of the article in this book. Finally, I wish to thank my family. The support of my father has been a great help to me. My mother has been a source of motivation throughout my academic career. She is a lighthouse in all things. Dondequiera que vaya, llevo la memoria de mis abuelos conmigo. My wife Rosalyn has read every word that I have written. Her observations have more than once led me to reconsider important details of my work. It is a privilege to have her as a partner. I am grateful too for the constancy of Penelope. In many ways this book belongs to my daughters; Isabel and the dissertation from which it sprang were born days apart. She has been a model of patience and intellectual curiosity throughout. I am fortunate beyond imagining to have had her by my side. Lily will be too young to remember the book’s publication, but she too has grown along with many of its pages. It is to them and to Rosalyn that I dedicate this book.

Abbreviations I refer to all ancient treatises by full English title in the main body of my text and in footnotes when referring to them in a discursive context. More precise references in the notes are made according to the standard abbreviations listed in A Greek-English Lexicon of Liddell, Scott, and Jones (LSJ). References to Galen and other medical authors require further explanation. All references to medical authors first include the standard critical edition, if one is available. Format is generally volume and page number followed by the name of the editor(s), sometimes abbreviated. When citing Galen’s work, I have taken Hankinson 2008: xix–xxi as a model. Titles in the footnotes are abbreviated from their full Latin titles, as listed in Appendix 1 of Hankinson 2008: 391–397. Titles are followed by standard book and chapter number in multi-volume treatises, and only chapter number in single volume ones. Where the work appears in Kühn’s (1819–1833) collection of Galen’s writings, a second reference to the collection will follow as a common point of reference, separated from the first by an “=”. Kühn references will include the volume in which a work appears, listed by Roman numeral, followed by a period and the page number where the reference may be found in that Kühn volume. All such references close with “K.”. For example, a reference to book one of Galen’s Anatomical Procedures might appear thus: AA 1.1 (78 Garofalo = ii.215 K.). References to the treatises of the Hippocratic Corpus follow a similar format, referring to a standard critical edition followed by a reference to the collected edition of Littré (1839–1861). As a final complication, if the later critical edition appears among those in the Corpus Medicorum Graecorum (CMG), the reference will follow a similar format, but lists “CMG” and the relevant volume in the series rather than the name of the editor. For example, a reference to the first ten lines of chapter one of Galen’s On Prognosis might appear thus: Praen. 1 (CMG v 8,1 68.1–10 = xiv.599 K.). As one will note, this reference includes line numbers. Where line numbers appear in a critical edition, they will follow the page number separated by a period, as in the example above. Critical editions to which I refer frequently also appear in the Bibliography. A list of common abbreviations not covered in the preceding note are included below. Full references are given in the Bibliography.

x BJP B-M Duckworth F-W Garofalo Helmreich Jouanna Lewis Littré Ricciardetto Schiefsky SM vdE vS

abbreviations Boudon-Millot, Jouanna, and Pietrobelli (2010) Boudon-Millot (2000) and (2007) Duckworth (1962) Furley and Wilkie (1984) Garofalo (1988) and (1991a) Helmreich (1907–1909) Jouanna (2003) and (2013) Lewis (2017) Littré, E. (1839–1861) Ricciardetto (2016) Schiefsky (2005) Scripta Minora in three volumes: Marquardt (1884), Müller (1891), and Helmreich (1893) van der Eijk (2000–2001) von Staden (1989)

Introduction I am writing this treatise for a good reason—if it were possible for people to preserve these things by passing them down [sc. orally] from generation to generation, writing would be superfluous. Consequently, I have disseminated everything I have come to know from the beginning to those who ask for it, since if it is possible I want all people to learn it. And I see already that some of those who have received instruction from me rankle at communicating it. If after I die, they suddenly die too, my research will be lost.1 galen, Anatomical Procedures 2.1

∵ In 1904 a series of inscriptions was discovered in the ancient city of Ephesus.2 They memorialize the winners of competitions held at the Great Asclepieia in the early second century ce. The Asclepieia was not an athletic festival. The competitors were not awarded prizes for their speed or strength, but they did excel in a variety of medical competitions. The contests were conducted before a live audience. They ranged from displays of pharmacological knowledge to medical device design, the interpretation and exegesis of medical literature, and finally to surgical demonstrations. While the medical competitions of the Great Asclepieia may appear as curiosities to modern eyes, they reflect a feature of elite medical practice that was pervasive in the Roman Period and whose roots can be traced throughout the written remains of Greek medical discourse to the early Classical Period. Indeed, across the span of Greco-Roman antiquity intellectual medical discourse was not only contentious. It was often polemical. Very little context survives to fill in details about the ritualized competitions sketched out on the stones in Ephesus. Ancient textual accounts, however, offer

1 AA 2.1 (176–178 Garofalo = ii.282–283 K.): εἰκότως ὑπομνήματα γράφομεν, ὡς, εἴ γε τῇ παρ’ ἀλλήλων διαδοχῇ τοῖς ἀνθρώποις ὑπῆρχε διασῴζειν αὐτὰ, περιττὸν ἂν ἦν τὸ γράφειν. ἐγὼ μὲν οὖν ἁπάντων, ὧν ἐξ ἀρχῆς ἔγνων, ἐκοινώνησα τοῖς δεομένοις, βουλόμενος, εἰ οἷόν τε, πάντας ἀνθρώπους ἐκμαθεῖν αὐτά. τῶν δ’ ὑπ’ ἐμοῦ διδαχθέντων ἤδη τινὰς ὁρῶ φθονοῦντας ἑτέροις μεταδιδόναι, οἷς ἐὰν ἐξαίφνης ἀποθανεῖν συμβῇ μετ’ ἐμὲ, συναπολεῖται τὰ θεωρήματα. All translations are my own unless otherwise indicated. 2 I.Ephesos iv (IKA 14), 1980: 1161–1169, 4101b and Samama (2003: 210–215 = pp. 334–338).

© Luis Alejandro Salas, 2020 | doi:10.1163/9789004443860_002

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a fuller picture of medical practice in Rome. In their pages, rival physicians may compete on a stage or at a patient’s bedside, vying for professional authority and the reputation, patrons, and students that followed from it. The monuments no less than the books underscore the public and competitive nature of Greco-Roman medicine. Cutting Words is a book about competition in ancient Greek and Roman medicine or, rather, the strategies with which competitors—and one competitor in particular—engaged with one another on a medical stage. Its main subject is the second-century-ce physician and philosopher Galen of Pergamum, who describes the culture of public medical experimentation at Rome in great detail throughout his voluminous work. I will use the language of experimentation often in this book, especially when discussing a number of demonstrations that took place after the fourth century bce. In doing so, I do not intend to conjure laboratories or the present-day institutional structures on which they depend. There were, after all, no comparable spaces or institutions in antiquity, a historical point that will prove to have great importance to this study. Nor do I intend to invest the experimental activities I discuss with significant theoretical baggage. By “experiment” and related words I mean only to pick out a range of activities—public and private—that purport to demonstrate some claim about the natural world and are deliberately constructed to do so through intervention.3 Experiments typically appeal to empirical observation in support of their conclusions. They are frequently performed in circumscribed social contexts, and they often require the use of specialized language and instruments. Galen’s experiments and the world of medicine that he maps out are vigorous, erudite, and combative. The intellectual sophistication of Roman experimental culture was matched by its lurid appeal. In Galen’s writing, for instance, theoretical debates on natural teleology play out on a Roman street corner with his dissection of an elephant’s heart, procured from the kitchens of the Emperor;4 an old man is dragged from his bed and out of his home to witness Galen refute his physiological beliefs before a crowd of onlookers, who jeer at his humiliation;5 theories over the nature and location of the mind are judged and settled by the public vivisection of a pig’s larynx.6

3 For discussion of experimentation in the Greco-Roman intellectual tradition, see von Staden (1975). 4 AA 7.10 (662–666 Garofalo = ii.619–621 K.). 5 AA 7.16 (698–700 Garofalo = ii.644–645 K.). 6 AA 8 (710–788 Garofalo = ii.651–706 K.), AA xi.4 and 11 (81–87 and 104–107 Duckworth), xiv.6–8 (203–217 Duckworth); UP 16.4 (ii.386.10–388.11 Helmreich = iv.278–281 K.); and Praen. 5 (CMG v 8,1 96.27–98.26 = xiv.628–630 K.).

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These examples do not only exhibit a pointed agonism characteristic of Galen’s experimental writing. They also show the keen attention Galen paid to the manner and occasion of their performance. Galen warns that the procedure on the larynx should not be performed on monkeys, since the expressions of their pained faces are too distressing to onlookers. Moreover, monkeys do not cry out so loudly as other animal subjects. He tells us that the demonstration should be performed on a pig instead, since its plaintive wailing arrests the audience’s attention.7 When Galen—or the reader who studies Galen’s work— cinches the laryngeal nerve, the animal’s sudden silence renders an audience dumbstruck. Nothing so stuns all those present, however, as the resumption of the pig’s cries at the moment the ligature is undone. As with the medical competitions at the Great Asclepieia, some of the social functions of these demonstrations may seem unintuitive to present-day readers, accustomed as we are to different mechanisms for establishing intellectual and professional authority. For a number of reasons I will discuss, public and highly polemical debates often served just this purpose for Greek and, later, Roman intellectuals. As I will argue, Galen’s written accounts of public experimentation also served this purpose. In a more specific sense, then, Cutting Words is a study of these experiments and others like them in Galen’s writing. Although it examines the experiments as live demonstrations, its focus lies in a close consideration of Galen’s sophisticated experimental narratives—medical demonstrations as writing.8 Galen’s experimental activity has received relatively little attention in modern scholarship,9 despite the importance of anatomy and anatomical writing to his work and despite the fact that Galen is the most prolific Greek author whose work comes down to us from antiquity—his extant output makes up nearly ten percent of Greek writing that survives from before the third century ce. Indeed, experimental demonstrations and experimental writing are not only central features of Galen’s work. They also played a key role in the advancement of his professional career during his lifetime, and in his tremendously influential afterlife in the later history of medicine. Yet, Galen’s public experiments, their place in the culture of demonstration in Rome of the Imperial Period, and their

7 AA 8.8 (766 Garofalo = ii.690 K.). 8 On science writing in Greco-Roman antiquity as discourse, rather than merely a repository for ancient views about the natural world, see van der Eijk (1997). While van der Eijk restricts his discussion to the 5th–4th centuries bce, most of his points are equally relevant to later ancient material. 9 Some notable exceptions are von Staden (1975), (1995), and (1997a); Debru (1995); Rocca (2003); and Gleason (2009).

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argumentative role in Galen’s written work have not received focused scholarly treatment to date, much less a study of monograph length.10 Galen’s work and other Greco-Roman writing understood as technical, so-called Fachtexte, continue to exist outside of the disciplinary mainstream. The stones of the old Romantic boundaries separating science writing from ‘literature’ remain in place, even if their erosion has begun to accelerate in the late twentieth century.11 Nonetheless, vast terrains remain uncovered, including some of the more technical of Galen’s anatomical writing.12 In Cutting Words I investigate Galen’s medical demonstrations as a set of medical practices. I argue that Galen’s polemical engagement with contemporary rivals and past authorities is a central feature of how he did medicine, and further that it is representative of how medicine in the Greco-Roman world was done, at least by certain groups of practitioners. On my view, Galen’s experimental writings—including their literary allusions, searing diatribes, and philosophical exegeses—should be read as part of his professional practice along with the live demonstrations that they reproduce. Moreover, both his written and live demonstrations should be understood in the broader context of other contemporary Greek intellectual practices, with which they hold much in common. While the highly wrought polemicism of Galen’s writing in many ways sets him in his own class among Greco-Roman medical authors, it is nonetheless part and product of a much older tradition. Greek and Roman medical writing squarely belongs in the broader discourse of Greco-Roman intellectual prose. The same holds for the demonstrations described in these texts, both more abstract discussions and their practical counterparts. Some of the more practical experiments that Galen reports, such as dissections and vivisections, are best attested in the Imperial Period. There is an abundance of evidence, however, for purely abstract medical demonstrations 10

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Galenic scholarship since the late twentieth century has focused, until recently, on Galen as a source for medical sectarianism, the vibrant second-century debates over medical epistemology, and to a lesser extent the social context they offer for medical practice in Rome of the Imperial Period. The secondary literature is extensive. For a sense of the scholarly terrain see, e.g., Hankinson (2008a). For recent and shifting directions in Galenic scholarship, see, e.g., Laskaris, Rosen, and Singer (forthcoming). Although the social role of experimentation in scientific discourse has been an area of scholarly interest for some time now in history of early modern science—at least as early as Shapin and Shaffer’s highly influential (1985) Leviathan and the Air Pump—disciplinary divisions remain sharp. On the historical misfortunes of science writing due to disciplinary exclusion, see Asper (2013: 1–5). On this state of affairs, although focusing on Hellenistic material, see Cuypers (2010: 331– 334). Cf. Singer (2013: 7–9). Van der Eijk (1997: 77–89) offers a helpful discussion of these issues.

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and the competitive social matrix in which they took place from the earliest writing to survive in the Greek medical tradition. Many treatises of the Hippocratic Corpus, for example, exhibit the agonistic tendencies common to other Greek intellectual writing, especially philosophical and oratorical texts.13 To cite but one example among many, the author of the Hippocratic Nature of the Human Being (late fifth century bce) begins the treatise with recriminations over the empty polemics endemic to medical debates of his day: And so, whoever is accustomed to listen to those who talk about the Nature of a human being beyond the extent to which it relates to the art of medicine, this speech is not designed for him to hear … when they [sc. those who talk about the Nature of human beings] all hold the same belief but do not say the same things about it, it is clear that they know nothing. One can recognize this fact, especially when in attendance at their debates. Although the same people debate with one another in front of the same audience, the same speaker is not ever the winner three times in a row in the debate; rather, one speaker wins at one time, another the second time, and finally, by chance, the one whose tongue seems smoothest to the crowd.14 It has become more or less a standard view, certainly since Geoffrey Lloyd’s pioneering work, that the sharp engagements of these medical authors reflect a general social mechanism common to ancient Greek intellectual discourse, one which serves to delimit the boundaries of ancient disciplines—and in doing so define them.15 Throughout Greek and then Roman antiquity there were no diplomas, white coats, no socially sanctioned places of medical practice or learning—there were no credentialing bodies such as hospitals, universities, or academic journals. It is thus important to keep in mind that the need of the ancient medical

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See, e.g., Ducatillon (1977); Lloyd (1979: 242–255) and (1990: 32–38, 58–67). Nat.Hom. 1 (CMG i 1,3 164.3–5 … 166.1–9 = 6.32–34 Littré): ὅστις μὲν οὖν εἴωθεν ἀκούειν λεγόντων ἀμφὶ τῆς φύσιος τῆς ἀνθρωπίνης προσωτέρω ἢ ὅσον αὐτῆς ἐς ἰητρικὴν ἀφήκει, τούτῳ μὲν οὐκ ἐπιτήδειος ὅδε ὁ λόγος ἀκούειν … ὁπότε δὲ γνώμῃ τῇ αὐτῇ πάντες προσχρέωνται, λέγουσι δὲ οὐ ταὐτά, δῆλον ὅτι οὐδὲ⟨ν⟩ γινώσκουσι. γνοίη δ’ ἂν τῷδέ τις μάλιστα παραγενόμενος αὐτοῖσιν ἀντιλέγουσιν· πρὸς γὰρ ἀλλήλους ἀντιλέγοντες οἱ αὐτοὶ ἄνδρες τῶν αὐτῶν ἐναντίον ἀκροατέων οὐδέποτε τρὶς ἐφεξῆς ὁ αὐτὸς περιγίνεται ἐν τῷ λόγῳ, ἀλλὰ τοτὲ μὲν οὗτος ἐπικρατεῖ, τοτὲ δὲ οὗτος, τοτὲ ᾧ ἂν τύχῃ μάλιστα ἡ γλῶσσα ἐπιρρυεῖσα πρὸς τὸν ὄχλον. καίτοι δίκαιόν ἐστι τὸν φάντα ὀρθῶς γινώσκειν ἀμφὶ τῶν πρηγμάτων παρέχειν αἰεὶ ἐπικρατέοντα τὸν λόγον τὸν ἑωυτοῦ, εἴπερ ἐόντα γινώσκει καὶ ὀρθῶς ἀποφαίνεται. See Lloyd (1979: 59–125). More recently, see Rosen (2019).

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practitioner to establish professional legitimacy was an acute and recurring one.16 Enjoyment of this authority was unstable, since it was largely the result of the approbation that a practitioner could negotiate with different audiences in a highly unregulated environment, often referred to as a “medical marketplace”.17 Public demonstrations were a common and powerful way in which this kind of social function was fulfilled for ancient Greeks and Romans. For them professional legitimacy was a highly contested space, in which intellectual elites—especially in the bustling world of second-century Rome—strove for authority in dazzling displays of learning, technical skill, and dramatic persuasion.18 By Galen’s time in the second century ce medical debates came to include the public dissection and vivisection of non-human animals. Except for a brief period in the first half of the third century bce, there is no evidence for systematic dissection of human beings in the Greco-Roman world. Consequently, 16

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Indeed, the author of the Hippocratic Prognostic is explicit on this point. See, e.g., Prog. 1.1, 1.3 (1–2.2, 3.5–11 Jouanna = 2.110–112 Littré). Prognosis, which in Greek medicine also included in its ambit what we would call diagnosis, was useful to the Hippocratic physician insofar as it helped him to chart the history and course of acute illness despite what patients might say or not say about their affliction. Armed with this information, the physician was less likely to have to make unexpected decisions at critical moments. This social function of Hippocratic prognosis responds to the same basic need to which competitive medical displays answer: establishing the legitimacy and authority of the practitioner and his practice. On the professional consequences of effective prognosis for the Hippocratic physician, see Edelstein (1967c: 65–85). This environment is commonly describe as a “medical marketplace”, a phrase popularized among historians of ancient medicine by Vivian Nutton. See, e.g., Nutton (1992) and (1995). The metaphor is drawn, however, from histories of medical practice in early modern England. It became a popular heuristic for discussions of the varied and highly unregulated therapeutic environment of early modern England among historians of medicine writing in the mid-1980s. See, e.g., Porter (1985); Bynum and Porter (1985); Loudon (1985); and Cook (1986). See also Park (1985), writing about the medical context of early renaissance Florence. The phrase has been criticized as overused and, for this reason, increasingly vague. For a recent overview of the history of the phrase including recent criticisms of it, see Jenner and Wallis (2014: 1–23). The kinds of issues raised in these criticisms have less bearing on discussions of the healthcare environment in the ancient Greco-Roman world, since the evidence available to us does not permit much more granular usage. For example, we currently possess too little knowledge about non-elite practitioners to make rigorous arguments about their place in the economies of ancient healthcare. Therefore, the primary sense of the phrase as I am using it, and as I take Nutton to use it, just is that the field of Greco-Roman health practitioners and the environment in which they operated was rich and variegated in theoretical, practical, and almost certainly economic terms. The phenomenon is not restricted to medical discourse. See, e.g., König and Whitmarsh (2007: 25–27) on its relevance to disciplinary self-presentation in technical literature of the Roman Imperial Period.

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most anatomical writing and all of the anatomical demonstrations I discuss involved non-human animal subjects, whose bodies were the basis for analogical arguments about the structure and function of human bodies.19 The rise of practical demonstrations such as these allowed the medical practitioner and agonist another means by which to define himself and his profession. Indeed, demonstrations of the body and its interior provided opportunities for spectacle far beyond what would have been possible in the context of abstract intellectual debates. It is difficult to say when this practice emerged. It probably arose some time in the century after Aristotle’s death in 322bce with the increasing normalization of systematic and invasive anatomical research. Certainly by the time of Rufus of Ephesus (late 1st–early 2nd century ce), practical demonstrations involving animal dissection and vivisection are common enough that Rufus refers to them casually.20 The medical competitions at the Great Asclepieia took place in Ephesus, and the inscriptions that memorialized them date to about this time. Whenever the emergence of practical anatomical demonstrations first took place, it introduced with it new avenues for the demonstrator to engage with his opponents and with his audience. Reference to a physical body worked to reify and confirm the speaker’s theoretical claims. After all, here was a subject that one could see first-hand. Public anatomical demonstrations—abstract and practical—were of considerable importance in Galen’s professional life. So much so that he associates them with some of his moments of greatest professional triumph. One such demonstration earned him the position of gladiatorial physician in his home city of Pergamum at about 157ce. Another vaulted him into the orbit of the Roman political elite and ultimately the imperial family by 169 ce. These experiments are not just a dominant theme in Galen’s biography, however. Experiments and experimentation are intimately entangled with his writing practices, and not merely because their narratives are prevalent in his work. The rich detail with which Galen describes his public and private demonstrations is unique among surviving Greek and Roman texts. Galen instructs the reader on what tools to use, where they can be bought, and how they should be con19 20

I give a fuller treatment of these points in chapter three. See Rufus of Ephesus, Onom. 127, where Rufus segues from his excursus on the external anatomy of the human body to its internal anatomy. While he demonstrates the surface anatomy on a human model, he explains that demonstrations of internal anatomy require dissection and, therefore, non-human animal subjects—here, monkeys. His explanation also alludes to an established system for determining animal subjects that will be suitable for dissection. Rufus’ passing reference to this system suggests that there was an existing tradition of dissective demonstrations in his time, for which such a system had been developed.

8

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structed.21 He tells us about animal subjects and the places in Rome where one may most reliably procure them.22 He offers careful guidance on how best to perform anatomical demonstrations before a live audience in order to amaze them.23 Moreover, his scathing criticisms of second-century rivals and their intellectual antecedents preserve a wealth of information about the views and identities of a stunning range of medical thinkers. Writing and writing technologies also allowed Galen to translate earlier models of live medical debate into a format that did not depend on a performative occasion—for a reading audience that was not constrained by the observational challenges of public anatomical experiments. Some of the obstacles for spectators are more mundane, such as lighting, proximity to the subject, and so on. Other difficulties endemic to live demonstration are more fundamental. The live-audience goer could not expect to understand an anatomical demonstration fully without knowledge of the theoretical or interpretative disputes on which a given experiment might have bearing. Many likely lacked the logical training required to follow Galen’s inferential processes. Nor would most have possessed the anatomical experience that made it possible to recognize and distinguish the structures under discussion from the blood and gore around

21

22

23

Galen frequently advises the reader in Anatomical Procedures on the proper instruments for different procedures. For a particularly detailed example, see AA 8.6 (754 Garofalo = ii.682–683 K.). In the passage Galen recommends that one use a special kind of scalpel of his own devising, which he calls an “elongated knife” (τὸ πρόμηκες μαχαίριον). He likens it to a pointed lancet (σκολοπομαχαίριον). On the lancets, see Bliquez (2015: 92–93). Galen adds that the lancet should be made of the best available materials, such as steel from Noricum. Cf. MM 13.22 (x.941–943 K.), where Galen offers instruction on what surgical sutures to purchase in Rome and where they can be found, imported Gallic thread sold along the Sacred Way. For the physician practicing in other cities, Galen recommends silk if it can be found, and dried gut if it cannot. See, e.g. AA 9.1 (794 Garofalo = ii.708 K.), where Galen advises the reader to procure the brains of oxen for neural demonstrations, since their large size facilitates observation of neural anatomy and they are readily available in the markets of Rome and other cities. In most cases, Galen recommends that one perform dissections on monkeys whose cranial features are closest to that of human beings (AA 1.2, 88–90 Garofalo = ii.222–223 K.). He offers a few circumstances under which other animal subjects are preferable to monkeys. Some structures, for example, are too small to be observed easily in human-sized creatures (AA xv.2, 228 Duckworth). Performative considerations may also determine the choice of animal subject, as in the case of Galen’s voice experiments, in which the louder screams of a pig make a greater impression on a live audience (AA ix.11, 15 Duckworth). On Galen’s animal subjects, also see Rocca (2003: 67–76). Performative instructions aimed at inducing wonder and amazement are common in Anatomical Procedures. For a representative example, see AA 8.4 (736.3–23 Garofalo = ii.669–670 K.).

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them. Finally, the live-audience goer had to contend with the brute limitations of the unaugmented human eye. Galen’s detailed written descriptions attempt to address these various difficulties. For example, Galen will sometimes give an exhaustive report to the addressee of a given work on the points at issue in a practical demonstration or debate. These explanations, he writes, are not necessary for the addressees of his treatises or certain other readers, who are always quite familiar with their intricacies. The details do, however, serve as helpful reminders to them of what they have already witnessed.24 The conceit not only calls the addressee to witness on his behalf, but also allows Galen to provide extensive background explanations to readers who require them. A written medium also permits Galen to present anatomical structures to his readers cleanly, apart from the chaos of a live demonstration, and suitably enlarged in the case of minute structures that are difficult for the inexperienced to distinguish during a live performance—or simply difficult to distinguish under any circumstances. With the tremendous importance of writing to Galen’s medical practice in mind, I aim to examine Galen’s experimental activity in its social context, as elite intellectual writing. Ultimately, the project of this book arises from a series of puzzling questions: what function(s) did Galen’s demonstrations of anatomical knowledge perform in a pre-modern medical context where such knowledge lacked therapeutic benefit? After all, one does not survive open heart surgery in the Greco-Roman world. How did Galen’s experimental writing function at the local level of his own treatises, and in the wider context of second-century Roman intellectual culture? Are the marked polemical functions of his writing, experimental and otherwise, separable from their heuristic functions? A theme that runs throughout Cutting Words is that Galen’s experimental writing performed or, rather, re-performed the credentialing functions of his live public experiments. I argue that Galen’s experimental writing engages in an elite intellectual discourse that combines second-century display culture with agonistic features already present in Greek intellectual prose traditions. Although Galen does stress the epistemological need for experimentation in medical knowledge claims, his experiments also engage in a broader polemic

24

The general strategy is common in Galen’s work. See, e.g., AA 1.1 (78–80 Garofalo = ii.215– 216 K.), 7.14 (686 Garofalo = ii.635 K.) AA 7.16 (696 Garofalo = ii.642–643 K.), 8.1 (710.1–10 Garofalo = ii.651–652 K.), 8.8 (766 Garofalo = ii.690 K.); Praen. 2 (CMG v 8,1 74.12–17 = xiv.605–606 K.), 2 (CMG v 8,1 78.3–10 = xiv.609 K.), 5 (CMG v 8,1 94.24–96.2 = xiv.626 K.), 13 (CMG v 8,1 134.9–11 = xiv.665 K.). On Galen’s use of witnesses in his writing, see Lehoux (2017).

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against rival theorists where expertise is a means to professional authority. As we have seen, competitive intellectual performances were already available as a natural mechanism for establishing professional legitimacy. Public anatomical demonstrations put the practitioner’s knowledge and command over the body on display. Even when these procedures did not have direct therapeutic application, their performance nonetheless exhibited command over the bodily domain where disease was found. In order to gain a closer understanding of Galen’s experimental practice in its historical context, my research expands notions of experimentation and philosophical demonstration in studies of Greco-Roman technical discourse. It considers the close connections between credentialing functions of Galen’s intellectual activity and that of contemporaries operating in other disciplines. Some of these practices are more obvious, such as those in philosophical writing, others perhaps less so, as in oratorical and sometimes even comic writing. Cutting Words is organized around four of Galen’s most detailed and influential experiments as case studies: on voice production, the ureters and ureterovesical junction, the heart, and the femoral artery. While these live demonstrations performed a licensing function for Galen’s medical practice, his experimental writing extended the influence of his public displays—otherwise limited by the context of their initial live performances—to an audience untethered to either a specific time or place. Readers incorporated into the narrative as confidants and critics bore virtual witness to these demonstrations. The vivid performative details of his technical writing should be understood not just from a didactic point of view but also as reproducing a powerful credentialing function normally restricted to the judgments of live audiences. I argue that Galen successfully exploited book technology as a mechanism to expand his circle of scientific influence, which invested his medical theory and practice with greater intellectual and social credibility. Chapter one introduces a distinction between experiment and experimental writing that I have sketched out in this introduction, and that runs throughout my book. It aims to present the reader with an anxiety over influence in Galen’s writing—not only the influence that earlier intellectual authorities have over his work, but also Galen’s anxiety to extend his own influence throughout time and place.25 On one level, this anxiety takes shape for Galen as it does 25

I have in mind here the kind of relationship to the past that Bloom (1973) has called an “anxiety of influence”. There is a tension in Galen’s attitude toward past authorities. While he turns to the writing of certain ancient thinkers as a model to be interpreted and emulated, he is of course also at pains to distinguish himself from them. See Asper (2007: 360–363).

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for many other Greek and Roman intellectuals of his time. The elite reading culture of the high Roman empire looked backward to the Classical and Hellenistic Greek past—ranging roughly from the early fifth to the first centuries bce—as a source of intellectual authority. Galen’s experiments and his experimental writing engage with past authorities as much if not more than with contemporary rivals. These authorities, almost exclusively from the Greek past, are thus central figures in any examination of Galen’s polemics. The focus of chapter one, however, lies in the second anxiety I have mentioned: an anxiety over the reach of the author’s influence and legitimacy in time and place. This story takes shape in the events following a catastrophic fire in the city of Rome in 192ce and sets the stage for my discussion of writing and the technologies associated with it in Galen’s intellectual practice. In a recently discovered treatise, Galen documents his losses in the Great Fire. Chief among them was the destruction of his library. Galen’s narrative of its devastation offers a wealth of information about his deliberate approach to the composition, distribution, and reception of his written work. Most importantly, the conflagration of Galen’s library tells the story of his sophisticated use of books—as a medium for presenting his ideas and for disseminating them—to reproduce the social functions of live public demonstrations in his narratives of them. To that end, in this chapter I also examine Galen’s live demonstrations as a groundwork for later discussion, in particular his public experiments on voice production. I distinguish between the spaces in which such demonstrations likely took place, with attention to the ways in which book technology allowed Galen to move seamlessly between the domains of private and public demonstration, spectacle and instruction, and between physical spaces and written ones. Chapter two returns to Lloyd’s thesis about the licensing function of agonistic intellectual discourse. I flesh out the socio-cultural context in which Galen’s anatomical experiments took place, and I formally introduce the importance of this sort of engagement to the professional authority of the elite medical practitioner. Here I discuss Galen’s demonstrations of the function of the ureters and ureterovesical valves against Asclepiadeans. Chapter two also introduces explicitly the notion of the group or multiple consultation, a social phenomenon that I argue puts further pressure on practitioners to distinguish themselves from one another competitively. I offer a more detailed account of the highly wrought performance culture of the Roman elite in the Imperial period, with an emphasis on the role of antiquarianism and literary expertise in the self-presentation of intellectuals (pepaideumenoi) such as Galen. I locate Galen’s handbook on human anatomy and his demonstrations of it, called Anatomical Procedures, in this social context. A particular aim of this

12

introduction

examination is to demonstrate Galen’s use of erudite doxography to undercut his rivals, a strategy which I refer to as a “doxographical polemic”. Chapter three fulfills a promise made in chapter one. It is an extended case study on Galen’s writing about massive animal subjects, such as the elephant. I argue that Galen’s experimental narrative of the elephant demonstrates his ability to leverage written demonstration, not only as a surrogate for live demonstration, but even as an improvement on it. In the absence of magnificatory technology, Galen’s narratives about these large animal subjects are an exposition—for a reading audience—of structures too small to be seen by audience members in a live demonstration. The elephantine trunk and gallbladder are central to this discussion. Two groups emerge more fully that will be the focus of Galen’s criticism throughout the course of Cutting Words. Asclepiadeans come under Galen’s fire for their anti-teleological views, their solidistic theories of the body, and for their later associations with Methodism. The primary target of Galen’s experiments, however, are contemporary Erasistrateans, the second-century ce followers of the third-century bce medical theorist and practitioner Erasistratus of Ceos. Two of Erasistratus’ views present a great threat to Galen’s system of physiology: first the view that the arteries contained only pneuma, an air-like substance, and second the view that not all physiological processes should be explained in teleological terms. Chapter four continues my discussion of the elephant’s body as a heuristic tool for the investigation of human anatomy. In his description of cardiac anatomy in Anatomical Procedures, Galen abruptly segues from a relatively impersonal narrative about the structure of the heart to a vivid account of a structure whose presence in the heart is under some dispute in the second century. The episode begins, as many do in Galen’s work, with a public confrontation. In response to his opponents’ claims, Galen produces the heart of an elephant from the kitchens of the emperor. He then has the heart dissected before his rivals and the crowd that has gathered to witness the spectacle, in the streets of Rome. The structure, a bone, is where Galen says it would be. His rivals are suitably humiliated. The episode closes with Galen’s aside to the reader that the bone remains on his desk as he writes Anatomical Procedures, a testament to his opponents’ intellectual and medical fraudulence. At the core of this chapter is a puzzle: The structure that Galen pulls from the heart of the elephant does not exist. I read this episode as a carefully constructed polemic aimed at undermining the legitimacy of rival theorists who believed that the heart was the control center of the body, in large part for the sake of reproducing the credentialing function of live demonstrations in a written space. I argue that while the explicit dispute in the episode is over the presence of this structure in the elephant’s heart, the underlying debate is over

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1) the teleological structure of the natural world and 2) the location of identity in the body. The argument aims at undercutting his rivals’ claims about the control center of the body, but the episode is structured so as to damage this argument collaterally. In order to undermine his opponents, Galen first argues that they do not adhere to the views of Aristotle—the ancient authority from which they draw their own—because they fail to understand them. Then Galen claims to show that his rivals also fail to make accurate empirical observations of cardiac anatomy. Once Galen has shown that his contemporary opponents can neither observe nor read accurately, he turns to a final dispute with Aristotle, whose teleological commitments are insufficiently robust for Galen. Chapter five examines a series of four vignettes that follow the heart-bone episode in Anatomical Procedures. Erasistratus and Erasistrateans figure prominently in these short and, as I shall argue, satirical accounts. Galen’s argues that his opponents can neither properly read nor do anatomy. Their failures are revealed in public contests, features of which I develop further here: Galen’s opponents are unpracticed in anatomy, lack a proper grounding in philosophy, and cover for their ignorance by deceiving a lay audience with their audacious falsehoods. Typically his opponents must be compelled to perform before an audience, thus revealing their mendacity. Galen turns to the language of new comedy and ancient diatribe throughout the four episodes in order to paint his rivals as socially and intellectually subaltern. They are, as he says, like the deceptive slaves that populate the pages of Menander’s comedies. Chapters six and seven examine the femoral artery experiment. While the procedure has been typically associated with Galen since at least the great revival of anatomy and Galenism in Western Europe of the sixteenth century, Galen was neither the first to conceive of it nor to conduct it. Indeed, Galen’s account of the procedure and his interpretation of its results are another example of doxographical polemic, in which he first interprets Erasistratus’ powerful arterial experiment within the framework of his own physiological theory, and then turns it against Erasistrateans of his own day. Galen’s polemical strategy was so effective that it all but erased Erasistratus’ authorship of the experiment from later histories of medicine. The relevant phenomena in the femoral artery experiment would certainly have been impossible to see for a larger audience in a public demonstration. It is also unlikely, however, that they could have been seen even by the experimenter under ideal conditions. I argue that Galen’s episodes are a sophisticated use of writing as a means of magnification. The peculiar reception of the experiment in the history of medicine is an illustration of Galen’s polemical efficacy. In this case, the history of the experiment has obscured the tremendous importance of it to Galen’s physiological theory. The polemical character of Galen’s experimental writing is so pronounced as to

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illuminate the main points of friction between his conception and execution of the procedure and that of Erasistratus. These agonistic points of contact also shed light on features of Galen’s conception of respiration and arterial physiology that might otherwise remain obscured. Chapter six thus attempts to discuss Galen’s femoral artery demonstration in isolation from its Erasistratean antecedent so as to highlight its place in Galen’s system of physiology. Chapter seven attempts to reconstruct the experiment in its original Erasistratean context. Although the two chapters examine the same basic procedure, I argue that in their respective theoretical and historical contexts Galen’s demonstration is distinct from Erasistratus’ in deep and significant ways, such that the same procedure constitutes two different experiments. Consequently, the chapters proceed in this order and are separated for pragmatic reasons. Erasistratus’ writing survives only in fragments, the majority of which are preserved in the works of Galen. For this reason, it is impossible to discuss Erasistratus and the femoral artery experiment without first discussing Galen’s account of it. Chapter seven uses the wealth of material present in Galen’s polemic against Erasistrateans to offer a reconstruction of Erasistratus’ original experiment. Ultimately this reconstruction is intended to show just how much of a threat the experiment was to Galen’s system of physiology—and perhaps more so to deeper Galenic commitments about the structure of the body and the natural world. The chapter focuses on key features of Erasistratus’ system of physiology in order to illuminate the stakes involved in the experiment’s earlier incarnation and to show how Galen repurposed the experiment for his own theoretical ends. Furthermore, it is likely that the experiment in its original Erasistratean context was developed to refute what was becoming a standard view of arterial motion in the early Hellenistic Period. The points of friction between Erasistratus’ physiological theory and those of his contemporaries—at least what can be said about them—offer promising evidence for the kinds of theoretical motives Erasistratus may have had to devise the femoral artery demonstration. In the process of this discussion, chapter seven also argues that Erasistratus’ use of his experiment against his rivals is fittingly similar to Galen’s use of it four hundred years later. Erasistratus’ experiment was a natural flashpoint for Galen, given his predecessor’s strong associations with experimentation in Greek intellectual writing. Chapter seven provides a crucial point of reference for Galen’s use of experimental writing to generate intellectual and professional authority through polemical engagement with his rivals. The final chapter of this book moves over a millennium forward in time. It focuses narrowly on the reception of Galen’s anatomical writing and method in the famous Preface to Andreas Vesalius’ De humani corporis fabrica. Here I

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examine how Vesalius (re)constructs Galen and the history of Greco-Roman medicine in his letter to the Habsburg king Charles v. I argue that Vesalius reproduces many of the credentialing features of Galen’s anatomical experiments in his own writing. Vesalius was a keen reader and translator of Galen’s work; he presents similar strategies of engagement with his Renaissance rivals, who with some historical irony were Galenists. There is another similarity between Vesalius’ medical practices and Galen’s, which is especially striking in the context of this book. It is well known that Vesalius invested tremendous care and attention in the printing, illustration, and artistry of the Fabrica. Indeed, one of the main avenues of scholarly interest in Vesalius’ Fabrica has been the book as a visual artifact or work of art. A main theme of this book has been that Galen’s experimental writing extends a licensing function performed by live demonstrations to written ones and that, in this way, Galen in a sense anticipates Vesalius’ use of book technology to establish his intellectual and professional authority. I close Cutting Words with the Preface of Vesalius in part because Vesalius’ work has often been seen historically as the death knell of Galenism, although this claim turns out to be overly simplistic. Vesalius looked back at Galen and suffered anxieties of influence similar to those that, as I argue, beset Galen himself. Like Galen, Vesalius leveraged erudite reading of past authorities as an argumentative instrument aimed at contemporary rivals. The performance culture of Western European elites during the Renaissance bears striking resemblances to the competitive display culture of pepaideumenoi in the late Roman Imperial Period. Like their second-century predecessors Renaissance Humanists established their status as cultured intellectuals and elite professionals through expressions of antiquarian erudition. The Fabrica recreates the physical spaces of Vesalius’ anatomical performances in a written domain, as I argue that Galen had done in Anatomical Procedures hundreds of years earlier. Vesalius also looked back to his medical past, and refashioned it as a precursor to his work. Vesalius engages in a sophisticated doxographical polemic learned from Galen himself. First, he deploys Galen against the Galenists, whom he accuses of making empty anatomical claims that they are too inexpert to demonstrate. Then he turns to Galen, and in correcting his work, Vesalius aligns himself with the authority of antiquity as Galen had done before him. Galen’s anxieties in the epigraph to this introduction were in a sense unfounded. Vesalius’ own written practices—with their striking affinities to Galen’s own—helped to insure that Galen’s research, his writing, and his influence were not lost after his death.

chapter 1

Experiment and Experimental Writing Some time in the spring of 192ce, perhaps in March, a raging fire broke out in the city of Rome. It began somewhere near the Temple of Peace, to which it spread, traveling south along the Sacred Way toward the Palatine Hill until finally it burned itself out.1 The conflagration would ultimately consume the Temple, much of the sacred precinct, and important libraries that lay in its path.2 In its wake many of the warehouses abutting the Temple of Peace and running alongside the Sacred Way were also gutted, their contents lost to the flames.3 These warehouses were prized as storage vaults, ironically, because they were thought to be fireproof—only their doors were wooden. This reason was among those that prompted Galen to pay the steep rent the warehouses commanded in order to store some of his wealth, medical instruments, molds for tools he was designing, and a massive stock of pharmacological supplies.4 Most importantly, however, the vaults contained book rolls. Galen had not only stored copies of his own works in them, but also the many edited editions he had produced of the works of major figures in Greco-Roman philosophy and medicine.5 Galen recounts the ravages of the fire in his treatise On Avoiding Distress, which takes the form of a consolatio letter written to an unknown addressee. Among other possible calamities, Galen singles out the loss of his writings as the kind of catastrophe that has laid other men low, but that his discipline and training have allowed him to overcome. Galen’s account is a remarkable and personal expression of the value he placed on the written word. Galen was, if 1 Galen discusses the fire throughout the text of On Avoiding Distress. He also reports on it elsewhere in his work: Comp.Med.Gen. 1.1 (xiii.362 K.); Ant. 1.13 (xiv.66 K.); and Lib.Prop. 3 (142.25–143.4 B-M = xix.19 K.). The fire is also described in Dio (73.24.1–3) and Herodian (1.14.3–6). 2 Galen refers to a library attached to the Temple of Peace, another attached to the Domus Tiberiana, and an unknown number of libraries on or around the Palatine Hill. The precise location and number of the libraries that Galen situates on the Palatine are uncertain (Ind. 12b = 5 BJP and 17–18 = 7–8 BJP). For a discussion of the libraries and the underlying uncertainties in their locations, see Singer (2019a: 10–12); Nutton (2013: 53–61); Tucci (2013), (2009), and (2008: 141–144); and Stramaglia (2011). 3 On the contents of these libraries, see Ind. 12b–19 = 5–8 BJP along with Nicholls (2011). 4 Ind. 4–6 = 3–4 BJP. For a careful discussion of the contents of Galen’s storage, see BJP (2010: xxxi–xxxviii). 5 Ind. 14–15 = 6 BJP.

© Luis Alejandro Salas, 2020 | doi:10.1163/9789004443860_003

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nothing else, a man dedicated to his writing. Indeed, Vivian Nutton has estimated that Galen’s literary output would have required him to have written or dictated roughly two or three pages a day over the course of his long professional career, which spanned over some sixty years.6 The prodigious amount of Galen’s output—and the significant outlay of time and energy that it cost him—are indeed striking. What is more, Galen was keenly attentive to the production and distribution of his written work throughout the Roman world. Moreover, as we will see, Galen’s medical practice and his written one were intimately entangled. One of the overarching aims of this study is to examine the centrality of writing to Galen’s professional practice, and to our understanding of his work. In this chapter, I focus on some of the material realities of Galen’s productivity, before examining some of its social functions.

1

A World of Text

Even a cursory reader of On Avoiding Distress will note the tremendous amount of effort that Galen invested in the curation of texts, from collating and editing the manuscripts of authors available to him, purchasing written versions of drug recipes from around the Roman world to incorporate into his pharmacological works, to making multiple copies of his own compendious body of work for distribution. Many of these professional activities depended on easy access to archives.7 Indeed, it is likely that Galen chose the ill-starred location of his storage-space, thought to have been in the Horrea Piperataria, because of its proximity to nearby libraries. Galen kept duplicates of his own books with him in Rome for personal use. Access to these was important enough to him that, on at least one occasion, Galen commissioned a second set of duplicates made for his use while at his summer home in Campania; the transcription of this second set was lamentably interrupted by the great fire. Not all of these copies were for Galen’s eyes alone, however. Besides his efforts at producing critical editions of texts that were important to him and his own work, Galen tells us that he would also have copies of many of his own works prepared for distribution (ἔκδοσις) to a wider audience. In one illustrative example of how he arranged for the dissemination of his ideas, Galen mentions that he would send copies to friends in Pergamum to be deposited in public (δημόσιαι) libraries there:8 6 See Nutton (2013: 391 n. 21). 7 For two succinct examples of Galen’s use of archives in his medical practice, see Loc.Aff. 3.5 (viii.148 K.) and Hipp.Epid. 6.4.21 (CMG v 10,2,2 233 = xviib.194–195 K.). 8 Ind. 20–22 = 8–9 BJP.

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All [of my works] had been written up in duplicate already for distribution (πρὸς ἔκδοσιν), apart from the ones that were meant to remain in Rome, [one set] since friends of mine in Pergamum were asking for all the treatises I had composed to be sent to them in order to deposit them in a public library just as also some others had deposited many of my works in other cities also, [the other set] since I had it in mind to keep copies of all my writing in Campania.9 Once in these libraries the books would probably have been available for transcription on a model similar to the one that allowed Galen to produce copies of the holdings of the Imperial libraries in Rome. The library at Pergamum and other provincial libraries would serve as hubs for the distribution of Galen’s work on a more cosmopolitan scale. Certainly, this is one explanation for the speed with which Galen’s writing appears to have spread throughout the Roman Empire. Shortly after his death, for example, The Doctrines of Hippocrates and Plato was being copied in Upper Egypt and Galen was being cited for his pharmacological authority throughout a Latin compendium on Medicines from Vegetables and Fruits.10 On Avoiding Distress offers further evidence for the methods Galen adopted in the composition and distribution of his writing. Galen only mentions a narrow range of his own treatises in the catalogue of those books permanently lost in the great fire, specifically his recently written works on Attic language and usage.11 Peter Singer has argued that it was unlikely, for reasons of plausibility and practicality, that Galen would have been preparing to make complete copies of all his own works at just the time that the fire broke out.12 Rather, Singer proposes that the books Galen was preparing for distribution in this pas9

10 11

12

Ind. 21 = 8–9 BJP: διπλᾶ γὰρ ἐγέγραπτο πάντα τὰ πρὸς ἔκδοσιν ἤδη, χωρὶς τῶν ἐν τῇ Ῥώμῃ μελλόντων μένειν, ἀξιούντων μὲν καὶ τῶν ἐν τῇ πατρίδι φίλων ἁπάσας αὐτοῖς πεμφθῆναι τὰς ὑπ’ ἐμοῦ γεγονυίας πραγματείας ὅπως ἐν βιβλιοθήκῃ δημοσίᾳ στῶσι, καθάπερ καὶ ἄλλοι[ς] τινὲς ἤδη πολλὰ τῶν ἡμετέρων ἐν ἄλλαις πόλεσιν ἔθηκαν, ἐννοοῦντος δὲ κἀμοῦ πάντων ἔχειν ἀντίγραφα κατὰ τὴν Καμπανίαν. See Nutton (2013: 358–359 with n. 21), Nutton (1984: 318), and Riddle (1984). Ind. 20 = 8 BJP. While the subject matter was narrow, Galen lists some fifty-nine entries for these treatises (Lib.Prop. 20, 173.5–11 B-M = xix.48 K.). For a helpful discussion of the importance of these works to Galen’s medical practice, see Nutton (2013: 84, n. 45). In brief, many later physicians considered the writing of the Greek classical period, especially that of Hippocrates, a repository for fundamental medical knowledge. Since the writing of comic playwrights was thought to appeal to a wide audience, their use of language would be most helpful in understanding the now ancient and sometimes difficult language of the treatises contained in the Hippocratic Corpus; see Med.Nom. 31–32 Meyerhof-Schacht. Singer (2019b: 111–120).

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sage were probably limited to the treatises he mentions by name, those on Attic language. On this view, Galen would have distributed new treatises to provincial libraries periodically—as he completed them. These particular books were permanently lost to the fire because he had not yet been able to secure their safety by depositing copies in a number of other libraries. In other cases, Galen could attempt to recover works that he had already distributed widely by having copies made of the circulated texts. Another reference to the fire in the later books of Anatomical Procedures bears Singer’s view out: For after I had written out the books of the work ‘On Anatomical Dissections’, as I was very nearly at the end of them, it so happened that there broke out that great fire in which the Temple of Peace was burnt down together with many warehouses and storehouses in the Via Maxima, in which were stored those books of mine on Anatomical Dissections, together with all my other books. None of my works survived, except what I had already handed over to be transcribed. At that time I had already published eleven Books of the present work also; but as for the Books which will follow these [i.e. Books xii–xv], and which were then burnt, I am returning to compose them for the second time. There were also burnt many other books on anatomy which I had not revised sufficiently to allow me to publish them.13 trans. duckworth

The reference does not offer much more information than Galen’s account in On Avoiding Distress, but it does add an important detail: the text of Anatomical Procedures was also lost in the fire. Galen retained access to books one through eleven and was able to recover them, since they had already been circulated. However, he had not yet prepared copies of books twelve through fifteen for distribution. These books were therefore permanently lost to Galen, who recomposed them after 192. Galen’s account reveals not only that he had copies of completed works made and circulated at various points during his career, but

13

AA xi.12 (107–108 Duckworth). This is Duckworth’s translation from the Arabic edition of the ninth-century medical scholar and translator Ḥunain ibn Isḥāq, which was itself based on his corrected edition of an earlier Syriac translation. The Arabic text survives in two manuscripts alone (Oxford, Bodleian MS. 158 and London, British Library, Additional Manuscript MS. 23406). These were edited in the very early 20th century by Simon with an accompanying German translation. The quotation is Duckworth’s 1962 translation of Simon’s Arabic text. For the principles of Duckworth’s translation as well as the manuscript tradition, see Duckworth (1962: xiii–xvii).

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also that he prepared his writing for distribution and disseminated it serially, at least in some cases such as that of Anatomical Procedures. While Galen’s description of this process is an invaluable addition to our understanding of the distribution and proliferation of medical ideas through books in the second century ce, it also gives an important sense for the deliberation with which Galen attended to the circulation of his written work and the promulgation of his views.14 Galen also tells us that he penned an early version of the treatise in two books for the ex-consul Flavius Boethus, to whom he had also dedicated it. When Boethus died in Syria Palestina with the only remaining copy in his possession, Galen took the opportunity to write a new version of Anatomical Procedures in fifteen books. Indeed, this is the version we have been discussing and whose final books were lost in 192. Galen offers the reader the following explanation for writing in the preface to the recomposed work: I wrote an Anatomical Procedures even earlier, when I had come to Rome for the first time towards the beginning of the reign of our current Antoninus [sc. Marcus Aurelius]. I have decided to write an Anatomical Procedures again for two reasons: first because the Roman consul Flavius Boethus, a man who burned with a keen interest in anatomical theory if there ever was one, asked me to compose the earlier treatise for him when he left Rome for his native Ptolemais. I also gave this Boethus other works when he left, along with my treatise on anatomical procedures in two volumes. While he had seen quite a lot in a short time when he was with me, he was afraid that in time he might come to forget what he saw and he asked me for some sort of record. But the man has now died, and I am not able to give my associates copies of the works I had already written, seeing as the copies I had in Rome were lost. Since they were asking me, it seemed better to write another set. A second reason [for writing again] is that the present treatise will be far more explanatory than the past one on account of its clarity, since it extends its discussion over more books;

14

It is difficult to say, given the present state of our evidence, to what extent Galen’s approach to the dissemination of his writing was typical of other Greek or Roman medical authors. Scribonius Largus Comp. 97 discusses a deposition of a manuscript of pharmacological recipes into Roman public libraries at the behest of Tiberius. See Scarborough (2018: 709). To my knowledge there is no evidence outside of Galen’s writing for this level of deliberate involvement on the part of a medical author in the disposition of his written work, for Galen’s diffuse strategy of manuscript distribution to regional libraries, or for his deposition of writing in serial installments. The nearest parallel for serial distribution with which I am familiar is the Hellenistic mathematical author Apollonius of Perga Con. 1.pr.

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it will at the same time be more precise than its predecessor, since I have discovered many anatomical observations in the time that has passed between them.15 A prominent theme in Galen’s writing emerges: his self-representation as a reluctant author. He frequently describes himself as writing only under the compulsion of his friends, students, or influential figures. The stance functions to insulate Galen from accusations of excessive self-promotion and contentiousness, among its other effects. It is also an indirect display of Galen’s intellectual authority insofar as it draws attention to the demand for Galen’s writing, which was so great as to force him to put pen to paper as a public service. I will discuss this theme further in chapter five. Here, however, I focus on Galen’s second reason for writing. Galen reports that over the years he had made further physio-anatomical discoveries that warranted exposition, and that a longer treatise would also allow him the space in which to expand his truncated treatment in the original work. While these reasons may well have been true, what was the purpose of Galen’s careful documentation of its textual transmission for the reader? What need was there for him to justify his recomposition of the lost work? The case of Anatomical Procedures is not unique, and a point of comparison may be illuminating. The first two books of Galen’s treatise Composition of Drugs by Kinds were also lost in the fire of 192. When Galen could not recover a copy of his work from acquaintances at Rome or libraries elsewhere, he tells us that he ultimately came to rewrite these two books as well:16

15

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AA 1.1 (78–80 Garofalo = ii.215–216 K.): Ἀνατομικὰς ἐγχειρήσεις ἔγραψα μὲν καὶ πρόσθεν, ἡνίκα τὸ πρῶτον ἀνῆλθον εἰς Ῥώμην, ἔναγχος ἄρχειν ἠργμένου τοῦ καὶ νῦν ἡμῖν ἄρχοντος Ἀντωνίνου, γράφειν δ’ αὖθις ἄλλας ἔοικα ταύτας διὰ διττὴν αἰτίαν. ἑτέραν μέν, ὅτι Φλάβιος Βοηθὸς ἀνὴρ ὕπατος Ῥωμαίων, ἐξιὼν ἐκ Ῥώμης εἰς τὴν ἑαυτοῦ πατρίδα Πτολεμαΐδα, παρεκάλεσέ με τὰς ἐγχειρήσεις ἐκείνας αὐτῷ γράφειν, δριμὺν ἔρωτα τῆς ἀνατομικῆς ἐρασθεὶς θεωρίας, εἴπερ τις καὶ ἄλλος τῶν πώποτε γεγενημένων ἀνθρώπων. τούτῳ τῷ Βοηθῷ καὶ ἄλλας μὲν ἔδωκα πραγματείας ἐξιόντι, καὶ μέντοι καὶ τὴν τῶν ἀνατομικῶν ἐγχειρήσεων ἐν δυοῖν ὑπομνήμασιν· ἐπεὶ γάρ τοι ἐτεθέατο πάνυ πολλὰ παρ’ ἡμῖν ἐν ὀλίγῳ, δεδιὼς δέ, μὴ λάθοιτό ποτε τῶν ὀφθέντων, ἐδεήθη τοιούτων ἀναμνήσεων. ἐπεὶ δ’ ἐκεῖνος μὲν ἤδη τέθνηκεν, ἐγὼ δὲ οὐκ ἔχω τῶν γενομένων ὑπομνημάτων ἀντίγραφα διδόναι τοῖς ἑταίροις, ἀπολομένων ὧν εἶχον ἐν Ῥώμῃ, διὰ τοῦτο παρακαλεσάντων αὐτῶν, ἔδοξεν ἄμεινον εἶναι γράφειν ἕτερα. δευτέραν δ’ αἰτίαν, διὰ τὸ βελτίω μακρῷ τῆς τότε τὴν νῦν μοι γενησομένην ἀποδειχθήσεσθαι πραγματείαν, ἅμα μὲν εἰς διέξοδον ὑπομνημάτων πλειόνων ἐκταθεῖσαν ἕνεκα σαφηνείας, ἅμα δ’ ἀκριβεστέραν ἐκείνης ἐσομένην, ὡς ἂν πολλῶν ἐν τῷ μεταξὺ προσεξευρημένων μοι θεωρημάτων ἀνατομικῶν. On Prognosis is an interesting exception to this practice. Galen believed that it was lost to him, and he did not manage to rewrite it before he died. The treatise, however, somehow survived and comes down to us intact.

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I had also already written this treatise earlier. The earlier two books were prepared for circulation and deposited in the vault on the Sacred Way along with other works, when the entirety of the Temple of Peace and the great libraries on the Palatine caught fire. The books of many others and my own, however many I had stored in the vault, were destroyed at that time. Since none of my friends in Rome reported having a copy of the first two and since they were pressing me to write the treatise again, it seemed to me that I had to make a clarification regarding the volumes that had been distributed previously, so that someone not look for a reason why I wrote a treatise about the same matters twice, if at some point he runs into my earlier work.17 As evidenced by the lives of both treatises, Galen took great steps to insure the survival of his written work. First, he prepared treatises for circulation and, as we will see, for circulation to different audiences. In cases of longer works, Galen appears to prepare sections of a treatise for distribution while concurrently working on the remainder of the volume, as he also reported having done with Anatomical Procedures. In addition, he included notices to the reader about the textual transmission of recomposed treatises in later editions of the works that he could no longer recover, perhaps, as he says elsewhere, to aid in distinguishing a later treatise from its predecessor should the reader happen to come across or have already read the earlier version.18 Galen’s attempt to maintain influence over the survival and reception of his writing also led him to create two autobibliographical treatises: The Order of My Own Books and My Own Books. He probably wrote the former treatise in the decade before the fire at the Temple of Peace; it instructs the reader on the order in which Galen’s work should be read according to one’s interest and experience. Galen composed My Own Books after the disaster at the Temple of Peace, and a relatively short time before his death sometime around 216 ce or a few years earlier. The treatise provides an authorized list of his written works. Galen 17

18

Comp.Med.Gen. 1.1 (xiii.362–363 K.): Ἤδη μοι καὶ πρόσθεν ἐγέγραπτο πραγματεία, δυοῖν μὲν ἐξ αὐτῆς τῶν πρώτων βιβλίων ἐκδοθέντων, ἐγκαταλειφθέντων δὲ ἐν τῇ κατὰ τὴν ἱερὰν ὁδὸν ἀποθήκῃ μετὰ τῶν ἄλλων, ἡνίκα τὸ τῆς Εἰρήνης τέμενος ὅλον ἐκαύθη, καὶ κατὰ τὸ παλάτιον αἱ μεγάλαι βιβλιοθῆκαι. τηνικαῦτα γὰρ ἑτέρων τε πολλῶν ἀπώλοντο βιβλία καὶ τῶν ἐμῶν ὅσα κατὰ τὴν ἀποθήκην ἐκείνην ἔκειτο, μηδενὸς τῶν ἐν Ῥώμῃ φίλων ἔχειν ὁμολογοῦντος ἀντίγραφα τῶν πρώτων δυοῖν. ἐγκειμένων οὖν τῶν ἑταίρων αὖθίς με γράψαι τὴν αὐτὴν πραγματείαν, ἀναγκαῖον ἔδοξέ μοι δηλῶσαι περὶ τῶν προεκδοθέντων, ὅπως μή τις προεντυχὼν αὐτοῖς ποτε ζητοίη τὴν αἰτίαν τοῦ δίς με περὶ τῶν αὐτῶν πραγματεύσασθαι. See, e.g., Lib.Prop. 1 (136–137 B-M = xix.11–12 K.), 2 (141.3–15 B-M = xix.17 K.), and 3 (145.15– 25 B-M = xix.22–23 K.).

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was motivated to produce such a list, he says, in part to provide his readership with a guide that might allow them more easily to distinguish his genuine writings from counterfeit ones. On Galen’s account in the preface to My Own Books, he came to realize that it was necessary to keep his intellectual work within his sphere of influence when on a walk through the Via Sandalarium, along which there had come to be a high concentration of booksellers. While passing through, he overheard two men arguing over a volume whose title included “Galen, the doctor” (Γαληνὸς ἰατρός).19 One of the men, Galen remarks, had received a proper (sc. Greek) education—he was a pepaideumenos. After reading the first two lines of the treatise the man tore up the title-tag on the grounds that the language was not up to Galen’s standard. The anecdote is part of a longer diatribe against the moral decline of Roman culture in the second century, and the need for men like Galen to defend themselves, their names, and their work from counterfeiters who would pass off other people’s work as their own or, as in this case, their own work as Galen’s.20 Before turning to a careful catalogue of his writing production in My Own Books, Galen offers an important and related justification for composing the treatise, and for indulging in the vivid details about his life in Rome that pepper it: The reason I was forced to say all these things is so that those who intend to read any of my works know at what age and for what reason I wrote each of them. On the basis of these considerations, they know how to distinguish those that were incompletely written from those that were completely worked out and those written for the refutation of charlatans from didactic texts. I will also make these points clear in what follows, if and where it is useful to do so. But now I will lay out treatises I have written that are extant, starting from my anatomical works …21 Galen introduces a theme here that is deep and pervasive in his work: fraudulent physicians and philosophers threaten the work of legitimate practitioners and the legitimacy of their intellectual pursuits. Galen has no choice, he often writes, but to engage with these charlatan intellectuals and to distinguish their 19 20 21

Lib.Prop. Prol. (134.8 B-M = xix.8 K.). See also Boudon-Millot (2007: 176 n. 3). See Lib.Prop. Prol. (134–136 B-M = xix.8–10 K.). Cf. Lib.Prop. 2 (141 B-M = xix.17 K.). Lib.Prop. 3 (145.15–25 B-M = xix.22–23 K.): πάντα δὲ ταῦτα διὰ τοῦτ’ ἠναγκάσθην εἰπεῖν, ὅπως ἴδωσιν οἱ μέλλοντες ἀναγνώσεσθαί τι τῶν ἐμῶν, κατὰ τίνα τὴν ἡλικίαν ἕκαστον ἔγραψα καὶ κατὰ τίνα τὴν αἰτίαν· ἐκ τούτων γὰρ εἴσονται τά τε ἐλλιπῶς γεγραμμένα διορίζειν ἀπὸ τῶν τελέως ἐξειργασμένων τά τε κατὰ τὸν πρὸς τοὺς ἀλαζονευομένους ἔλεγχον ἀπὸ τῶν διδασκαλιῶν. ἐπισημανοῦμαι δὲ ταῦτα καὶ διὰ τῶν ἑξῆς, ἐάν που γένηται χρεία· νυνὶ δὲ τὰ διασῳζόμενα τῶν ὑπ’ ἐμοῦ γραφθέντων δηλώσω τὴν ἀρχὴν ἀπὸ τῶν ἀνατομικῶν ποιησάμενος.

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work from his own so that readers may not be taken in by them. And, on the basis of this passage, one may get the sense that some of Galen’s books are refutational while others are didactic, but as we will see, the boundary between instruction and invective is rarely sharp in Galen’s work. In the personal narrative that precedes this passage, Galen laments that he only writes this treatise because he must. Some of the treatises that he authored as a younger man were written at the insistence of friends, he says. After circulating to a wider audience, they eventually fell into the hands of unethical and opportunistic readers, who claimed authorship of them and mangled their contents. This sordid process compelled him to catalogue, correct, and keep careful control over the trajectories of his writing. My Own Books and this passage in particular are remarkable in the context of Greco-Roman literature, in which authors do not typically exhibit such explicit concern over their intellectual property— maintaining authority over its authenticity, its dissemination, and its reception. In contrast, Galen is keen to lay out the treatises he sanctions as Galenic in My Own Books, which also arranges his work by chronology, by subject matter, and by the level of expertise Galen expects of his target audience. In his other autobibliographical work, The Order of My Own Books, Galen instructs the reader in how his disseminated and authorized work should be read, in what order, and with what sorts of expectations the reader should do so.22 Galen’s discursive references to different readers for whom he is writing are not restricted to his more overt reflections on audience in treatises like My Own Books and The Order of My Own Books. The production history of Galen’s monolithic anatomical treatise Anatomical Procedures exhibits a similar preoccupation with its reception among different strata of readers. In book eight, Galen writes the following about its aims: This book provides instructions for anatomical procedures on the organs of respiration also, which you all have seen performed often. And as I have said before, since the task before me is not only to reach you, for whom this treatise is a reminder [of what you already know], but also to reach everyone else, however many are serious about dissections, it is necessary that I write the book in such a way that its contents are as clear as possible even to people who have never seen the dissections.23 22 23

Ord.Lib.Prop. 1 (88–89 B-M = xix.49–51 K.). AA 8.1 (710.1–10 Garofalo = ii.651–652 K.): ἔστι μὲν ἔτι καὶ τοῦτο τὸ βιβλίον ἀνατομικὰς ἐγχειρήσεις διδάσκον ἐπὶ τῶν τοῦ πνεῦματος ὀργάνων, ἃς ἐθεάσασθε δεικνυμένας πολλάκις. ἐπεὶ δ’ οὐχ ὑμῶν μόνον, οἷς ἀνάμνησίς ἐστιν ὁ λόγος ὅδε, πρόκειταί μοι στοχάσασθαι, καθότι καὶ πρόσθεν εἶπον, ἀλλὰ καὶ τῶν ἄλλων ἁπάντων, ὅσοι σπουδάζουσι περὶ τὰς ἀνατομάς, ἀναγκαῖόν ἐστιν

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Galen here apologizes to his explicit addressee(s) for including details about the performance of his experiments that may be superfluous to more knowledgeable readers who have witnessed them. His apology acts as both a captatio benevolentiae for those who see themselves as belonging to this stratum of learned readers and as an inducement to those who do not.24 Beyond this didactic and self-promoting function, however, Galen’s apology for the great detail of his written account offers him a sophisticated explanation for the rich performative features that dominate his experimental narratives: these accounts of his demonstrations are also intended for people who have never witnessed Galen perform the dissections in person. Galen’s stated aim is straightforward; it is difficult to visualize and understand complex structures familiar to one only in writing, especially without images to accompany words. One may reasonably ask why it is that Galen did not include anatomical illustrations in his work.25 Diagrams are rare in Greco-Roman technical literature, outside of medical herbals and writing in more exact fields, such as geometry.26 While rare, however, they did exist. Diagrams were present in anatomical writing as early as Aristotle’s Dissections, although this treatise does not survive.27 In the first century bce, Apollonius of Citium refers to diagrams in the text of his commentary on the Hippocratic On Joints.28 A little over a generation before Galen’s time, Soranus may have provided illustrations in his gynecological writings, among them diagrams of

24

25

26

27

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οὕτως γράφειν αὐτόν, ὡς ἂν καὶ τοῖς μηδὲ πώποτε θεασαμένοις αὐτὰς ὅσον οἷόν τε μάλιστα γενέσθαι σαφέστατα. On Galen’s narrative use of the testimony of his named addressees—and generic second person addresses—in order to buttress his authority through appeal to eye-witnesses, see Lehoux (2017). Cf. Lehoux (2012: 77–105) and Hine (2009). While there is no evidence for illustrations in Galen’s anatomical writing, there are rare occasions on which he uses diagrammatic language, such as in his explanation of the movement of the deltoid muscle in AA 1.11 (162 Garofalo = ii.273–274 K.) and that of his optics in UP 10.12, 10.15 (ii.97–98, 111–113 Helmreich = iii.819–822, 839–841 K.). Cf. Galen’s geometrical description of the trapezius muscle at AA 4.6 (410–412 Garofalo = ii.444–446 K.). See Stückelberger (1994: 78–83), Marganne (2004: 35–58), and Hardy and Totelin (2016: 113–123). For a collection of illustrated herbals, see Waugh, Bernabò, and Grmek (1984) along with Collins (2000). For discussion of mathematical examples, see Netz (1999) and (2004). Aristotle refers to diagrams at various points in his writings. See, e.g., Aristotle GA 2.7, 746a14–15; HA 1. 17, 497a30–32; 3.1, 510a29–35; 3.1, 1.511a11–14; 4.1, 525a6–8; 5.18, 550a23–26; and 6.11, 566a10–15. See also von Staden (2013: 113–119) and Stückelberger (1993). While internal references in Apollonius’ text are good evidence that the commentary contained diagrams originally, it is unclear if the illustrations transmitted in the manuscript tradition are a faithful representation of them. On the use of diagrams and illustrations in

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uterine anatomy, uterine fistulas, and forms of fetal malpresentation.29 Since they were intended as therapeutic aids to midwives—for ease of identifying malpresentation of the fetus in childbirth—they did not require a great deal of detail or accuracy.30 While I offer no secure answer to this question, there are at least three plausible explanations for the phenomenon in Galen’s work, all of which are consistent with, if not complementary to, one another. First, Galen’s anatomical descriptions are highly detailed. To faithfully render the complex structures under discussion would have required equally detailed drawings. Production of such illustrations would have been prohibitively difficult to produce in quantity—a significant issue, especially for Galen if my arguments about his commitment to the wide-spread dissemination of his writing are correct.31 That having been said, it is worth considering that some texts instruct the reader to perform operations on a diagram or on some body in the real world, in a “game of make believe” played with a diagram as a guide.32 Impressionistic anatomical drawings of the sort that may have been present in Soranus’ work

29

30 31

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Hellenistic mathematical and medical writing, especially those in Apollonius of Citium, see Berrey (2017: 139–150). The late Latin author Mustio wrote a paraphrase of Soranus’ gynecological writings that contained illustrations. The conclusion that Soranus’ work contained drawings hinges on whether they belong to their ancient exemplar or are a later addition. The fetal diagrams are highly impressionistic. Cf. Hanson and Green (1994: 1023–1024). Hanson and Green (1994: 1024). Pliny’s criticism of the use of illustrations in herbals supports this claim. See Pliny NH 25.8: “Besides these, Greek authors, whom we have discussed in their proper places, have dealt with the subject [sc. of plants]. Among them Crateuas, Dionysius, and Metrodorus (have done so) in a most pleasant manner, but one in which nothing is discerned except for the difficulty of the subject. For they painted pictures of the plants and then wrote their effects under them. But a picture is deceptive when there are so many colors involved—especially for the purpose of imitating nature—and the various discrepancies between copyists cause significant distortion”. (Praeter hos Graeci auctores prodidere quos suis locis diximus, ex his Crateuas, Dionysius, Metrodorus ratione blandissima sed qua nihil paene aliud quam difficultas rei intellegatur. pinxere namque effigies herbarum atque ita subscripsere effectus. verum et pictura fallax est coloribus tam numerosis, praesertim in aemulationem naturae, multumque degenerat transcribentium fors varia). Netz (1999: 54–56) uses the language of “make-believe” to explain the semiotic function of a diagram (56): “it is similar to the intended object; it is functionally identical to it; what is perhaps most important, it is never questioned”. Roby (2016: 174) discusses the use of the diagram as a guide in mechanical treatises. There are helpful parallels here to the gynecological diagrams under discussion. Although medical writing falls mainly outside of her focus, Roby’s (2016: 155–191) broader discussion on diagrams in ancient technical writing is lucid and informative.

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(and certainly were in Mustio’s) did not have to be highly detailed and accurate to do their work. Given the nature of Galen’s intellectual practice, which placed a high premium on enargeia in thought and expression, there would have been little place in his writing for rough illustrations.33 Second, Galen may have eschewed illustrations to draw attention to his status as an educated elite (pepaideumenos), by putting the power of his rhetorical skills on display for his readers. Indeed, there is some evidence that Galen may have considered the use of the visual representations in medical writing to be amateurish.34 Finally, it is also important to keep in mind an historically contingent feature of GrecoRoman anatomical practice—especially in the second century—that informs Galen’s written practice. Anatomical demonstrations were a public affair, and a large part of what Galen’s prose conveys is the public nature of his anatomical practice. Galen’s descriptions of anatomy are descriptions of anatomical performances, rather than accounts of bodies and their dissections taken in isolation. Detailed illustrations might have called attention to the organs and away from the anatomical procedures that Galen evokes.

2

Demonstration: Instruction and Display

Let us consider an example of such an account, one in which Galen explains an anatomical procedure requiring the ligation of the intercostal nerves. These nerves ramify from the spine, run between the ribs, and innervate the internal

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As a corollary to this point, clear and precise expression are crucial to Galen’s selfpresentation as an anatomical authority. The presence of detailed illustrations might risk drawing the spotlight away from Galen’s clarity of expression. For a discussion of Galen’s self-presentation in his anatomical writing, see Petit (2018: 153–162). Marganne (2004: 43) raises this point to explain a puzzling line in book one of the Method of Healing, where Galen disparages the Methodist Julian for entertaining pointless questions, such as whether painting may be useful for physicians. See MM 1.7 (x.53–54 K.): “For in the more than twenty years now that have passed since I was with this man [sc. Julian] in Alexandria, although he has written one introductory work after another— for he always changes and amends them because he is never satisfied with what he has written—he has not dared to say what diseases is in any one of them. Nevertheless, he writes in great detail about nothing that has a point, going so far as to inquire about such things as whether illustration is useful for physicians”. (ἐτῶν γὰρ ἤδη πλειόνων ἢ εἴκοσι γεγονότων ἐξ οὗπερ ἡμεῖς ἐπὶ τῆς Ἀλεξανδρείας αὐτῷ τούτῳ συνεγενόμεθα, γεγραφὼς εἰσαγωγὰς ἄλλας ἐπ’ ἄλλαις, ἀεὶ γὰρ αὐτὰς μετατίθησί τε καὶ μεταῤῥυθμίζει τῷ μηδέποτ’ ἀρκεῖσθαι ταῖς γραφείσαις, κατ’ οὐδεμίαν αὐτῶν ἐτόλμησεν εἰπεῖν ὅ τί ποτ’ ἐστὶ νόσος, καίτοι γε μηδὲν πρὸς ἔπος ἐν αὐταῖς διεξέρχεται μέχρι τοῦ καὶ τὰ τοιαῦτα ζητεῖν, εἰ ζωγραφία χρήσιμος ἰατροῖς ἐστιν·).

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intercostal muscles. The intercostal muscles are necessary for voice production, and their motor function depends on the intercostal nerves. Therefore, interrupting the motor nerves destroys voice production in the subject. Following general instructions to the reader, Galen adds performative guidance: It is possible for you to do the same thing even if at some point, on your own, you examine the sort of thing that happens to the animal after the nerves are interrupted in this way [by ligation]. But for making this demonstration (ἐπιδεικνυμένῳ), it is better to prepare a thread placed under all these nerves without having tied [them].35 Galen’s explanation of the procedure is consistent with his mode of address and expression throughout Anatomical Procedures. He writes to an unnamed addressee in the second person—here more intimately singular. A rich series of details immerse the reader in the performance. They range from the tactile sensations involved in grasping the intercostal nerve and separating it from the intercostal muscle to the proper choice of instrument.36 So, for example, one should avoid using the smaller hook (τὸ ἄγκιστρον) used on varices;37 rather, the operation calls for a hook with a short bend: You can also cut these nerves. But because of the depth of the flesh, you cannot easily pass the sort of hook that I use for surgery on varices under the exposed nerve. One that is small in length (its tip pointed only so much) can pass under the exposed nerve and not pierce the pleural membrane.38 On the other hand, one that is reasonably sharp can on occasion pierce it, while one that is extremely blunt goes through the tissues beneath the nerve with difficulty. Therefore it is necessary that the hook not be [too] pointed,39 just as it not be extremely blunt, rather it

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36 37 38

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AA 8.4 (734.29–736.3 Garofalo = ii.669 K.): ταὐτὸ μὲν οὖν σοι πράττειν ἔξεστι, κᾂν μόνος ἐπὶ σαυτοῦ ποτ’ ἐξετάζῃς, ὁποῖόν τι πάσχει τὸ ζῷον ἐπὶ τοῖς νεύροις οὕτω διαληφθεῖσιν. ἐπιδεικνυμένῳ δὲ βέλτιόν ἐστιν αὐτῷ παρεσκευάσθαι τοῖς νεύροις ἅπασι λίνον ὑποβεβλημένον ἄνευ τοῦ δεδέσθαι· AA 8.4 (734.6–16 Garofalo = ii.668 K.). On the ἄγκιστρον, see Bliquez (2015: 173–177). The Greek that I have translated in parenthesis is extremely difficult to construe. Garofalo includes a translation of the Arabic into Italian for this section of the Greek, which appears to be corrupted. I translate the Italian above and include it in brackets in the Greek. See Garofalo (1991a: 733 n. 34). Garofalo (1991a: 733 n. 35) is surely right to mark οὐδαμῶς as another corruption. The sense is clear.

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must taper to such a point that it is not hindered by the underlying muscle tissue while passing under the nerve and easily goes through all the tissues.40 Galen’s language is procedural. It effects an intimate didactic relationship between him and the reader of his work. Galen’s narrative lens, however, remains focused on a generic operating table. He cautions one on the sharpness of the hooks involved in fishing out the intercostal nerves: too sharp and one runs the risk of severing the nerve or piercing the pleural membrane, too blunt and one cannot pass the hook through the tissue beneath the nerves. There are no contextual details outside the narrow focus of the procedure. So it is with the separation of the nerve from the underlying tissues. The curved needle is threaded beneath the nerve as near the spinal cord as possible so as to paralyze the whole muscle. Instruments are mentioned insofar as they are mechanically useful. Galen advises the reader that the operation can be performed with either of two instruments: a curved needle (βελόνη καμπύλη) or a pierced hook (ἄγκιστρον διάτρητον).41 While all of these procedural details maintain a close instructional rapport with the reader, Galen’s focus remains on the body on which the procedure is conducted. A crucial performative element is absent from his description thus far: the spectators of his live demonstration. Galen’s instructions also distinguish what one must consider when performing the dissection in public, explicitly as a piece for public display (ἐπιδεικνυμένῳ). His language evokes the sorts of live performances in which intellectuals in Greco-Roman antiquity, but especially in Rome of the second century ce, might compete in order to confirm and assert their intellectual authority. Indeed, this kind of public demonstration or epideixis is one of the core features of rhetorical showpieces in writing of the Imperial Period, often associated with the so-called Second Sophistic.42 The language of demonstration in Greek

40

41 42

AA 8.4 (732.16–734.1 Garofalo = ii.667 K.): ἔξεστι δέ σοι καὶ τούτους αὐτοὺς τέμνειν· ἀλλὰ διὰ βαθείας σαρκὸς οὐκ εὐπετῶς ἂν ὑποβάλοις τῷ νεύρῳ γυμνωθέντι τὸ ἄγκιστρον, οἵῳ μάλιστα χρώμεθα κατὰ τὰς κιρσῶν χειρουργίας· μικρὸν μὲν τῷ μήκει πάντῃ κατ’ αὐτὸ ⟨e l’ estremità di esso sia appuntita tanto⟩ ὑποβάλλεσθαι τῷ γυμνωθέντι νεύρῳ, μήτε διατρῆσαι τὸν ὑπεζωκότα· τὸ δὲ ἱκανῶς ὀξὺ καὶ τρώσειέ ποτε, τὸ δ’ ἐσχάτως ἀμβλὺ μόγις διεξέρχεται τῶν ὑποκειμένων τῷ νεύρῳ σωμάτων. χρὴ τοίνυν ὀξὺ μὲν [οὐδαμῶς] ὑπάρχειν αὐτὸ, καθάπερ οὐδ’ ἐσχάτως ἀμβλὺ, λελεπτύνθαι δ’ εἰς τοσοῦτον κατὰ τὸ πέρας, ὡς ὑποβαλλόμενον τῷ νεύρῳ μὴ κατέχεσθαι πρὸς τῶν ὑποκειμένων ἰνῶν τοῦ μυός, ἀλλὰ διεξέρχεσθαι πάσας ἑτοίμως αὐτάς. See Bliquez (2015: 147–148) on the βελόνη καμπύλη and (177) on the ἄγκιστρον διάτρητον. For the “Second Sophistic” and the debates on its nature and reference, see generally Whitmarsh (2005), (2001); Taplin (2000); Schmitz (1997); Swain (1996); Gleason (1995); and Anderson (1993). Bowersock (1969) sets the stage for these subsequent discussions. Von

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does not always distinguish between demonstration as display (epideixis) and demonstration as proof (apodeixis), even where one might expect it to do so— as, for example, in explicitly philosophical writing. The immediate context of this passage and Galen’s own fastidious attention to usage, however, mark his choice of expression.43 Heinrich von Staden has argued for this general point, about the affinity of Galen’s anatomical experiments with other public exhibitions in the context of the culture of intellectual display common in the second century:44 A central feature of Galen’s self-understanding—a feature he shares with Second Sophistic—accordingly is the distinction between public and private, between public “showing” or “display” or “exhibition” and private rehearsal or instruction, between private anatomical exploration and public dissection or vivisection. Although Galen’s anatomical audiences varied in size and expertise, and although at times it is hard to draw a clear line of demarcation between a public anatomical performance and a private one, the important point is that Galen himself insistently deploys the “private/public” distinction as a crucial piece of his self-construction.45 The contrast Galen draws in the passage mentioned earlier—between preparations for the procedure on the intercostal nerves as a solitary exercise (κᾂν μόνος ἐπὶ σαυτοῦ ποτ’ ἐξετάζῃς) and as an epideictic demonstration—closely reflects the distinction between procedures held in private or in small groups (ἰδίᾳ) and those held in public (δημοσίᾳ) to which von Staden points. The private demonstration that Galen describes may have had a more prominent didactic or exploratory dimension, while its more public counterpart would have been designed for intellectual competition. Galen’s emphasis in his description of the procedure is on its public demonstration, rather than as a private exercise. This focus on its public dimensions suggests that Galen is instructing his reader first and foremost on how to perform the experiment more effectively as part of an agonistic anatomical presentation. The explanation Galen offers for his detailed instructions is stronger

43 44 45

Staden (1995a) and (1997) note the difficulty with the phrase and opt to put the issue of the “Second Sophistic” to one side. Cf. Kollesch (1981). I do not think that these issues bear on my discussion. See von Staden (1995a: 53–54) for brief comments on Galen’s use of words with the deikroot. Cf. Hankinson (1991a: 15–28). See von Staden (1995a: 48–53). Von Staden (1995a: 53).

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evidence for this point. Indeed, it underscores the degree to which for him public performance was not just a feature of effective anatomical demonstration, but a central one: For, in this way, when the animal is struck it lets out a howl, then after tightly constricting the nerves with the threads it suddenly becomes voiceless. [The procedure] takes the audience’s (τοὺς θεατὰς) breath away (ἐκπλήττει), as it seems amazing [to them] (θαυμαστὸν) that phonation is destroyed when tiny nerves in the midriff are ligated. Make sure that in these sorts of demonstrations (κατὰ τὰς τοιαύτας ἐπιδείξεις) your assistants are numerous in order that the loops may be set around all the nerves quickly. If you do not want to release them again, constrict [the nerves] however you like. But, if you also want to release [them] all at once to show (δεῖξαι) the animal crying out again—for thus the audience is even more amazed (οὕτω γὰρ μᾶλλον οἱ θεαταὶ θαυμάζουσι)—slide rings on the loops and constrict them gingerly; the ring will be useful to you for releasing the loops since the so-called blind knot is difficult enough to untie. But constrict it just so for the animal to cry out suddenly; the nerves are crushed when they are constricted too tightly by the loops around them if the thread is hard, while they are sawed open and cut if it is soft …46 Galen conjures an audience of spectators dumbstruck by his demonstration. His language, which emphasizes the spectators’ visual experience of the procedure, draws attention to the impact of witnessing anatomical displays firsthand. In part, Galen’s descriptions of a viewing audience and its reactions to his anatomical demonstrations allow him to recreate the credentialing functions of live medical demonstrations—in a written medium for a reading audience.47 46

47

AA 8.4 (736.3–23 Garofalo = ii.669–670 K.): κέκραγε γὰρ οὕτω παιόμενον, εἶτ’ ἐξαίφνης ἄφωνον γινόμενον ἐπὶ τῷ σφιγχθῆναι τοῖς λίνοις τὰ νεῦρα τοὺς θεατὰς ἐκπλήττει· θαυμαστὸν γὰρ εἶναι δοκεῖ, νεύρων μικρῶν κατὰ τὸ μετάφρενον βροχισθέντων, ἀπόλλυσθαι τὴν φωνήν. ἔστωσαν δὲ πλείονες οἱ ὑπηρετούμενοί σοι κατὰ τὰς τοιαύτας ἐπιδείξεις, ἵνα ταχέως ἅπασι τοῖς νεύροις οἱ βρόχοι περιβληθῶσιν. ἐὰν μὲν οὖν μηκέτι λύειν ἐθέλῃς αὐτοὺς, ὅπως ἂν ᾖ σοι φίλον, οὕτως σφίγγε. βουλόμενος δὲ εὐθέως λῦσαι, καὶ δεῖξαι φωνοῦν αὖθις τὸ ζῷον, (οὕτω γὰρ μᾶλλον οἱ θεαταὶ θαυμάζουσι,) ἀγκύλας τε κατὰ τοὺς βρόχους ἐπίβαλλε καὶ μετρίως σφίγγε· γενήσεται γάρ σοι πρὸς μὲν τὸ λῦσαι τάχεως ἡ ἀγκύλη χρήσιμος, ὡς τό γε τυφλὸν ἅμμα καλούμενον ἱκανῶς ἐστι δύσλυτον, πρὸς δὲ τὸ φωνῆσαι τὸ ζῷον αὐτίκα τὸ μετρίως ἐσφίγχθαι, τὰ γὰρ σφοδρότερον ὑπὸ τῶν περιβληθέντων βρόχων σφιγχθέντα νεῦρα σκληροῦ μὲν ὄντος τοῦ λίνου θλᾶται, λεπτοῦ δὲ διαπρίεται καὶ τέμνεται … While expressions in the first person plural are common in Greek and Roman scientific writing, Galen’s use of the first and second person singulars effects a more intimate didactic relationship between himself-as-teacher and the reader-as-student. For a helpful

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I return to this point in chapter two. For the present, I would like to focus on performative aspects of these live demonstrations that figure so prominently in Galen’s instructions to his readers. Here Galen describes the circumstances under which the careful student of his work can cause a live audience to be suitably and similarly amazed. One has only to attend to Galen’s instructions, rehearse them in private, and then perform them in public. It is to this reader that the anatomical details seen by onlookers as thaumata, the levers behind the curtain, are revealed. This strategy is not uncommon in Galen’s writing. Information is revealed to the actual reader either through an addressee who is established as one of the cognoscenti or, as in this passage, by drawing an implicit contrast between the reader and an audience of the uninitiated.48 In private the procedure is conducted without fanfare. In public certain steps guarantee that a live audience is breathless or thunderstruck (ἐκπλήττει). The demonstration is a source of amazement (θαυμαστόν) to spectators, when pressure on the nerves interrupts phonation. Later they are even more amazed (οὕτω γὰρ μᾶλλον οἱ θεαταὶ θαυμάζουσι), when the animal resumes crying immediately upon the relief of that pressure. Galen effects this amazement by making the transition from sound to silence and back again, as abruptly as possible. For that reason, several assistants who act in concert are necessary for its public performance. One can make do with fewer assistants when conducting the demonstration in private. These theatrical differences hinge exclusively on whether the procedure is held on a more public occasion such as the one described above (κατὰ τὰς τοιαύτας ἐπιδείξεις) or in a more private setting.

48

elucidation of this strategy in Galen’s writing, see van der Eijk (2013: 158–166). In his discussion, van der Eijk (166) draws attention to the features of live oral presentation that Galen encodes in these sorts of narratives: “We could of course regard this combination of references to the readers in the third person plural with the addresses of the students in the second person singular as just another example of variation or alternation (similar to the variation, in cross references, between the use of first person singular and plural, or between personal and impersonal instructions); but we can also view the text as reflecting, and perhaps as intended to reflect, an oral presentation to students that at the same time is being prepared for later, written consumption by an audience of readers”. Cf. van der Eijk (2015) and (2018: 37–40). To van der Eijk’s point about audiences, I would add that we need not draw a sharp distinction between the student whom Galen addresses in Mixtures (and in Anatomical Procedures) and the reading audience of these texts. Indeed, I think that the anonymity of the second person addressee is an inclusive feature of Galen’s prose that encourages the reader to become a virtual student and, in the case of Anatomical Procedures, a virtual participant. On which more shortly, but cf. Praen. 3 (CMG v,8,1 82–86 = xiv.613–618 K.), which is an especially rich example of this strategy in action.

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Galen’s attention to performative detail is not restricted to the manner in which the intercostal nerve demonstration is to be carried out. His advice to the reader includes circumstantial concerns, such as the range of subjects best suited for phonation experiments. Galen elsewhere writes that the ape is the ideal experimental subject for the study of human anatomy and physiology, in virtue of the animal’s close physical analogy to human bodies.49 Galen’s claim is not haphazard. Indeed, as a result of the cultural limitations placed on the use of human beings for experimentation in the Roman period, Galen had considered views on the criteria relevant to establish analogy across animal kinds. These criteria were informed by a system of animal classification that was ultimately Aristotelian in origin, although it bears closest resemblance to that of Rufus of Ephesus—active around the turn of the second century. Rufus also encourages one to conduct anatomical experiments on primates because of their structural similarities to human beings.50 In the context of public phonation demonstrations, however, Galen advises the reader to opt for swine over primates. Why choose pigs, given the widespread availability of primates in Rome? Galen explains the choice in a later section of Anatomical Procedures on other vivisectory experiments conducted on the thorax: It would be logical to proceed in such a way that someone would render the entire thorax immovable, tying ligations around only the nerves that move its muscles. You all have seen me demonstrate (δεικνύντα) this very thing to you all often in private (ἰδίᾳ) but also in public (δημοσίᾳ). Indeed, you immobilize the intercostal muscles through the nerves passing into them from the spine in the manner described earlier, then the diaphragm when you injure the origins of its nerves similarly. And, in particular, you 49

50

In particular, Galen prefers the Barbary ape (Macaca inuus) and the Rhesus monkey (Macaca mulatta). See Singer (1956: 240 n. 22). Also see Rocca (2003: 67–78). Cf. Praen. 5 (CMG v 8,1 96.11–15. = xiv.627 K.). For general overviews of Galen’s system of physiology, see Debru (2008) and Salas (forthcoming). For Rufus’ discussion of his classificatory scheme, see Onom. 127. I discuss Galen’s classification of animal subjects according to the anatomical similarities they hold toward human beings in greater detail in chapters three and four. Here a brief cautionary note— the language of taxonomy in biological contexts may imply a hierarchical grouping of animal kinds. It is not clear that Galen or Rufus would have subscribed to such a system. Aristotelian classifications proceed mainly from structures or activities. The focus remains on the parts and their activities. Consequently, animals are similar or different with respect to the morphology or function of this or that organ. In contemporary contexts, taxonomical talk may also evoke hierarchies arranged according to evolutionary considerations. The ancient authors under discussion here would not have had been engaged with such considerations.

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all have seen me demonstrate all of these sorts of things on pigs often, in private and in public (ἰδίᾳ τε καὶ δημοσίᾳ), on account of the fact that an ape is no advantage at all in these sorts of anatomical demonstrations and the spectacle (τὸ θέαμα) is odious. It is not possible to describe clearly, in language, the place where one ought to [separate the skin alone and find the nerves of the diaphragm]. But my account will be useful as a reminder to those who have already witnessed the procedure and as a sort of inducement to those who have not yet witnessed [it].51 Many of Galen’s thoracic experiments are fundamentally aimed at demonstrating nerve function and the related claim that the brain is the source of volition—and therefore of identity. Some recurring features of his experimental writing emerge in these passages. Galen frequently appeals to the explicit addressee’s familiarity with his work, an appeal that can often function to invoke the addressee as a witness to his credibility. As elsewhere, Galen contrasts the usefulness of his narrative as a propaedeutic for a broader readership and as a reminder for readers more intimately acquainted with his person and his work. As in the procedure on the intercostal nerve, here Galen refers to private and public versions of the same experiment, which is further evidence that the same procedure could have different performative settings with different requirements and aims. This passage on the immobilization of the intercostal muscles and diaphragm contains two references to semi-private and public anatomical displays. The first singles out a demonstration that involves paralysis of the thorax through the ligation of intercostal muscles. The second picks out the whole suite of phonation experiments. Galen’s comments on the most useful animal for the procedure described in his second set of experiments are illuminating.

51

AA 8.8 (766 Garofalo = ii.690–691 K.): Κατὰ λόγον δ’ ἂν εἴη διελθεῖν, ὅπως ἄν τις ἀκίνητον ἐργάσαιτο τὸν ὅλον θώρακα, μόνοις τοῖς κινοῦσι τοὺς μῦς αὐτοῦ νεύροις βρόχους περιβάλλων, ὅπερ οὐ μόνον ἰδίᾳ πολλάκις ὑμῖν, ἀλλὰ καὶ δημοσίᾳ δεικνύντα με ἐθεάσασθε. τοὺς μὲν δὴ μεσοπλευρίους μῦς διὰ τῶν ἐπ’ αὐτοὺς ἰόντων ἀπὸ τοῦ νωτιαίου νεύρων ἀκινήτους ἐργάσῃ, καθ’ ὃν εἴρηται τρόπον· τὸ διάφραγμα δὲ τὰς ἀρχὰς καὶ τούτου τῶν νεύρων ὁμοίως κακώσας. ἐφ’ ὑῶν δὲ μάλιστα πάντα τὰ τοιαῦτα δεικνύντα με ἐθεάσασθε πολλάκις ἰδίᾳ τε καὶ δημοσίᾳ, διὰ τὸ μήτε πλέον ἔχειν τι πίθηκον ἐν ταῖς τοιαύταις ἀνατομαῖς, εἰδεχθές τ’ εἶναι τὸ θέαμα. λόγῳ μὲν οὖν ἑρμηνεῦσαι σαφῶς οὐκ ἔστι τὴν χώραν, ἔνθα χρὴ ⟨in cui bisogna dividere la pelle soltanto, e trovare i nervi del diaframma⟩ [δηλῶσαι σαφῶς]. εἴς τε γὰρ τῶν ἤδη τεθεαμένων τὴν ἀνάμνησιν, εἴς τε τῶν μηδέπω μηδὲν ἑωρακότων τοιαύτην ἐπαγωγὴν πρὸς τοὖργον ἡ διήγησις ἔσται χρήσιμος. A lacuna in the Greek text is indicated by the pointed brackets above. Garofalo (1991a: 767 and n. 84) provides an Italian translation of the Arabic text that supplies the contents of the lacuna. The English is my translation of his Italian.

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First, they answer the question I posed above: why pigs? Galen reminds the reader that pigs are more suitable than apes in the whole range of voice demonstrations, on the grounds that (a) the ape offers no advantage over swine and (b) the spectacle (τὸ θέαμα) of the ape is ugly, unseemly, or hideous (εἰδεχθές). I take (a) to mean that apes offer no apodeictic advantage over swine in the vast majority of these experiments, since swine are sufficiently close anatomical analogues to human beings for Galen’s experimental purposes. According to (b) swine are clearly preferable to apes for other reasons, probably aesthetic or psychological. Regardless, the ape’s unseemliness in (b) depends entirely on the visceral reaction of an audience to the procedure. Galen’s choice of swine as animal subjects is not relevant on apodeictic grounds, only on epideictic ones, a point which his distinction between (a) and (b) makes clear. Since the motivating force of (b) in Galen’s choice of animal subjects implies the presence of an audience, Galen’s advice on the kinds of animal subjects appropriate for this procedure also provides evidence for the essentially public nature of these demonstrations, even those conducted in private (ἰδίᾳ). On many occasions, swine are not just adequate subjects; Galen refers to the pig as an ideal subject, in this instance along with goats, for certain demonstrations on the brain. In the later books of Anatomical Procedures, which survive only in Arabic translation, Galen writes: I say, then, that for this purpose you must procure either a pig or a goat, in order to combine two requirements. In the first place, you avoid seeing the unpleasing expression of the ape when it is being vivisected. The other reason is that the animal on which the dissection takes place should cry out with a really loud voice, a thing one does not find with apes. Make this experiment, of which I wish to tell you, upon a young fresh animal and afterwards upon old and decrepit ones. For in that way you will discover a remarkable contrast and a great difference between the young and the worn-out animals. But as for what concerns the vivisection itself, it should proceed on both animals in all details after the same fashion.52 trans. duckworth

In the earlier passage on thoracic experiments, Galen argued merely that swine are preferable, because apes—the closer anatomical analogues to humans— are to be avoided. This second reference adds a further performative dimension to Galen’s choice of animal subject. Pigs and goats are preferable in part for

52

AA ix.11 (15 Duckworth).

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mundane reasons; they are common sacrificial animals and easy to obtain. They are also desirable subjects, however, because they cry out loudly, creating a spectacle that affects the demonstration’s audience more profoundly.53 While performing the procedure on a pig avoids the risk that an ape’s humanlike expression will disgust the audience, the pig is also chosen for theatrical effect. Its squealing and dramatic exsanguination are intended to arrest the audience’s attention. Likewise, apes do not merely upset onlookers. They also fail to produce the kinds of displays that induce amazement among them.54

3

The Physical Spaces of Public and Private Medical Performances

The physical spaces in which these performances would have been conducted, and Galen’s narrative reconstruction of them, also bear on the social status of their audiences. Galen frequently distinguishes between public (δημοσίᾳ) and private or semi-private (ἰδίᾳ) demonstrations in his accounts of live anatomical experiments. It is difficult to know with any certainty what the boundary conditions were that separated public from private in the context of the live performances on which the written ones were modeled. It is equally difficult to estimate the size of their audiences. It is clear, however, that most of those present would not have been able to see very much of what was being demonstrated. It would not have been easy to discriminate the relevant parts of the demonstration from the tangle of flesh, vasculature, and blood without earlier and repeated instruction, even for those spectators who might have a privileged vantage point near the operator of the procedure. Much more can be said about the force of Galen’s distinction between public and private audiences in his written practice. It is instructive, therefore, to examine how Galen’s experimental narratives may differ from the live performances they describe. For example, Galen alludes to public medical performances in Roman auditoria:

53

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See also Praen. 5 (CMG v 8,1 96.9–15 = xiv.627 K.): where Galen seems to have politely but expressly refused Flavius Boethus’ offer to procure some apes for his voice demonstrations, explaining to Boethus—and the reader—that the experiment called for the loud cries of pigs or goats to be maximally persuasive. This consideration may suggest that professional doctors—especially surgeons and anatomists who would likely have been less moved by these performative considerations— were not a target audience for the gamut of these demonstrations, whether conducted before a private audience or a public one.

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For my part I laughed and felt contempt for them [sc. critics] but my friends, angered, demanded that I publicly demonstrate the truth of the anatomical observations contained in my writing in one of the large lecture halls (κατά τι τῶν μεγάλων ἀκουστηρίων). When I did not concede— for this is how I was already, such as not to pay my reputation any mind— these slanderers supposed that I was afraid of being refuted, rather than that I was showing magnanimity, because I felt contempt for their nonsense. And they did not stop mocking me every day when they went to the Temple of Peace, as before the fire it was the custom for everyone pursuing intellectual studies to congregate [there].55 The term ἀκουστηρίον is very rarely attested in Greek. Its earliest attestations are in Galen’s work, where two of its four total occurrences in Greek can be found.56 It seems as though ἀκουστηρίον is merely a direct translation of the Latin auditorium into Greek, which offers one a sense for the size of some of the spaces in which these demonstrations could take place.57 The question of typical audience size is more difficult to assess. For our purposes it is enough to say that the audiences for medical performances appear to have been of a similar order as public sophistic performances. This is also the view, at least in a relevant sense, of Nicholls.58 He argues that the akoustērion suggested to Galen would likely have been one of the auditoria located at the Temple of Peace, where Galen tells us that intellectuals held public debates daily and where, as we have seen, 55

56

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Lib.Prop. 3 (144.7–19 B-M = xix.21 K.): ἐγὼ μὲν οὖν ἐγέλων τε καὶ κατεφρόνουν αὐτῶν· ἀγανακτοῦντες δ’ οἱ φίλοι παρεκάλουν με δημοσίᾳ δεῖξαι κατά τι τῶν μεγάλων ἀκουστηρίων τὴν ἀλήθειαν τῶν ὑπ’ ἐμοῦ γεγραμμένων ἀνατομικῶν θεωρημάτων. ἐπεὶ δ’ οὐκ ἐπειθόμην- ἤδη γὰρ οὕτως εἶχον, ὡς μὴ πεφροντικέναι ⟨τῆς⟩ δόξης—, οἰηθέντες οἱ βάσκανοι [ἔχειν] ἐξελελεγχθῆναί με φοβούμενον, οὐ καταφρονοῦντα τῆς φλυαρίας αὐτῶν προσποιεῖσθαί με μεγαλοφροσύνην, οὐδὲ τοῦ σκώπτειν ἀπείχοντο καθ’ ἑκαστὴν ἡμέραν εἰς τὸ τῆς Εἰρήνης τέμενος ἀφικούμενοι, καθ’ ὅ τι καὶ πρὸ τοῦ καυθῆναι πᾶσιν ἦν ἔθος ἀθροίζεσθαι τοῖς τὰς λογικὰς τέχνας μεταχειριζομένοις. The other instance of “akoustērion” in Galen is found in Ven.Sec.Er.Rom. 1 (xi.194 K.), where Galen excuses the composition of On Venesection Against Erasistratus. He explains that it was not prepared as a book, but had been dictated to a tachygrapher as a facsimile of a speech, the type given by intellectuals at akoustēria. Cf. Porphyry Plot. 15.11 and Themistius Ad Const. 26c3 for other attestations of the term. For other references to public intellectual activity in the Temple of Peace, see Aulus Gellius Noct.Att. 5.21.19 and 16.8.2. One expects that, for logistical reasons, anatomical demonstrations would take place at venues that had drainage or some other feature that allowed for the disposal of blood and gore. If one takes Galen at his word, his anatomical experiments could involve large numbers of animal subjects over multiple days, all of which would require considerable clean-up during and especially after the demonstrations were complete. Nicholls (2011: 128–129).

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he rented space in which to store his books and medical supplies. Other spaces Galen mentions are also capacious. For example, he refers to regular public intellectual displays held at the gymnasium in the Baths of Trajan.59 Indeed, Galen takes one orator’s regular appearances at the Baths as evidence that he would be familiar to contemporary readers: “Many people knew the case on account of the man’s reputation, since he used to hold discourse in public daily at the gymnasium in the Baths of Trajan”.60 The public speaker in this reference was Theagenes, a Cynic philosopher and student of Peregrinus, made famous by Lucian’s eponymous satire. Besides its relevance to the present discussion of the spaces in which intellectual displays could be held, Galen’s account of Theagenes offers an unusual insight into just how cutting Galen’s polemics could be. In the wider context of the reference, Galen has advised a prominent Methodist physician and student of Soranus of Ephesus, Statilius Attalus, on how to treat Theagenes’ inflamed liver.61 Attalus dismisses Galen rudely, insists that non-Methodist medicine is quackery, and promises that Theagenes’ liver would be free from inflammation in four days. Theagenes, who was also a patient of Galen’s, dies. At which point, Galen offers a coda to the reader about Methodist incompetence: And the funniest part of all is that Attalus had brought in some friends who had asked how Theagenes was doing, hoping to show them that he was doing so well that he was going to bathe. So Attalus went, all puffed up, with a bunch of people into the house where Theagenes lay (dead). Some of Theagenes’ friends, Cynics and philosophers of other schools, were busy washing the dead man, these being the funeral rites. It so happened, then, that Attalus was at the man’s death bed with a chorus of witnesses (μετὰ τοῦ χοροῦ τῶν θεατῶν), seeing as no one inside was lamenting. For Theagenes had no domestic slave, child, or wife. Only his philosopher friends were with him, and while they were handling the funeral rights for the dead, they did not have it in mind to lament. So the Thessalian ass 59

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For the Forum of Trajan, see Aulus Gellius Noct.Att. 11.17.1. Cf. Samama (2003: 441, n. 44) on the gymnasium as a traditional place for Greek public intellectual activity, including orations and debates. The note refers to Samama text no. 341, in which a Hellenistic physician delivers a public lecture in a gymnasium. MM 13.15 (x.909–910 K.): ταύτην [sc. the cure] γὰρ ἔγνωσαν οὐκ ὀλίγοι διὰ δόξαν τἀνθρώπου, δημοσίᾳ διαλεγομένου κατὰ τὸ τοῦ Τραϊανοῦ γυμνάσιον ἑκάστης ἡμέρας. The Gynaikeia of Soranus of Ephesus is the only treatise by a Methodist author to have survived in Greek. On Soranus and the Gynaikeia, see Temkin (1956). The extant fragments of the Methodists are collected in Tecusan (2004). On Methodism more generally, see Pigeaud (1991).

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was indeed distinguished when he showed (ἐπιδείξας) the man free from inflammation in four days to a throng of witnesses (ἐπὶ πολλῶν θεατῶν), as he promised.62 The impact of the joke with which Galen closes the anecdote about Theagenes depends, in part, on the layers of audience that he has built into his account.63 Attalus arrives at Theagenes’ home with a crowd of people to whom he had been boasting. A group of philosophers is already present at the home, washing the body. Indeed, Galen pointedly refers to those gathered at Theagenes’ deathbed as a chorus of witnesses or spectators (μετὰ χοροῦ τῶν θεατῶν). Galen does not appear to have been present, nor is it expected that any of his readers would have been. But in the telling, the throng of audience-goers that Galen writes into his narrative recreate the public context of display—and adjudication—that is typical of epideictic performances. Not only does Galen invoke theatrical languages (e.g., μετὰ χοροῦ τῶν θεατῶν) in the anecdote, but he also closes the episode by writing that Attalus put what he had promised on display (ἐπιδείξας) to a large audience of spectators (ἐπὶ πολλῶν θεατῶν). He says that, indeed, this quack Attalus was true to his word, since the dead man’s liver was indeed free from all inflammation on the fourth day. The rich context of Galen’s anecdote places Galen and the reader on the scene, to join the gathered philosophers and important audience-goers in laughing at Attalus’ incompetence. Indirect references to medical performances in other literature support the interpretation that these demonstrations were large and spectacular affairs. In the late first century ce, for example, the orator Dio Chrysostom derides sophistic performances by comparing them to public medical demonstrations: 62

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MM 13.15 (x.914–915 K.): καὶ τὸ πάντων γελοιότατον, ὁ μὲν Ἄτταλος ἦγέ τινας τῶν ἠρωτηκότων φίλων ὅπως διάγοι, δεῖξαι βουλόμενος αὐτὸν οὕτως ἔχοντα καλῶς ὡς λούεσθαι μέλλειν, ἀγαλλόμενός τε μετὰ πολλῶν εἰσῆλθεν εἰς τὸν οἶκον ἐν ᾧ κατέκειτο· τὸν Θεαγένη δὲ τεθνεῶτα λούειν ἐνεχείρουν ἔνιοι τῶν φίλων, ταῦτα δὴ τὰ νενομισμένα, Κυνικοί τέ τινες ὄντες καὶ ἄλλως φιλόσοφοι. διὸ καὶ μέχρι τοῦ νεκροῦ παραγενέσθαι συνέβη τῷ Ἀττάλῳ μετὰ τοῦ χοροῦ τῶν θεατῶν, ἅτε μηδενὸς ἔνδον οἰμώζοντος. οὔτε γὰρ οἰκέτης οὔτε παιδίον οὔτε γυνὴ τῷ Θεαγένει ἦν, ἀλλ’ οἱ φιλοσοφοῦντες μόνοι παρῆσαν αὐτῷ φίλοι, τὰ μὲν ἐπὶ τοῖς τεθνεῶσι νομιζόμενα πράττοντες, οὐ μὴν οἰμώζειν γε μέλλοντες. οὕτω μὲν ὁ Θεσσάλειος ὄνος εὐδοκίμησεν, ἐπὶ πολλῶν θεατῶν ἐπιδείξας ἀπηλλαγμένον τῆς φλεγμονῆς ἐντὸς τῶν τεττάρων ἡμερῶν, ὡς ὑπέσχετο, τὸν ἄνθρωπον. The anecdote is also interesting for what it may have to say about the ethical expectations of medical practitioners in the Roman period. From a contemporary perspective, at least, it is peculiar that Galen uses the death of his patient—or a patient, depending on how we analyze his relationship with Theagenes at this time—as the set-up for a joke at Attalus’ expense. Does this anecdote suggest that patient expectations of privacy in antiquity differed so dramatically from our own or that Galen’s anecdote was highly transgressive?

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So this sort of recitation [sc. in which some problema is proposed, on which a sophist holds forth persuasively], insofar as it is a spectacle and parade, is nearly like the demonstrations (ταῖς ἐπιδείξεσι) of the so-called physicians, who detail the articulation of joints, the arrangement and comparison of bones, and other things of this sort such as imperceptible pores, pneumata, and excretions. And the many become slack-jawed and hypnotized even more than children. But the real doctor is not like this nor does one talk to people who are in real need this way.64 The reference is contained in a speech composed for an audience in Tarsus. At the time—only a generation before Galen’s birth—Tarsus had a reputation for cultivating paideia and for enjoying performances of it. Dio’s comparison is intended to draw out the ersatz intellectual character of sophistic displays and the large crowds who attend them. It is partly a clever play on the stereotype that sophistic is a quintessentially fraudulent intellectual pursuit. In Dio’s analogy, the degenerate character of public medical performances is a basic truth that explains the character of certain sophistic counterparts. The comparison, if it is to be effective, is evidence of the close cultural connections his audience in a major urban center, here in Asia Minor, could be expected to make between sophistical performances and public medical displays. Dio’s analogy between sophistic and medical demonstrations also gives one a sense of the theatrical dimensions of these public medical performances; Dio’s audience understands public medical demonstrations to be characteristically epideictic and well-attended. These live public performances could take place over the course of multiple days.65 They might also include demonstrations of anatomical skill as well as theoretical expertise and erudition, such as the ones to which Dio alludes. However, as we have seen in the passages quoted, Galen’s narratives of his own public demonstrations typically do not make reference to the spaces in which they took place. Rather than physical space, what marks Galen’s public demonstrations were their emphatically spectacular dimensions and the audience that experienced them. 64

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Dio Chrysostom Or. 33.6.1–7: ἡ μὲν οῦν τοιάδε ἀκρόασις θεωρία τις οὖσα καὶ πομπὴ παραπλήσιον ἔχει τι ταῖς ἐπιδείξεσι τῶν καλουμένων ἰατρῶν, οἳ προκαθίζοντες ἐν τῷ μέσῳ ξυμβολὰς ἄρθρων καὶ ὀστέων συνθέσεις καὶ παραθέσεις καὶ τοιαῦθ’ ἕτερα ἐπεξίασι, πόρους καὶ πνεύματα καὶ διηθήσεις. οἱ δὲ πολλοὶ κεχήνασι καὶ κεκήληνται τῶν παιδίων μᾶλλον. ὁ δ’ ἀληθὴς ἰατρὸς οὐκ ἔστι τοιοῦτος οὐδὲ οὕτως διαλέγεται τοῖς ὄντως δεομένοις. Lib.Prop. 3 (144.19–21 B-M = xix.21 K.): So I was compelled by my friends and publicly demonstrated, over the course of many days, that I had not lied about any particular … (ἀναγκασθεὶς οὖν ὑπὸ τῶν φίλων καὶ δείξας δημοσίᾳ πολλαῖς ἡμέραις ἐμαυτὸν μὲν οὐδὲν ἐψευσμένον …).

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Galen offers far less information about the occasion for his private demonstrations; indeed, as I mentioned earlier, it is not clear to what extent they can be clearly distinguished from their public counterparts. Galen’s silence on the spaces in which his performances occurred contributes to the vagueness of the boundary separating public from private demonstration, perhaps deliberately so. By blurring boundaries between categories such as public and private or eristic and didactic, Galen creates a space in which readers’ expectations help to shape the nature of the written performance, effectively allowing readers to place themselves among different audiences. In the case of Theagenes, Galen’s narrative vagueness offers his reader license to participate in the spectacle of medical displays from the perspective of a member of his inner circle looking outward at his opponents. Of course, this is not to say that Galen’s private and public experiments—whether written or live—are wholly indistinct from one another. Galen’s descriptions of his private demonstrations suggest they were performed before more elite audiences, while the attendees of public demonstrations seem to have been more socially heterogeneous. Without further information, however, it seems very unlikely that we will recover evidence for non-elite attendees in the audience; these are figures that typically remain invisible in elite writing. Galen’s work is no exception. Whatever the historical realities of Galen’s live demonstrations may have been, Galen’s written performances suggest that we are swimming in a fundamentally rarefied pond, although not all the figures he mentions are equal. Some may be less educated than the reader, and certainly less educated than Galen. Nonetheless, Galen’s private demonstrations appear to have been aimed at the most elite intellectual audiences in Rome and with those interested in being instructed by him, two groups that could largely be coextensive and would almost certainly have identified themselves as pepaideumenoi.66 Galen 66

While the language of amazement and stupefaction in Anatomical Procedures gives the sense that these audiences are less sophisticated in virtue of being more susceptible to these spectacular displays, Galen sometimes uses the same kind of language to describe the reactions of his most elite and erudite associates at Rome. Indeed, there is no reason to suppose that Galen’s demonstrations are limited to only one audience or that their audience(s)—whether reading or live—should exclude another. On this general point about reader expectations, see van der Eijk (1997: 86–89). For a representative but not exhaustive set of examples, see the reactions of Eudemus and those of others in his social circle to Galen’s prognostications at Praen. 2 (CMG v 8,1 80.21–82.7, 82.22–31 = xiv.612– 614 K.), 3 (CMG v 8,1 84.5–10, 88.1–13 = xiv.615, 618–619 K.), 4 (CMG v 8,1 90.1–4 = xiv.620 K.). Flavius Boethus is likewise astounded upon Galen’s discovery of the cause of his son’s fever—surreptitious bouts of late-night snacking—at Praen. 7 (CMG v 8,1 104.24–26 = xiv.635 K.). The entire episode is replete with the language of wonder-working. Indeed, Galen refers to himself as a wonder-worker (παραδοξοποιός) and wonder-speaker (παρα-

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also suggests that the aims of his private demonstrations may have been more didactic, while public displays were primarily epideictic showpieces.67 For von Staden, as we have seen, the identification between public and epideictic as well as private and didactic are central points of congruence between Galen’s professional activity and the sophistic performances associated with elite practice among intellectuals of the second century ce.68 On this model, one of the central professional functions of Galen’s public performances would have been the display of his erudition and technical expertise in order to promote his professional authority. This self-promotion would ultimately have served as, among other things, a mechanism for the recruitment of students, who were themselves most probably members of the educated elite. The didactic elements of Galen’s private performances, then, would have aimed at the education of the students acquired through their public counterparts. Plutarch, a contemporary of Dio Chrysostom, offers direct evidence for public displays as mechanisms for the recruitment of students and other business in his treatise On How to Tell a Flatterer from a Friend. His reference also reinforces the notion that, at least in the context of Greek intellectual culture of the Imperial Period, the association between medical and sophistic performances was a relatively straightforward one. In a discussion of discretion and

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δοξολόγος) at Praen 8 (CMG v 8,1 110.16–17 = xiv.641 K.). For a fuller discussion, see Barton (1994: 133–168). The field of secondary scholarship on performative elements of technical demonstrations is still relatively sparse, an exception is Berrey (2017: 179–209) on Andreas of Carystus and Herophilus. On the performative dimensions of Galen’s anatomical demonstrations specifically, see Debru (1994, 1995); von Staden (1995a, 1997a); and Gleason (2009). See von Staden (1995a: 49–56) and (1997a: 47): “Not only the technical terminology used to describe his public performances and the central role of the distinction between ‘public’ and ‘private’ in his professional self-characterization, but also the larger cultural ideal within which Galen situates his public exhibitions therefore has its sophistic counterpart. ‘Public performance’ implies an audience, and this gives rise to the question whether Galen’s public audiences were, in his perception or depiction of them, similar to those of his sophistic contemporaries in any respect. Several suggestive affinities with the ‘Second Sophistic’ emerge from an examination of Galen’s remarks about the size, composition, and reactions of his audiences. First, like the sophists, Galen, according to his own testimony, at times performed in front of large crowds. Whether or not such autobiographical remarks about the size of his audience, like other autobiographical comments introduced above and below, are merely self-serving and therefore should be subjected to the hermeneutics of suspicion to which some modern critics tend to subject all remarks in the first-person singular, is not decisive for present purposes, since at issue here is principally Galen’s self-presentation and its relation to sophistic self-staging”. Von Staden (1995a) and (1997) note the difficulty with the phrase and opts to put the issue of the “Second Sophistic” to one side. Cf. Kollesch (1981).

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the need to distinguish between speech that is only appropriate for private spaces, Plutarch compares the public admonition of friends to the sophistry of physicians who conduct public medical experiments: For it is the business of sophistry not friendship to gain your reputation by airing other people’s faults, putting on a show before an audience like the doctors who perform technical procedures (οἱ χειρουργοῦντες) in theaters (ἐν τοῖς θεάτροις) for the sake of acquiring business.69 This passage offers corroborative evidence not only for scholarly arguments that have proposed a close affinity between oratorical displays and public medical demonstrations in the Imperial Period, but also for the recruitment of clientele as a shared social function of these performances. The relatively public nature of group or multiple consultation is relevant here as well. (See next chapter). The relative aims of a given demonstration, as advertisement and instruction, may be more meaningful indicators of whether Galen would have considered it a public or private event than the size of the audience or venue.70 One notes, for example, how little the passages from Anatomical Procedures quoted above lend themselves to a view of private performances as being private in any strict sense. The procedures Galen describes his coterie as attending are still conducted before an audience, albeit a smaller one made up of a more select circle, suggesting that perhaps the word ἰδίᾳ connotes the exclusivity of audience members rather than the exclusion of an audience. But while a close comparison of Galen’s professional practice with the practice of contemporary sophists may offer a plausible account of his live performances, it does not consider the striking textuality of Galen’s professional practice, which may be fashioned on live practice but need not perform just the same functions as it. There is an unfortunate and conspicuous gap in our knowledge of Galen’s live instruction. Galen provides almost no specific information about his pedagogical activity, beyond his seemingly continuous composition of instructional texts for the edification and pleasure of former classmates, friends, and influ-

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Plutarch Mor. 71a: οὐ γὰρ φιλικὸν ἀλλὰ σοφιστικὸν ἀλλοτρίοις ἐνευδοκιμεῖν σφάλμασι, καλλωπιζόμενον πρὸς τοὺς παρόντας, ὥσπερ οἱ χειρουργοῦντες ἐν τοῖς θεάτροις ἰατροὶ πρὸς ἐργολαβίαν. Of course, in limit cases this sort of claim may fail for practical reasons. Certain kinds of instruction, such as the observation of many anatomical structures, would have been impossible in any but the most intimate of settings and certain displays of epideictic virtuosity might require larger settings to be effective.

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ential patrons. Galen does not refer to any of his students by name. Moreover, there are no surviving references in other authors to any students Galen may have taught. Galen’s silence—and our ignorance—about his teaching activity and any students he may have instructed are circumstances that hold true, for the most part, for other extant medical authors.71 Neither Herophilus nor Erasistratus, for example, mentions students in their surviving writing. If it were not for the extant scraps of some of their students, there would be no direct evidence that they existed at all.72 If Galen’s practice followed the model of the typical elite intellectual, it is extremely likely that he did have students—even if we lack any further information about them. Galen does often mention groups of people who act as surrogates for him in various public contests, especially of technical skill. He indicates his connection to these surrogates in passing acknowledgments that they have seen, heard, or learned what they are doing “at my side” (παρ’ ἐμοί). Whether they did so also in fact or merely in Galen’s narratives, it is likely that these figures in Galen’s writing, whose identities he never reveals, play the role of student.

4

Public and Private Demonstrations in Writing

We do have an abundance of information about Galen’s pedagogical interactions with the many addressees, explicit and implicit, in his writing. Access to Galen’s live performances of medical experiments, his displays of theoretical knowledge, and other exhibitions of his erudition would all have shared certain constraints. These might range from mundane realities, such as the occasions of their performance (i.e., they occur at a certain time, in a certain place) and the constraints of the spaces in which they were performed (i.e., the audience capacity of the venue, practical limitations on the audience-members’ ability to observe procedures requiring close proximity), to more complicated questions of audience demographics: who could and did, formally and practically, 71

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Galen refers to a treatise written by Bacchius, a Herophilean, titled Memoirs of Herophilus and Those from his House (ἐν τοῖς Ἀπομνημονεύμασιν Ἡροφίλου τε καὶ τῶν ἀπὸ τῆς οἰκίας αὐτοῦ), which may have been a rare exception to this general observation (Hipp.Epid. 6.4.9, CMG v 10,2,2 203.19–22 = xviib.145 K.). The treatise, unfortunately, does not survive. For Bacchius, see von Staden (1989: 484–500). On the evidence for the term oikia to denote affiliations between physicians and their students, see Berrey (2017: 84, n. 299) and Berrey (2014: 434). On Herophilus and his students, see von Staden (1989: 445–471) and Stok (2018: 372–375). Von Staden (1989: 471–578) collects the testimonia of Herophileans. For Erasistratus and his students, see Garofalo (1988: 4–5) and Stok (2018: 375–377).

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attend these procedures? These are interesting questions, to which I have no satisfactory answers. When articulated, however, these issues make clear the great importance that Galen’s written narratives of his experimental performances stood to have for his professional practice. Galen’s written performances do not require the reader to attend the performative occasion at a certain time or place nor do the practical constraints of live demonstrations keep them from “seeing” even the most minute details of the procedures that Galen describes. In principle, the cost of entry to Galen’s written performances comes at the price of the treatise and knowledge of Greek. This reality, however, presents its own difficulties to Galen’s practice, which he consciously fashions as a part of the culture of elite Greek intellectuals (pepaideumenoi). The culturally encoded signs present in a performance conducted in propria persona, in a certain kind of place, and on a certain kind of occasion are absent in a text, all of which would have had social meaning to an audience-goer at a live performance. Galen is keen to supply these signs to the reader. Consider the thoracic experiment I have already mentioned earlier in this chapter. In Anatomical Procedures the reader is invited to participate in the demonstration as a member of Galen’s retinue. This relationship is effected by a combination of Galen’s second person addresses, his careful instruction on practical and performative aspects of the procedure, and—most of all—the distance he places between the procedure’s unwashed and awestruck audience, on the one hand, and the reader who is being instructed on its performance, on the other. Galen narrates a truncated version of this demonstration in On Prognosis, in which he offers a wealth of detail about the occasion of its performance and the audience in attendance. This specific demonstration was arranged by an ex-consul, Flavius Boethus, who also provided the animal subjects for the experiment at Galen’s instruction.73 Named attendees included Boethus’ instructor in philosophy Alexander of Damascus (perhaps to be identified as the father of Alexander of Aphrodisias)74 as well as the sophists Demetrius of Alexandria, who was a student of the influential orator Favorinus of Arelate, and Adrian of Tyre, who was the imperial chair of rhetoric at Athens and later in Rome. When Galen eventually conducted the experiment, its attendees also included the consulars Claudius Severus, Sergius Paulus, and Vetullenus Barbarus as well as “all the intellectuals who were in the city of Rome” 73

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For the circumstances leading up to Galen’s performance, the provision of animal subjects, and these named attendees, see Praen. 5 (CMG v 8,1 96.5–23 = xiv.627–628 K.). Cf. Praen. 2 (CMG v 8,1 80.25–82.7 = xiv.612 K.). See Nutton (1979: 189, n. on 96.7) and Nutton (2020: 33, n. 22).

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(τοῖς φιλολόγοις ἅπασιν ὅσοι κατὰ τὴν τῶν Ῥωμαίων πόλιν ἦσαν).75 The demonstration was arranged in at least two parts. In the first part, he would offer a logical demonstration that included the experiment’s results and his interpretation of them.76 In the second, which is interrupted in his narrative, Galen would have conducted the anatomical experiment he had just explained to this audience. Galen describes the experiment as occurring over the course of multiple days. It made such an impression on Boethus, Galen tells us, that he first asked for a copy of his lecture notes and then dispatched trained tachygraphers to record Galen’s account of the experiment.77 Galen suggests that this demonstration completed his professional entrance to the most elite intellectual circles of Rome. While certain observers—such as the assemblage of philosophers and physicians that attended this demonstration on the recurrent laryngeal nerve—may have had access to a causally explanatory account of the procedure, it is very probable that these cognoscenti were not the only audience members present at public anatomical displays, certainly the ones conducted demosia. What, then, of the audience-goers who were in attendance and would not have propositional knowledge of Galen’s anatomical proofs?78 These audience goers are convinced largely by the spectacle of the event, which is not to suggest that the cognoscenti were immune to Galen’s showmanship. After all, in On Prognosis Galen asked Boethus to provide swine and goats rather than apes for his demonstration to an audience that is overwhelmingly marked as pepaideumenoi. As we have already seen, the operative criterion for this choice in animal subject is the audience’s potential disgust at the expressions on the faces of vivisected apes as well as their amazement at the sight and sound of the anatomized pig. Furthermore, he advises the reader of Anatomical Procedures to make the same choice for private as well as public experiments. Regardless of the number or elite status of the attendees present at live public and private performances, it is clear that in Galen’s written demonstrations the internal audience is stratified into layers whose boundaries are determined by the audience-goers’ relative cultural education, their paideia. Certain elements of the displays are accessibly only to the intellectually elite, 75 76 77 78

Praen. 5 (CMG v 8,1 98.12–13 = xiv.629 K.). The order in which the parts of Galen’s demonstration proceed and its results are laid out at Praen. 5 (CMG v 8,1 96.19–98.4 = xiv.627–628 K.). Praen. 5 (CMG v 8,1 98.27–100.1 = xiv.630 K.). For a discussion of the relative size of these performances, see von Staden (1995a) and (1997a). He comes to no final conclusions about the absolute size of the audience. The exact number of audience-goers, however, does not fundamentally affect the terms of the discussion.

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the pepaideumenoi, while others are accessible to decreasingly educated rings of attendees. Consider, for example, the clever frame by which Galen reveals esoteric prognostic information about the pulse to the reader in On Prognosis: And so when I arrived, not waiting for me to sit down, he stretched out his hand then asked me to feel his pulse. And after it was taken, he eagerly asked what I had to say. And, grinning, I said, “What else, other than things are good?” He said, “Tell me specifically what these things are”. And I said, “Isn’t it enough for you to be happy in what’s to come after hearing a general summary?” “Not in the slightest!” he said, “For I also want to hear a step by step account”. “Then listen: this evening you will completely let go the entire morbid condition. The resolution of all the symptoms connected to it and the ones to come will follow. And I was saying that the nature maintaining your body has made it clear to me just now, through your pulse, that it has already become active and is at work to expel everything toxic in you, that is in the humors in your body”. “What do you mean that this has been made clear to you by nature? As it obviously didn’t tell you these things by speaking, answer me. For you know well that I can follow your reasoning (τῷ λόγῳ) better than all these stupid doctors”.79 In the episode from which the quoted passage is drawn, Galen diagnoses and cures Eudemus, his former teacher and a Peripatetic philosopher.80 Throughout the episode, Galen’s method is inscrutable to the gathered doctors. As frequently occurs in his writing, Galen at first appears to have worked some medical wonder. Indeed, he claims to have been accused by a certain Martialius of practicing divination (μαντική) rather than medicine.81 When Galen’s predic79

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Praen. 3 (CMG v 8,1 86.2–16 = xiv.616–617 K.): ὡς δ’ οὖν ἀφικόμην, οὐδὲ καθίσαι με περιμείνας ἐξέτεινε τὴν χεῖρα, κελεύων ἅψασθαι τῶν σφυγμῶν. ἁψαμένου δὲ μετὰ σπουδῆς ἐπυνθάνετο τί ποτε ἀγγέλλοιμι. κἀγὼ μειδιάσας, “τί ἄλλο”, ἔφην, “ἢ ἀγαθά;” “ποῖα”, εἶπε, “ταῦτα εἰδικῶς μοι φράσον”. ἐγὼ δ’, “οὐκ ἀρκέσει”, ἔφην, “σοὶ τὸ κεφάλαιον αὐτῶν ἀθρόως ἀκηκοότι χαίρειν ἐπὶ τοῖς ἐσομένοις;” “οὐδαμῶς”, εἶπεν. “ἀκοῦσαι γὰρ ποθῶ καὶ ⟨τὰ⟩ κατὰ μέρος”. “ἄκουε δή· ἀπαλλαγήσῃ τῇ νυκτὶ ταύτῃ τελέως ἁπάσης τῆς νοσώδους διαθέσεως, τῶν ⟨τ’⟩ ἐπιγενομένων καὶ τῶν ἐσομένων αὐτῇ συμπτωμάτων ἁπάντων ἡ λύσις ἀκολουθήσει. καὶ τοῦτ’ ἔφην ἄρτι μοι διὰ σφυγμῶν δεδηλωκέναι τὴν διοικοῦσάν σου τὸ σῶμα φύσιν ἐπεγηγερμένην ἤδη καὶ κινουμένην, ὡς ἐκβαλεῖν ἐκ τοῦ σώματος ἅπασαν οὖσαν ἔν σοι μοχθηρίαν τὴν ἐν τοῖς κατὰ τὸ σῶμα χυμοῖς”. “πῶς οὖν δὴ παρὰ τῆς φύσεως τοῦτο λέγεις σοι δεδηλῶσθαι—οὐ γὰρ δὴ φθεγξαμένη γε ταῦτ’ εἶπεν—ἀπόκριναί μοι· πάντως γὰρ οἶσθα παρακολουθήσαντά με τῷ λόγῳ μᾶλλον ἁπάντων τούτων ἰαλέμων ἰατρῶν”. On Eudemus, see Nutton (1979: 157–158, n. 74,16) and Praen. 3, 4 (CMG v,8,1 82, 92 = xiv.613 K., xiv.624 K.). Praen. 3 (CMG v 8,1 84.8 = xiv.615 K.). On Galen as detective and wonder-worker, see Barton (1994: 133–168). There is some confusion over whether the person mentioned here was

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tions have proven true Eudemus asks him to explain how he made them. Some witnesses, however, lack the ability and the training to follow Galen’s rigorous account of his prognosis, such as the rival physicians present during Eudemus’ case. They react to Galen mainly as a wonderworker and exist on the narrative margins. Galen’s explanation to Eudemus encodes evidence that his practice of medicine has an articulable method (logos), a feature that Galen takes to be central to technical expertise. Eudemus, who is carefully introduced into the narrative of On Prognosis as a Peripatetic philosopher,82 not only prompts Galen’s account but also sanctions it as philosophically legitimate: “you have logically (διαλεκτικῶς) laid out the chain of inferences (συνελογίσω) that led you to a discovery of this prognosis”.83 Even if Galen’s method is not apparent to the unwashed, to the truly erudite his method is a clear inferential movement from indicative sign to a pathological condition, and finally to successful prognosis. The explanation, Eudemus’ approval of Galen’s reasoning, the charges of divination, and the general ignorance of other physicians all function to separate out audiences on the basis of their medical knowledge—or their capacity for it. There are three parts to Eudemus’ role at this point in the story. First, he serves as a vehicle by which Galen, in his guise as magician, can pull back the veil on his secrets and reveal them. Then, Eudemus’ reaction to Galen offers a mechanism for the adjudication of Galenic medicine and method as legitimate practice for pepaideumenoi, a group to which Eudemus belongs and with whom the reader is encouraged to align. Finally, the contrast that Eudemus draws against Galen’s rivals emphasizes the practical and intellectual failings of those doctors present who cannot comprehend Galen’s method. This last narrative function is crucial, since, public or private, Galen’s written performances require an internal audience whose intellectual and social shortcom-

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named “Martialius” (Μαρτιάλιος) or “Martianus” (Μαρτιανός). All of the manuscripts of On Prognosis read “Martianus”. However, the name is attested as “Martialius” in the two surviving Greek manuscripts of My Own Books and in Ḥunain ibn Isḥāq’s Arabic translation. Nutton (1979: 168–169, n. 84.2) prefers “Martianus” on the basis of the manuscript tradition for On Prognosis, since at the time of his writing My Own Books possessed only one Greek manuscript authority. With the discovery of the Vlatadon manuscript in 2005, there is more evidence to support the reading of “Martialius”. For the present state of the issue, see Boudon-Millot (2007: 185–186). The identification is uncertain. Boudon-Millot, however, suggests that this person was Martialius, an Erasistratean who had enjoyed some success as an anatomical writer and with whom Galen debated on anatomical matters. Praen. 2 (CMG v 8,1 74.16–17 = xiv.606 K.). Praen. 3 (CMG v 8,1 86.29–30 = xiv.618 K.): “διαλεκτικῶς”, ἔφη, “συνελογίσω τὴν εὕρεσιν τοῦ γενησομένου”.

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ings exclude them from the more elite circles in which Galen places himself, along with his intended readers and the internal audience that stands in for them. As a surrogate for Epigenes, Galen’s implied reader, the actual reader belongs implicitly to this inner circle. So does Eudemus, whose questions trigger Galen to reveal his method to the reader in the narrative. Galen figures both as being the sort of people who can comprehend the method Galen has to offer. Moreover, there is an implicit promise that one too can possess the technical acumen to work medical wonders, if only one is sufficiently attentive to Galen’s instructions.84 The foregoing sections have laid out some of the performative dimensions of Galen’s live medical demonstrations and some of those that he hardwires into his accounts of these experiments. In this vein, I have emphasized one of the narrative functions that kinds of audience play in Galen’s experimental writing. These audiences occupy two poles, the one legitimate and legitimizing, the other fraudulent and marginalizing. These poles reflect a fundamental historical feature of Greek and, later, Roman elite medical practice. The interaction among elite Greco-Roman medical practitioners was deeply and pervasively agonistic, in keeping with the behavior of Greeks and Romans who engaged in a variety of other intellectual pursuits. The case of Theagenes, which Galen turns into a stinging and satirical rebuke of Methodist practice is a pointed example of this agonism. By the late Roman period, the agonistic character common to intellectual interaction and authorship—already a traceable feature for over five hundred years in the Greek intellectual tradition—was compounded by the antiquarianism of Greek intellectuals in the second century, who turned to their Greek past as a source of self-definition.85 Intellectuals of Galen’s time took this intellectual disputation to a fever pitch.86 Although it is never wholly absent, Galen

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Cf. Nutton (2012: 42). I intentionally leave aside mention of the ‘Second Sophistic’. I am here concerned primarily with establishing that Galen’s anatomical displays have certain performative features in common with other traditionally ‘non-technical’ or ‘literary’ texts written in the late Roman Empire. Whether these texts and their authors form a temporal, cultural, or literary movement is not directly relevant to this chapter’s discussion of the argumentative strategies, as epideixeis, that anatomical demonstrations play in Anatomical Procedures. For the classical context, see especially Lloyd (1979: 59–125); for sophistic debate and medicine in the second century see, e.g., Gleason (1995) and (2009); and von Staden (1995a), (1997a). It is sometimes difficult, if not anachronistic, to draw clear lines of demarcation between medical and sophistic debates, despite the deceptive certainty with which ancient authors characterize themselves and their rivals: this clarity, of course, is an out-

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varies the intensity of this polemic engagement with his predecessors and contemporaries both from treatise to treatise and from author to author.87 Galen’s generally positive opinion of his Classical past, especially the past associated with Athens of the fifth and fourth centuries, is of a piece with the Atticizing tendencies of other intellectuals of the second century, regularly discussed under the general heading of second-sophistic antiquarianism. This is not to say that this use represents a wholesale endorsement of anything Classical or a rejection of anything Hellenistic. For instance, while Galen is quite critical of the classical atomists for their non-teleological accounts of the natural world, he frequently praises the Hellenistic anatomist Herophilus for his anatomical discoveries. In some cases, as in his treatments of the Stoic philosopher Chrysippus of Soli, the same author can in one context be marked for abuse and in another for praise.88

5

Antiquarianism and Galen’s Doxographical Polemics

Galen’s sophisticated relationship to textuality and technologies of the book should not be wholly surprising to us. Discussion, explanation, and formal commentary on the writing of ancient authors had been a feature of high intellectual Greek culture since the Hellenistic period. Doxographical exegesis, which was often philological in character, was one form of antiquarianism common to intellectual culture in the high Roman Empire. And Galen was, at least in this respect, representative of his times. His antiquarian interests are manifest not only in his lexigraphical works and his frequent comments on Attic style, but also in the careful attention he pays to his own usage, which cultivates Atticism without shackling him to it.89 Throughout Galen’s work, references

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growth of their agonistic interactions. The spaces in which medicine and sophistic operate are often shared, as evidenced by, among other things, the references to medical demonstrations in Dio Chrysostom and Plutarch. The disciplines bleed into one another, generating internal pressures to establish disciplinary boundaries in opposition to rival disciplines. Practitioners often define themselves and their disciplines in opposition to rival professionals and professions employing categorizations that are highly constructed. This claim holds especially for medicine and philosophy—for the philosopher there was the sophist (σοφιστής). For the physician there was the magician (γόης) or charlatan (ἀλαζών). One telling linguistic marker of this latter sort is Galen’s evaluative description of a given predecessor as either one of the class of ancients (παλαῖοι) or one of the class of later (νεώτεροι) and therefore less august intellectuals. See Frede (1985: xviii). See, e.g., Morison (2008), Petit (2012).

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to the past and to his intellectual antecedents abound.90 He generally refers to earlier authors in order to underwrite his own intellectual authority or to undermine the intellectual authority of his rivals; of course, the two strategies are not mutually exclusive. Hippocrates and Plato are frequent points of reference for Galen. And, while he appeals straightforwardly to the authority of both authors in some contexts, in others it becomes necessary for him to reconcile their views with his own in order that he may appear to maintain a relatively seamless connection with the past.91 Therefore, interpretation of the right sort plays as powerful a role in undercutting his rivals as it does in endorsing himself. Galen’s interpretation of past authorities is another competitive act, in which he and his contemporaries struggle against one another logically and philologically in order to establish their intellectual bona fides.92 One common tactic in Galen’s writing that I wish to discuss capitalizes on the agonistic potential of doxographical exegesis.93 In this sort of doxographical polemic Galen critically examines a set of views held by a contemporary rival, often in three phases. In the first stage, Galen makes the case that his opponents have misread or misunderstood the work of the ancient author(s) on whose authority they draw. This stage is primarily doxographical and sometimes also philological. In one example taken from On Venesection against Erasistrateans at Rome,94 Galen attacks contemporary Erasistrateans for the bloodletting of patients who are fasting: Since these [Erasistrateans] do not honor the truth but Erasistratus, I must demonstrate for them that the argument written by him in his treatise On Bringing Up Blood is not exclusive to that affliction but is common to every kind of inflammation.95

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References to his predecessors abound. For a short piece on references to other authors in Galen, see Nutton (2009b: 19–34). Cf. Sluiter (1995: 519–535). On Galen’s reading of Hippocrates and Hippocratic writing as precursors to his own work, see Smith (1979: 77–176). On Galen’s affiliation with Plato, see De Lacy (1972). See, e.g., Brunt (1994); von Staden (1995a), (1997a); Lloyd (2008). For a clear and helpful discussion of Galen’s exegetical engagement with Aristotle and second-century Aristotelians, see van der Eijk (2009), esp. pp. 272–281. Cf. van der Eijk’s (2000–2001: ii.xiv) discussion of Galen’s representation of Diocles of Carystus. For the episode, see Ven.Sec.Er.Rom. 6 (xi.224–225 K.). Ven.Sec.Er.Rom. 6 (xi.225 K.): ἐπεὶ τοίνυν τὴν ἀλήθειαν οὐ τιμῶσιν ἀλλ’ Ἐρασίστρατον,* ἐπιδεικτέον ἀυτοῖς ἐστὶν ὡς ὁ γεγραμμένος ὑπ’ αὐτοῦ λόγος ἐν τῷ περὶ αἵματος ἀναγωγῆς οὐκ ἔστιν ἴδιος ἐκείνου τοῦ πάθους, ἀλλὰ κοινὸς ἀπάσης φλεγμονῆς. *I read “οὐ τιμῶσιν ἀλλ’ Ἐρασίστρατον” rather than “οὗτοι τιμῶσιν, οὐκ Ἐρασίστρατον”, following Kotrc 1973.

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As a preliminary, Galen accuses Erasistrateans of grounding their medical beliefs exclusively on the authority of Erasistratus rather than on observation and experience. Then Galen produces passages from Erasistratus’ work, on the basis of which he argues that contemporary Erasistrateans fail to understand the source of their views. Of course, it is a corollary to Galen’s argument that he understands what his opponents cannot. This prong of Galen’s attack emphasizes his status as pepaideumenos by contrasting his erudition with his opponents’ lack of paideia. In the second stage of this kind of polemic, Galen shifts his attention from the erudite exegesis of the ancient author’s writing to a critique of the views contained within it. In the continuation of the present example, Galen mounts an extended discussion of Erasistratus’ views on bloodletting—which, as we recall, he has argued are misunderstood by later Erasistrateans—throughout the remainder of the treatise.96 In the final stage of his doxographical polemic, Galen turns his attention back to his contemporaries. They not only lack the education to read their source material properly—education in which Galen is steeped—but the material is itself flawed: It is impossible to undertake both fasting and phlebotomy as therapies in one and the same patient. So it is clear if one ever finds Erasistratus prescribing fasting that he is not employing bloodletting at that time. For this reason, as I said, he made no further mention of the treatment in his other treatises. For in all of these treatises, as I have shown, when he prescribes fasting he clearly takes bloodletting off of the table. He is wrong on this score [sc. about bloodletting], as I have shown earlier in quotation after quotation, but less so than those who make the mistake of thinking that all those who require fasting, need bloodletting immediately afterwards.97 The structure of the critique is powerful. Galen marshals a double indictment of his contemporaries: they are poor readers and poor thinkers. Furthermore, 96 97

Cf. Lonie’s important article on Galen’s use of Erasistratus, Lonie (1964). Ven.Sec.Er.Rom. 9 (xi.247–248 K.): οὐκ οὖν ἐνδέχεται καθ’ ἕνα καὶ τὸν αὐτὸν ἄρρωστον ἄμφω παραλαμβάνειν τὰ βοηθήματα, τὴν ἀσιτίαν καὶ τὴν φλεβοτομίαν. ὥστε εὔδηλον εἴποθ’ εὕροι Ἐρασίστρατον συμβουλεύοντα τὴν ἀσιτίαν μὴ χρῆσθαι τηνικαῦτα φλεβοτομίᾳ, διὰ τοῦτο γοῦν οὐδὲ ἐμνημόνευσεν, ὡς ἔφην, ἔτι τοῦ βοηθήματος ἐν ταῖς ἄλλαις πραγματείαις. ἐν ἁπάσαις γὰρ αὐταῖς, ὡς δέδεικται, συμβουλεύων ἀσιτίαν ἀναιρεῖ δηλονότι τὴν φλεβοτομίαν οὐκ ὀρθῶς μὲν πράττων, ὥσπερ καὶ καθ’ ἑκατὸν ἡμῖν πρότερον, ὡς ἔφην, ἐδείχθη γράμμα, μικρότερον ἁμαρτανόντων τῶν οἰομένων ἅπαντας ὅσοι χρῄζουσιν ἀσιτίας, εὐθὺς τούτους δεῖσθαι φλεβοτομίᾳ. *I read “Ἐρασίστρατον συμβουλεύοντα” rather than “Ἐρασίστρατος συμβουλεύοντος” following Kotrc 1973.

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in asserting his status as hermeneut and critic of ancient writing he subtly positions himself as a coeval to the ancients who authored it. Galen’s polemical use of doxography has affinities with the sort of doxographical exegesis expected of intellectuals performing in other public contests typical of Rome in the second century, such as sophistical debates and meletai. It is likely that one such example of Galen’s public exegeses survives as his treatise On Venesection against Erasistratus. The identification depends on comments Galen makes in the similarly titled treatise On Venesection against Erasistrateans at Rome, which we have been discussing, as well as in his autobibliographical work My Own Books. In My Own Books, Galen recounts a public debate on the views of ancient physicians that was held at Rome in about 163 ce. A treatise of Erasistratus’ was proposed for discussion:98 Once while I was speaking on the works of the ancient physicians in public (δημοσίᾳ), Erasistratus’ On Bringing Up Blood was proposed (προβληθέντος) to me and a stylus was placed in it according to custom. When it pointed to that part of the book in which he deprecates venesection, I spoke against him even more in order that I might upset Martialius, that self-styled Erasistratean.99 This passage is a rich source of indirect information for the performance context of these public demonstrations and how they might proceed. We are told that the debates took place daily, in front of a public audience (δημοσίᾳ), and involved a proposed topic (προβληθέντος) about which the speaker was expected to deliver an extemporaneous and learned exposition. This scenario was no ad hoc argument, but a regularly planned performance to which speakers could come and deliver these improvised lectures. The topic for discussion might be proposed by an audience member. Here Galen reports a different mechanism for choosing prompts for debate. A stylus was inserted into a book roll; participants would be expected to discuss the passage indicated by its placement. Thus some element of chance—and therefore risk— was introduced into the performance by ensuring that neither the speaker(s) 98

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If On Venesection against Erasistratus is a version of this disquisition, as I think it is, then Galen would have been about thirty-four years old when he composed it. See Lib.Prop. 1 (139.13–14 B-M = xix.15 K.). Lib.Prop. 1 (138.21–139.3 B-M = xix.14 K.): καὶ λέγων γέ ποτ’ εἰς τὰ τῶν ἰατρῶν τῶν παλαιῶν βιβλία δημοσίᾳ προβληθέντος μοι τοῦ περὶ αἵματος ἀναγωγῆς Ἐρασιστράτου καὶ γραφείου καταπαγέντος εἰς αὐτὸ κατὰ τὸ ἔθος, εἶτα δειχθέντος ἐπ’ ἐκεῖνο τὸ μέρος τοῦ βιβλίου, καθ’ ὃ τὴν φλεβοτομίαν παραιτεῖται, πλείω πρὸς αὐτὸν εἶπον, ὅπως λυπήσαιμι τὸν Μαρτιάλιον Ἐρασιστράτειον εἶναι προσποιούμενον.

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nor the audience-members could prepare for the precise topic of discussion in advance. The passage also offers us some insight into Galen’s method of composition, in at least some of his treatises. Galen refers to this performance in On Venesection against the Erasistrateans at Rome.100 He writes that after he finished the disquisition, an associate and school-friend, named Teuthras, asked him to repeat the demonstration to a tachygrapher so that he might have a copy of it while traveling to Ionia. Galen complied, reperforming the demonstration so that it might be transcribed: For at that time the custom somehow came to pass of speaking every day before a crowd on proposed topics (εἰς τὰ προβαλλόμενα). So then the topic for discussion was put forward by someone: whether Erasistratus was right not to use phlebotomy. I gave a detailed response to the question (πρόβλημα), which seemed most helpful to those who were listening at the time. And it was for this reason Teuthras asked me to dictate the things I had said to a slave whom he would send. He kept on telling me that he really wanted to have them, seeing as he was going home to Ionia and was about to depart. And so my friend won me over and I dictated my talk. But it so happened that my book got out to many people, although it was not distributed by him intentionally. For the talk was not composed to suit the page, but the auditorium, since my friend had asked that I dictate it as it had been spoken.101 Once leaked out to a wider audience, the document was destined to become On Venesection against Erasistratus.102 As this episode illustrates nicely, Galen 100 101

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Nicholls (2011: 128, n. 27) conjectures that these quotidian performances probably took place at the Temple of Peace before the fire. Ven.Sect.Er.Rom. 1 (xi.194–195 K.): συνέβη γάρ πως ἐν ἐκείνῳ τῷ χρόνῳ καθ’ ἑκάστην ἡμέραν εἰς τὰ προβαλλόμενα λέγειν ἐν πλήθει. προεβλήθη μὲν οὖν ὑπό τινος, εἰ δεόντως Ἐρασίστρατος οὐ κέχρηται φλεβοτομίᾳ. διῆλθον δ’, ὡς ἔδοξε τοῖς τότε ἀκούσασιν, ὠφελιμώτατον πρόβλημα. διὸ καὶ παρεκάλεσεν ὁ Τεύθρας ὑπαγορεῦσαί με τὰ λελεγμένα* τῷ πρὸς αὐτοῦ πεμφθησομένῳ παιδί. καὶ γάρ τοι καὶ μέλλων εἰς τὴν Ἰωνίαν ἐπιδημῆσαι καὶ ἐξορμήσασθαι πάντως ἔφασκεν ἔχειν αὐτὰ βούλεσθαι. ἐγὼ μὲν οὖν ἐπείσθην τε τῷ ἑταίρῳ καὶ τὸν λόγον ὑπηγόρευσα. συνέβη δ’ ἐκπεσεῖν εἰς πολλοὺς τὸ βιβλίον, οὐ κατὰ τὴν γνώμην ὑπ’ ἐκείνου διαδοθέν. ὁ γάρ τοι λόγος οὐ συγγράμματι πρεπόντως, ἀλλ’ ἀκουστηρίῳ συνέκειτο, δεηθέντος τοῦ φίλου καθ’ ὃν ἐρρέθη τρόπον, οὕτως αὐτὸν ὑπαγορευθῆναι. *I read “με τὰ λελεγμένα” rather than “μεταλελεγμένα” following Brain (1986: 41, n. 9) with reference to Kotrc (1970). Cf. Brain (1986: 105–106) and Mattern (2008: 11). The unregulated dissemination of Galen’s ideas is a topos in Galen’s references to many of his own treatises. See, e.g., Diff.Puls. 4.1 (viii.696 K.); MM 7.1 (x.458 K.); Comp.Med.Gen. 1.1 (xiii.362–363 K.); and Hipp.Epid. 3.2 (CMG v 10,2,1 60.4–11 = xviia.576–577 K.).

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takes great pains not only to recreate his live public performances in writing, but also to report to the reader the circumstances—often competitive—that led to their textualization. This writing practice has special relevance to the structure of Galen’s anatomical narratives, many of which I argue aim at replicating the credentialing function of live performance on a scale untrammeled by spatio-temporal constraints.

chapter 2

Galen and Agonistic Anatomical Demonstration Galen’s public demonstrations were often not solo performances. It is fitting, given the importance of anatomy to Galen’s success, that an anatomical demonstration provided Galen with his initial entrance into medical practice. Galen returned to Pergamum in 157ce after a ten-year Wanderzeit, during which time he had zealously sought out a variety of prominent physicians throughout the Greco-Roman world in pursuit of his medical training. In On Recognizing the Best Physician, which survives only in an Arabic translation, Galen reports that on his return he entered into or perhaps even instigated a public surgical competition with other physicians for the post of chief gladiatorial physician of the arena at Pergamum.1 As part of the interview, Galen disembowels an ape. When its intestines burst forth, Galen puts them back into place and sutures the wound. Moreover, he also pressures other physicians present to participate in his demonstration: Once I attended a public gathering where men had met to test the knowledge of physicians. I performed many anatomical demonstrations before the spectators: I made an incision in the abdomen of an ape and exposed its intestines: then I called upon the physicians who were present to replace them back (in position) and to make the necessary abdominal sutures—but none of them dared to do this. We ourselves then treated the ape displaying our skill, manual training, and dexterity. Furthermore, we deliberately severed many large veins thus allowing the blood to run freely and called upon the Elders of the physicians to provide treatment but they had nothing to offer. We then provided treatment, making it clear to the intellectuals who were present that (physicians) who possess skills like mine should be in charge of the wounded. That man was delighted when he put me in charge of the wounded—and he was the first to entrust me with their care.2 trans. iskandar

1 For Galen’s experience as a gladiatorial physician, see Scarborough (1971), especially 105–111, in which Scarborough provides a brief catalogue of the limited contribution that Galen’s surgical experience with the gladiators at Pergamum may have made to his subsequent anatomical knowledge. 2 Opt.Med.Cogn. 9.6–7 (CMG Suppl.Or.iv 105.4–15 Iskandar).

© Luis Alejandro Salas, 2020 | doi:10.1163/9789004443860_004

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Galen’s account of the event gives a sense for the gory spectacle and high stakes of which his anatomical experiments were capable. It also exhibits an important thematic cluster that recurs both in his live and written demonstrations. Unlike previous demonstrations I have discussed, Galen’s performance for the post of gladiatorial physician involves a second set of participants: rival professionals. It is not enough for Galen to dazzle an audience and display his technical skill. A point of comparison is needed. Galen challenges his opponents to do what he can do. First, he demands that they reposition the ape’s intestines and suture its abdomen; once they fail his challenge, Galen severs some of the ape’s veins and again urges them to treat the wounds. Since they lack Galen’s training, however, they do not even dare to try. Galen writes that they “have nothing to offer”. While his opponents fumble, Galen proceeds methodically to break apart and reconstitute the bodies of his subjects. Despite the graphic spectacle he describes in the background, Galen’s selfpresentation is overtly clinical. This rhetorical strategy permits Galen to exploit spectacular features of public vivisection, what Caroline Petit has called an “esthétique de l’horreur”, while maintaining an air of cerebral and detached authority.3 In the coda to the scene, Galen sums up the purpose of his challenge. When taken alongside the utter failure of his opponents to treat the animal, Galen’s successful treatment of it is evidence to the intellectuals present of Galen’s professional authority—the Greek is lost but “pepaideumenoi” is likely. At least partly as a result of their acclaim the hierarch in charge of selecting gladiatorial physicians was moved to appoint Galen to the position.4 Galen’s accounts of these performances are characterized by their pointed agonism. They exhibit a central tension between binary poles of legitimacy and charlatanry, on the one hand, and Galen’s expert training and its absence in his opponents, on the other. His accounts also put a point on the important part 3 See Petit (2018: 153–161). On this passage, she writes (157): “Galien nous fournit le point de vue détaché, objectif du médecin, comme lorsqu’ il défie ses collègues, après les avoir ôtées, de replacer les entrailles d’un singe dans sa cavité abdominale. Les gestes froids et précis de l’anatomiste évacuent toute émotion; mais ils devaient être perçus (et lus) avec un frisson d’horreur par les auditeurs et lecteurs de Galien, tous patients réels ou potentiels du médecin de Pergame. C’était d’autant plus le cas lorsque les animaux soumis aux expériences, ou les patients victimes de traitements drastiques, se mettaient à crier et à tenter de se débattre malgré leurs liens, sous l’effet de la douleur … ” 4 See Opt.Med.Cogn. 9.4–5 (CMG Suppl.Or.iv 103.10–105.3 Iskandar). In the broader context of this episode Galen tells us more about his opponents and the process of selection. Among the elder physicians present, two or three had previously been placed in charge of care for the wounded among the gladiators. Galen reports that the hierarch grew confident in his selection because he was witness to Galen’s rigorous training and his anatomical demonstrations, in comparison with the anatomical ignorance and less rigorous training of his opponents.

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that audience plays in adjudicating the relative position of Galen and his opponents along these axes—these contests require their losers in order to have their winners. This characterization should not be taken as limited to Galen’s accounts of practical anatomical demonstrations. Galen’s more theoretical experiments and his experimental writing are also frequently and emphatically agonistic. As a practical matter, many of Galen’s theoretical digressions and anatomical experiments were occasioned by some point of disagreement that would prompt him to debate before audiences of varying sizes, a process indistinguishable from the proposed topics of discussion (problēmata) in sophistic demonstrations. Audiences could range from an individual, to a handful of onlookers, and sometimes to crowds of spectators. The athletic resonances of these intellectual contests were not lost on Galen, whose language of competition and choice of metaphors reflect the polemical dimensions of his engagement with intellectual rivals. He often characterizes the practice of medicine— and intellectual pursuits more generally—as athletic agōnes. Consider, for example, Galen’s introductory comments to his treatise The Best Doctor is also a Philosopher: Many athletes are afflicted with the following sort of thing: although they desire to become Olympic victors, they do not make an effort to act so as to achieve this. This sort of thing also happens to many doctors. For while they praise Hippocrates and consider him the first among all [doctors], they count themselves among his equals but do everything except act like him.5 For Galen, physicians, like athletes, compete in a public arena where there are winners and losers, all striving for social and professional rewards. This passage is no mere hyperbole. It highlights the agonistic context in which the secondcentury physician operated. It also underscores two features crucial to Galen’s estimation of authorized practitioners. First, the legitimate physician is marked not only by the right sort of training but also by commitment to its assiduous pursuit, as we saw in Galen’s account of his selection as gladiatorial physician and the Pergamene hierarch’s method for the selection. Then, and at an opposite professional pole, there is a fraudulent physician, who is an inverted image 5 Opt.Med. 1 (284.3–9 B-M = i.53 K.): οἷόν τι πεπόνθασιν οἱ πολλοὶ τῶν ἀθλητῶν ἐπιθυμοῦντες μὲν ὀλυμπιονῖκαι γενέσθαι, μηδὲν δὲ πράττειν ὡς τούτου τυχεῖν ἐπιτηδεύοντες, τοιοῦτόν τι καὶ τοῖς πολλοῖς τῶν ἰατρῶν συμβέβηκεν. ἐπαινοῦσι μὲν γὰρ Ἱπποκράτην καὶ πρῶτον ἁπάντων ἡγοῦνται, γενέσθαι δ’ αὑτοὺς ἐν ὁμοίοις ἐκείνῳ πάντα μᾶλλον ἢ τοῦτο πράττουσιν.

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of his legitimate counterpart. The characters of both doctor and charlatan are cause and symptom of their conditions.6 In the previous chapter, I discussed the public nature of medical demonstrations in Greco-Roman antiquity. In particular, I drew attention to Galen’s performative instructions to readers, to his choice of experimental subjects for their effect on audience-goers, and to his descriptions of audiences’ reactions when demonstrations are performed according to his instructions. In this chapter, I discuss this social function that live competitive demonstrations performed for Greek and Roman intellectuals in greater detail, focusing on the role different audiences played in adjudicating professional legitimacy for the ancient medical practitioner. I will ultimately argue that Galen’s written polemics should be read as playing a key role in his recreation of live medical demonstration and, by extension, in his reperformance of their social functions for a reading audience. Before proceeding further, however, it is necessary first to examine crucial features of the cultural matrix out of which experiments such as these arose.

1

Credentialing and the Medical Marketplace

It is a standard observation that professionals were not credentialed by independent bodies in the Greco-Roman world.7 There were no institutions to speak of that might sanction the practices or practitioners of a given discipline as legitimate.8 Without the stabilizing effects of such authorities on the pro6 For an extended diatribe against the moral and professional failings of Roman physicians in Galen’s day, see Praen. 1 (CMG v 8,1 68–72 = xiv.599–603 K.). For the jealousy and bitter aggression that competence inspires in the illegitimate practitioner, see, e.g., Praen. 1–2 (CMG v 8,1 72–74 = xiv.604–606 K.). 7 This is an observation frequently made by Vivian Nutton. See, e.g., Nutton (2013: 88–89) and (1995: 26). Cf. Lloyd (1987: 103–104). 8 This general claim holds true with two exceptions that need not delay us for long: the external sanction of state-sponsored physicians, evidence for which is scarce before the Hellenistic period, and tax-status of medici starting in the Roman period. These state-sponsored physicians were not the norm or, better said, even at times that state sponsorship was more common, there were very few state-sponsored physicians. Evidence suggests that state sponsorship consisted in payment of a retainer fee to keep otherwise itinerant physicians in a polis. Whether this fee was merely a retainer or was also a flat payment for medical service to the people of the city is uncertain. Our earliest evidence for this practice is found in Herodotus Hist. 3.129–137. Evidence for the practice is more common in the Hellenistic period but remains uncommon enough not to affect the basic claim that practitioners lacked external licensing bodies throughout the Greek and the later Roman periods under discussion. For a synoptic discussion of public physicians, see Nutton (2013: 87, 153–154, 255–256,

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fessional statuses of practitioners, membership in a discipline and even the disciplines themselves were spaces of continual contest. As a result of this historical circumstance, medical authority and legitimacy from the Classical to the Late Imperial period were acquired largely through displays of knowledge, successful engagement with rival practitioners, and the perception of successful treatment. Professional status was deeply bound up in the estimation of different audiences: spectators, listeners, patients, and patrons.9 A wide range of healers—midwives, rootcutters, pharmacologists, divine healers, herbalists, eye-couchers, physical trainers—vied for legitimacy, along with the clientele and students it afforded, in a bustling ‘medical marketplace’.10 Their authority hinged on the ability to persuade relevant constituencies of their therapeutic efficacy.11 While victories in the marketplace may have depended on successful treatment, they were not reducible to health outcomes. The physician had to establish a causal connection between treatment and its positive outcome, while creating distance between treatment and any negative outcomes. The physician was sufficiently aware of these demands that medical authors regularly comment on implicit performative criteria by which they are evaluated.12 The perceived success of any treatment hinged on how the physician was determined, in many cases publicly, to have influenced patient health. The physician had to be judged effective. To this end, public diagnosis, prognostication, and treatment—accompanied by the right sort of account—all played a

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and 373 n. 133). For the tax-status of physicians in the Hellenistic and Roman periods, see Nutton (2013: 153–156, 167–168, 185–186, 255–260). Cf. Justinian Dig. 27, 1, 6, 8. Evidence for medical patronage emerges in the royal courts of the Hellenistic world and continues through the Roman period. For the relationship between the production of scientific ideas and Hellenistic courts, see Berrey (2017). I use the term here in a broad sense merely to emphasize the diversity of mainstream therapeutic practices available in the Greco-Roman world. See Nutton (1995: 15–58). The authors of the prescriptive Hippocratic texts Decorum and Precepts—both generally dated to the Hellenistic or early Roman period—are self-conscious and direct about the successful physician’s need of effective performance. Nature of the Human Being appeals to the kind of audience that will find the author’s argument persuasive, followed by a sketch of a late fifth-century bce medical debate (Nat.Hom. 1, CMG i 1,3 164–166.11 = 6.32–4 Littré). Ancient Medicine targets proponents of hypotheseis, whose theoretical arguments fall outside the purview of medicine (Vet.Med. 20, 100.17–102.15 Schiefsky = 145.17–146.15 Jouanna). The author of Sacred Disease accuses his rivals of being charlatans, who defraud patients and audiences with fake treatments (Morb.Sac. 1.4–6, 3.18–6.5 Jouanna = 6.354– 358 Littré). In Diseases 1, the reader is encouraged to listen closely for a rival physician to make a mistaken assertion, then catch him out and refute him (Morb. 1.1, 6.140–142.12 Littré). Cf. Regimen in Acute Diseases 6, On Joints, The Art, Breaths, and Precepts 8. See also Dean-Jones (2003); Nutton (1995); and Lloyd (1983), (1979).

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role in the physician’s perceived success. Prognosis, which in its ancient context combined knowledge of the present and past with predictions about the future, is a point of concern and attention throughout the treatises of the Hippocratic Corpus.13 These treatises make the professionalizing functions of prognosis apparent, although the main audience for prognostication may have been more localized than some of the other public demonstrations we are discussing—it consisted mainly of patient, household, and perhaps the immediate community. In the Hippocratic Prognostic, for example, the most prominent professional function that the Hippocratic author assigns to prognosis is to establish the practitioner’s professional legitimacy and to insulate him from accusations of iatrogenic harm: I think it best for the physician to be practiced in prognosis. For when he anticipates and predicts what is happening, what has happened, and what is going to happen at his patients’ bedside, explaining in detail what patients do not mention, he will inspire (πιστεύοιτο) confidence that he knows matters of the sick, with the result that people will have the courage to entrust themselves to him as their physician … In this way one would rightfully be a source of amazement (θαυμάζοιτο) and a good physician. For when one has more time to prepare for each of these eventualities, one is even more able to preserve the patients who can survive. And by anticipating and announcing in advance who will die and who will be saved one can remain blameless (ἀναίτιος).14 The later accounts of medical demonstrations we have seen share some affinities with this Hippocratic author’s account of prognosis. Insofar as the Hippocratic physician was able to describe the past, present, and likely course of a condition afflicting the patient, his prognosis astonishes (θαυμάζοιτο) and persuades (πιστεύοιτο) the patient of his professional legitimacy. Furthermore, by firmly locating the cause(s) of the patient’s harm outside the sphere of his 13 14

Ludwig Edelstein makes a similar point in his discussion of Greek medical prognoses (Edelstein 1967c). Prog. 1.1., 1.3 (1–2.2, 3.5–11 Jouanna = 2.110–112 Littré): τὸν ἰητρὸν δοκέει μοι ἄριστον εἶναι πρόνοιαν ἐπιτηδεύειν· προγινώσκων γὰρ καὶ προλέγων παρὰ τοῖσι νοσέουσι τά τε παρεόντα καὶ τὰ προγεγονότα καὶ τὰ μέλλοντα ἔσεσθαι ὁκόσα τε παραλείπουσιν οἱ ἀσθενέοντες ἐκδιηγεύμενος, πιστεύοιτ’ ἂν μᾶλλον γινώσκειν τὰ τῶν νοσεόντων πρήγματα, ὥστε τολμᾶν ἐπιτρέπειν τοὺς ἀνθρώπους σφέας ἑωτοὺς τῷ ἰητρῷ … οὕτω γὰρ ἄν τις θαυμάζοιτό τε δικαίως καὶ ἰητρὸς ἀγαθὸς ἂν εἴη· καὶ γὰρ οὓς οἷόν τε περιγενέσθαι, ἔτι μᾶλλον ἂν δύναιτο διαφυλάσσειν ἐκ πλείονος χρόνου προβουλευόμενος πρὸς ἕκαστα, καὶ τοὺς ἀποθανουμένους τε καὶ σωθησομένους προγινώσκων τε καὶ προαγορεύων ἀναίτιος ἂν εἴη.

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own influence, the physician could maintain a safe distance from any socioprofessional repercussions of its effects, remaining blameless (ἀναίτιος). By identifying these social functions of ancient prognosis I do not mean to comment on its therapeutic value nor imply that the Hippocratic physician was invested solely in fashioning a defense against accusations of medical malpractice. I mean to underscore the pervasive need that the Greek (and later Roman) physician would have had for social mechanisms to generate and maintain his status as a legitimate medical practitioner. This need is also reflected in the advice of the author of On Fractures, who counsels the reader on the importance of avoiding—if one has a good excuse—cases in which the fractured bone has broken the skin and is protruding, on the grounds that the chances of a healthy outcome are low and the risks of complication are high: One should really avoid these sorts of cases if one has a good exit strategy. For the hopes [sc. for a good outcome] are few and the risks are many. And, if one manages to reduce the fracture, one will push the patient closer to death than safety; while, if one does not manage to reduce the fracture, one will seem to have no skill (ἄτεχνος ἂν δοκέοι εἶναι).15 The process places the patient at risk of death, even if the practitioner should succeed in reducing the fracture. If he should fail, he risks his status as a legitimate practitioner (ἄτεχνος ἂν δοκέοι εἶναι). The author of Prorrhetic 2 offers a similar warning to the reader, advising care in making prognoses on the grounds that if the prediction turns out to be true the patient who understands is, indeed, astonished (θαυμασθείη ὑπὸ τοῦ ξυνιόντος ἀλγέοντος); but a failed prognosis engenders hatred and even doubt in the practitioner’s sanity: I advise you to be as moderate as possible both in the rest of your craft and in these sorts of prognoses, since you all know that if someone gets the prognosis right, he is found astonishing by the patient who understands (θαυμασθείη ὑπὸ τοῦ ξυνιόντος ἀλγέοντος); but if someone gets it wrong, he will appear fit for hatred and even out of his mind. For these reasons I bid you to make prognoses conservatively, along with all the other things [that belong to your profession].16 15

16

Fract. 36 (101.8–12 Kühlewein = 3.540.9–12 Littré): μάλιστα δὲ χρὴ τὰ τοιαῦτα διαφυγεῖν, ἅμα ἤν τις καλὴν ἔχῃ τὴν φυγήν. αἵ τε γὰρ ἐλπίδες ὀλίγαι, καὶ οἱ κίνδυνοι πολλοί· καὶ μὴ ἐμβάλλων ἄτεχνος ἂν δοκέοι εἶναι, καὶ ἐμβάλλων ἂν ἐγγυτέρω θανάτου ἀγάγοι, ἢ τῆς σωτηρίης. Prorrh. 2 2.10 (9.10.8–13 Littré): συμβουλεύω δὲ ὡς σωφρονεστάτους εἶναι καὶ ἐν τῇ ἄλλῃ τέχνῃ καὶ ἐν τοῖσι τοιούτοισι προρρήμασι, γνόντας ὅτι ἐπιτυχὼν μὲν ἄν τις τοῦ προρρήματος θαυμασθείη

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These passages show the concern of the Hippocratic physician with the estimation of a fairly restricted audience in what were probably semi-private spaces—the homes and bedsides of their patients, perhaps also surgeries or workshops in more urban environments. Treatises of the Hippocratic corpus, however, also bear witness to more public and formal medical demonstrations, such as the ones already familiar to us from Galen’s work. These demonstrations are of a piece with other expressions of Greek intellectual skill common from at least the fifth century bce onward:17 And so, whoever is accustomed to listen to those who talk about the Nature of a human being beyond the extent to which it relates to the art of medicine, this speech is not designed for him to hear … when they [sc. those who talk about the Nature of human beings] all hold the same belief but do not say the same things about it, it is clear that they know nothing. One can recognize this fact, especially when in attendance at their debates. Although the same people debate with one another in front of the same audience, the same speaker is not ever the winner three times in a row in the debate; rather, one speaker wins at one time, another the second time, and finally, by chance, the one whose tongue seems smoothest to the crowd.18 While the author of Nature of the Human Being is targeting single-element accounts of the human body alongside Eleatic monism, the intellectual arena in which these theoretical disputes are presented is public and agonistic. The contests are adjudicated by the acclaim of the audience. The debates them-

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18

ὑπὸ τοῦ ξυνιόντος ἀλγέοντος, ἁμαρτὼν δ’ ἄν τις πρὸς τῷ μισεῖσθαι τάχ’ ἂν καὶ μεμηνέναι δόξειεν. ὧν δὴ ἕνεκα κελεύω σωφρόνως τὰ προρρήματα ποιέεσθαι καὶ τἄλλα πάντα ταῦτα. For this general phenomenon in Greek intellectual writing, see Lloyd (1979: 86–98). Lloyd (1979: 246–264) argues that this phenomenon is partly due to the increased prominence of professional rhetoricians starting in the fifth century bce. Nat.Hom. 1 (CMG i 1,3 164.3–5 … 166.1–9 = 6.32–34 Littré): ὅστις μὲν οὖν εἴωθεν ἀκούειν λεγόντων ἀμφὶ τῆς φύσιος τῆς ἀνθρωπίνης προσωτέρω ἢ ὅσον αὐτῆς ἐς ἰητρικὴν ἀφήκει, τούτῳ μὲν οὐκ ἐπιτήδειος ὅδε ὁ λόγος ἀκούειν … ὁπότε δὲ γνώμῃ τῇ αὐτῇ πάντες προσχρέωνται, λέγουσι δὲ οὐ ταὐτά, δῆλον ὅτι οὐδὲ⟨ν⟩ γινώσκουσι. γνοίη δ’ ἂν τῷδέ τις μάλιστα παραγενόμενος αὐτοῖσιν ἀντιλέγουσιν· πρὸς γὰρ ἀλλήλους ἀντιλέγοντες οἱ αὐτοὶ ἄνδρες τῶν αὐτῶν ἐναντίον ἀκροατέων οὐδέποτε τρὶς ἐφεξῆς ὁ αὐτὸς περιγίνεται ἐν τῷ λόγῳ, ἀλλὰ τοτὲ μὲν οὗτος ἐπικρατεῖ, τοτὲ δὲ οὗτος, τοτὲ ᾧ ἂν τύχῃ μάλιστα ἡ γλῶσσα ἐπιρρυεῖσα πρὸς τὸν ὄχλον. καίτοι δίκαιόν ἐστι τὸν φάντα ὀρθῶς γινώσκειν ἀμφὶ τῶν πρηγμάτων παρέχειν αἰεὶ ἐπικρατέοντα τὸν λόγον τὸν ἑωυτοῦ, εἴπερ ἐόντα γινώσκει καὶ ὀρθῶς ἀποφαίνεται. Cf. Praec. 12 (9.266.16–268.5 Littré).

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selves are at least semi-formalized. There are explicit conditions for victory. They must have been held with some regularity; otherwise the author’s appeal to the reader’s experience would fall flat. The Hippocratic treatise On Joints contains two other powerful examples of the social dynamics of public medical demonstrations. In the first, which presents a context for professional debate similar to the one embedded in the passage from Nature of the Human Being, the Hippocratic author describes the aftermath of a medical debate. In the broader context of this excerpt, the author reports that many other practitioners mistake protrusions of certain shoulder bones for a kind of dislocation. The author asserts that in his experience these dislocations do not exist: Once I heard myself disparaged both by the physicians and by the public in such a case, when I denied that this sort of thing was a dislocation. For to them I alone seemed ignorant while the others seemed knowledgeable. And I could not convince them, if it was even possible, that this is how it was …19 On Joints is framed as though it was written to defend the author’s maligned view and reassert his professional competence. The passage presents us with the perspective of a practitioner who has been delegitimized by the disparagement of rival physicians and a public audience.20 After describing his public ridicule, the author rehearses for the reader what he might have said to this unpersuadable audience. The author seems to make a written appeal to the judgement of a reading audience in order to rehabilitate his professional credibility, in an unusual and early instance of this phenomenon. In a second example taken from much later in the treatise, the author of On Joints describes the kinds of machines that the practitioner can and should use to reduce disloca-

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20

Artic. 1 (111.12–112.4 Kühlewein = 4.78.9–80.1 Littré): καὶ ἔγωγέ ποτε τὸ τοιοῦτον οὐ φὰς ἐκπεπτωκέναι ἤκουσα φλαύρως ὑπό τε τῶν ἰητρῶν ὑπό τε τῶν δημοτέων διὰ τοῦτο τὸ πρῆγμα· ἐδόκεον γὰρ αὐτοῖσιν ἠγνοηκέναι μοῦνος, οἱ δὲ ἄλλοι ἐγνωκέναι, καὶ οὐκ ἠδυνάμην αὐτοὺς ἀναγνῶσαι, εἰ μὴ μόλις, ὅτι τόδ’ ἐστὶ τοιόνδε· The status of anatomical demonstration in On Joints is also interesting. Prior to the anatomical activities of Herophilus and Erasistratus in the first half of the third century bce, we have no evidence of systematic human dissection in the Greek medical tradition. Indeed, there is only the most tenuous evidence for the dissection of non-human animals before Aristotle. See, e.g., Lloyd (1975). The author of On Joints presents arguments for the anatomical morphology and movement of the shoulder in the form of a thought experiment. The reader is asked to conceptualize the naked shoulder and mentally remove layers of flesh and muscle in order to visualize the underlying structure of the shoulder under discussion. See Artic. 1 (112.4–17 Kühlewein =4.80.1–11 Littré).

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tions.21 The reader is warned not to trust in dangerous procedures that aim to arrest an audience’s attention, such as succussion:22 The physicians who employ it [the succussion ladder] are thus eager to make a big crowd go slack-jawed (ἐκχαυνοῦν τὸν πολὺν ὄχλον). These sorts of things are amazing (θαυμάσια) to them: if they get to see someone hung up or hurled around or any number of similar procedures. They always applaud these procedures and pay no further mind to what has resulted from the treatment, whether bad or good.23 The treatment aims at straightening skeletal deformations, such as humpedbacks. The patient is tied to a ladder. Then, patient and ladder are suspended from the roof of a home or some other elevated place, from which they are dropped in the hopes that the force of the impact will straighten out the crooked bone(s). There are limited instances in which the Hippocratic author sanctions use of the succussion ladder. In general, however, he considers that physicians who turn to its use are charlatans. Their treatment is merely spectacle, designed to move a credulous audience, who are the slack-jawed masses (ἐκχαυνοῦν τὸν πολὺν ὄχλον). In this way, charlatans exploit the power of an audience’s judgement to legitimize the practice and the practitioner. For the most part the healers described in the Hippocratic Corpus vie with one another in unambiguously public spaces, before crowds of onlookers. While there is some evidence for therapeutic activity in a public context, such as in the case of the succussion ladder I have just mentioned, most treatment appears to take place either in a patient’s home or less frequently in a physician’s workshop or surgery. At some point, probably in the late Hellenistic or early Roman period, the model of the itinerant Hippocratic physician, who often treated patients on his own or was accompanied by a small group of assistants or perhaps students, gives way to a new therapeutic model. In environments where there was an abundance of dedicated healers, medical performances spread from the public into the private sphere in the form of the multiple consultation. It is difficult to say when this phenomenon first emerges 21

22 23

See Artic. 72 (228–230 Kühlewein = 4.296–300 Littré) and Nutton (2013: 95–96). Nutton observes that many of the machines reported in On Joints are immovable or impractically movable, suggesting an increased urbanization of Hippocratic medical practice. Artic. 42–43 (167–170 Kühlewein = 4.182–186 Littré). Artic. 42 (167.10–16 Kühlewein = 4.182.15–20 Littré): χρέονται δὲ οἱ ἰητροὶ μάλιστα αὐτῇ οὕτως ἐπιθυμέοντες ἐκχαυνοῦν τὸν πολὺν ὄχλον· τοῖσι γὰρ τοιούτοισι ταῦτα θαυμάσιά ἐστιν, ἢν ἢ κρεμάμενον ἴδωσιν ἢ ῥιπτεόμενον ἢ ὅσα τοῖσι τοιούτοισιν ἔοικεν· καὶ ταῦτα κληΐζουσιν αἰεὶ καὶ οὐκέτι αὐτοῖσι μέλει, ὁποῖόν τι ἀπέβη ἀπὸ τοῦ χειρίσματος, εἴτε κακὸν εἴτε ἀγαθόν.

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but it is best attested in the Roman period.24 This argument is consistent with the instructions presented to readers about how the physician ought to comport himself before patients and to engage with other practitioners in some of the so-called deontological treatises of the Hippocratic Corpus—Physician, Precepts, and Decorum—all of which date to the second half of the third century bce or later. In these treatises, the authors advise the physician on how best to bring in other practitioners for consultation.25 The treatises do not, however, offer clear evidence for the practice of multiple consultation. In a multiple consultation, a patient might be visited by a group of practitioners. The practitioners would evaluate the patient’s condition, often make claims about its underlying causes, and predict the course of health and disease. Once the evaluations were made, the patient would decide from among them which practitioner and which treatment to pursue. Frequently, there are others present in the home and at the patient’s bedside. These attendants—family, friends, and sometimes gawking passersby—can chime in with their own views about which practitioner and which treatment the patient should choose. The case of Theagenes the Cynic philosopher, which I discussed in the previous chapter, is a striking example of the public context for medical consultation and treatment in Rome. One recalls that Statilius Attalus—the Methodist physician treating Theagenes—had brought a group of people to Theagenes’ home to witness the improvement of the man’s condition under Attalus’ treatment. Indeed, the presence of these witnesses and the philosophers already present in the home plays a crucial role in the humiliation of Attalus and the vindication of Galen’s treatment plan.26 The case studies that Galen reports in On Prognosis are illustrative of the competitive bedside displays that characterize the kind of multiple consul24

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26

Evidence for multiple consultation becomes more common in Roman literature of the first century ce, often in satirical contexts. See, e.g., Martial Ep. 5.9 (centum … discipulis); Pliny NH 29.11 (turba se medicorum perisse). On Physician, see Dean-Jones (2010). The treatises instruct the practitioner on how to how to speak, dress, and in general how to act in order to inspire trust and confidence in their patients. Precepts discusses the physician’s consultation with other practitioners at Praec. 7–8 (CMG 1.1 32.14–33.16 = 9.258–264 Littré). The author also discourages live abstract demonstrations of the sort we have previously discussed—if one must, the author writes, it is best at least not to quote too much poetry (Praec. 12, CMG 1.1 34.5–9 = 9.266–268 Littré). Cf. Dec. 1–3 (9.226–228 Littré). Ecca (2016a: 23–25) dates Precepts to the early Roman period on the basis of stylistic analysis and philosophical associations with Epicureans and Empiricists. Leven (2005, s.v. ‘Ärztekonsil’) considers the passages in Praec. 7–8 our earliest evidence for multiple consultation. I am thankful to Marquis Berrey for bringing these references to my attention. The episode runs from MM 13.15 (x.909–916 K.).

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tation I am discussing. A group of physicians—gathered for this purpose— presents the Peripatetic philosopher Eudemus with a series of treatment plans to consider.27 In another case, the wife of Flavius Boethus is too embarrassed by her illness, some sort of vaginal discharge, to summon male physicians as Galen implies would be customary. When the midwives she trusts cannot treat her effectively, Boethus calls the best physicians in Rome to evaluate the treatments they propose:28 Boethus’ wife had fallen ill with the so-called female flux at that time. Since she was embarrassed to do so before elite physicians—one of whom I was considered to be already by everyone—she entrusted herself to the care of her usual midwives, who were themselves among the best in the city. When she did not begin to recover, Boethus gathered all of us together and then asked us what had to be done.29 Likewise, Galen reports that Marcus Aurelius summoned him along with a number of other physicians to diagnose his condition. When Galen does not offer a diagnosis immediately, Aurelius asks him to produce it before the gathered physicians, along with its explanation.30 This is the standard model for medical practice in Galen’s world at Rome, where treatment became a competition not only against disease but also against rival physicians, who now vied against one another for clientele in the sick room as well as semi-private and public arenas.31

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Praen. 2 (CMG v 8,1 74.12–80.25 = xiv.605–612 K.). For a brief attempt at reconstructing Galen’s daily medical practice, see Horstmanshoff (1995). For the entire case, see Praen. 8 (CMG v 8,1 110.13–116.19 = xiv.641–647 K.). Praen. 8 (CMG v 8,1 110.18–22 = xiv.641 K.): ἡ γὰρ τοῦ Βοηθοῦ γυνὴ τῷ καλουμένῳ ῥῷ γυναικείῳ περιπεσοῦσα κατ’ ἀρχὰς μὲν αἰδουμένη τοὺς ἀξιολόγους ἰατρούς, ὧν εἷς ἤδη κἀγὼ πᾶσιν ἐδόκουν εἶναι, ταῖς συνήθεσι μαίαις ἀρίσταις οὔσαις τῶν κατὰ τὴν πόλιν ἑαυτὴν ἐπέτρεπεν· ὡς δ’ οὐδὲν ὠφελεῖτο, πάντας ἡμᾶς ὁ Βοηθὸς ἀθροίσας ἐπεσκοπεῖτο τί χρὴ ποιεῖν. Praen. 11 (CMG v 8,1 126.16–130.10 = xiv.657–661 K.). For the image of the physician contending with disease, cf. MM 9.4 (x.612 K.), where Galen is said to butcher a fever against which he is fighting. There are other examples in On Prognosis that I do not discuss here. See, e.g., Praen. 13 (CMG v 8,1 134.9–138.12 = xiv.665–669 K.) and 14 (CMG v 8,1 138.13–23 = xiv.670 K.).

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Rome and the Centrality of Public Display

Intellectual displays were a common expression of cultural status among the educated elite (pepaideumenoi) in the late Roman Empire, among whom Galen is squarely situated. Insofar as these pepaideumenoi valorized the Classical Greek past, their expressions of cultural status were replete with antiquarian gestures, peppered with allusions and direct references to earlier Greek intellectual writing. Their fondness for reproducing Attic diction even prompted the compilation of dictionaries of Attic usage, such as the ones Galen lost in the fire of 192.32 To a large extent, Galen’s writing exhibits features typical of elite cultural expression in his time, although he is sufficiently self-aware to be critical of the antiquarianism that he also embraces. As a part of this cultural expression, intellectuals continued to engage in open debates on a range of topics, among which were medical issues. Some of these public debates were wholly theoretical; others were more practical in nature. The two categories frequently overlapped in the case of anatomical demonstration, a point I will discuss further in due course.33 While the abstract debates will be more familiar to us from earlier Hippocratic evidence, the advent of invasive anatomical demonstrations had to wait for the growth of systematic inquiry into animal bodies that began in the late fourth century bce, especially among the Peripatetics; it reached full bloom in the first half of the third with the work of Herophilus and Erasistratus, who also conducted their anatomical inquiries on the bodies of human beings. Invasive anatomical demonstrations shared many of the performative elements of their purely theoretical counterparts, especially their agonism and spectacle. In his treatise Whether Blood is Naturally Contained in the Arteries, for example, Galen devotes considerable energy to refuting a series of Erasistratean claims

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Galen, for example, wrote a forty-eight-volume lexicon of Attic prose, as well as dictionaries of popular terms drawn from comedy (e.g., Eupolis, Aristophanes, Cratinus, and a volume on words exclusively attested in comedy). He also composed a treatise on important Attic terms, along with books regarding topics related to linguistic antiquarianism (e.g., Whether The Texts of Ancient Comedy are a Worthwhile Part of the Curriculum and To Those Who Criticize Linguistic Solecisms). None of these treatises appear to have survived. Galen lists them in Lib.Prop. 20 (173.5–15 B-M = xix.48 K.). On Galen’s use of comic diction as a resource for ancient idiomatic usage that could inform his reading of earlier medical writing, see Boudon-Millot (2007: 233, note on p. 173) and von Staden (1998). On Galen’s use of philology as a heuristic tool of scientific discovery, see von Staden (1995b: 515–517). On the agonistic and public contexts of anatomical displays, see von Staden (1995a); Gleason (2009); and Salas (2014). For medical demonstrations as spectacles, see also Vegetti (1987).

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about the contents and function of the arterial system. I take up the theoretical points at issue in this debate and their underlying importance to Galen’s system of physiology in chapter six. But, for the present, I turn to Galen’s characterization of the debate, which develops some of the athletic metaphors we have already seen: I had supposed that they [sc. Erasistrateans] would offer no rebuttal to these [refutations] and that they would come to understand what that they had formerly misunderstood. But, they were unwilling to do so; rather, just as in wrestling rank amateurs cling to the neck[s] of those who have thrown them and do not permit them to stand upright, since sometimes they do not realize that their back[s] are lying on the ground, so these [Erasistrateans], since they are ignorant of the falls in arguments, do not permit [me] to be free while they turn out some trick or another, always new, ducking and dodging until anyone would leave, disgusted (μισήσαντά) and exasperated (ἀποδυσπετήσαντα) at the shamelessness (ἀναισχυντίαν) they compound with their ignorance.34 This quotation is of a piece with Galen’s attitude toward argument throughout his writings, although the attitude is by no means exclusive to him. Opponents whose arguments fail to pass muster are intellectually pinned or thrown to the ground. They fail to realize that they have been refuted and continue to debate with Galen, as amateur wrestlers may persist in snatching at the necks of professionals from the ground. Their failures are due in large part to a lack of proper intellectual training; the Erasistrateans fail to recognize defeat because they are ignorant of the rules of intellectual engagement—the falls in arguments (ἀμαθεῖς ὄντες τῶν ἐν τοῖς λόγοις πτωμάτων). Galen puts himself and his opponents at opposite poles of this binary: to the degree that his opponents fail because they are ignorant, Galen succeeds because of his paideia. Charlatanry and legitimacy, which we have already seen arising in these kinds of agonistic contexts, occupy the poles of a second binary common in Galen’s work. In some instances, for example, Galen’s opponents compound

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Art.Sang. 5 (160.1–10 F-W = iv.717 K.): πρὸς ταῦτ’ ἐγὼ μὲν ᾠόμην αὐτοὺς μήτ’ ἀντιλέξειν μηδὲν μαθήσεσθαί τε τὰ κακῶς ἐγνωσμένα. οὐ μὴν ἐθέλουσί γε, ἀλλ’ ὥσπερ οἱ παντελῶς ἰδιῶται παλαισμάτων οὐ γνωρίζοντες κείμενον ἐπὶ γῆς ἐνίοτε τὸν νῶτον αὐτῶν ἔχονται τραχήλου τῶν καταβαλόντων οὐδ’ ἐπιτρέποντες ἀναστῆναι, τὸν αὐτὸν τρόπον καὶ οὗτοι ἀμαθεῖς ὄντες τῶν ἐν τοῖς λόγοις πτωμάτων οὐκ ἐπιτρέπουσιν ἀπαλλάττεσθαι καινάς τινας ἀεὶ στροφὰς στρεφόμενοι καὶ παντοίως λυγιζόμενοι μέχρι τοῦ μισήσαντά τινα τήν τ’ ἀναισχυντίαν ἅμα καὶ τὴν ἀμαθίαν αὐτῶν ἀποδυσπετήσαντα χωρισθῆναι.

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their intellectual inadequacies with moral ones. The Erasistrateans’ desperate attempts to avoid a legitimate fall cause any reasonable observer to be disgusted by their shamelessness (μέχρι τοῦ μισήσαντά τινα τήν τ’ ἀναισχυντίαν). In cases such as these, his rivals’ lack of shame moves them to conceal their lack of professional training, painting themselves not merely as amateurs but also as frauds. This pair of accusations, ignorance and fraudulence, are recurring themes in Galen’s polemics against rival intellectuals. They are for the most part, however, restricted to contemporary rivals, in this case second-century Erasistrateans at Rome. Authors of the Classical period (palaioi), on whose authority Galen depends in part for his own, may occasionally be ignorant but are never uneducated or fraudulent. So, for example, Galen may criticize Aristotle for being ignorant of certain anatomical knowledge, but he attributes this lack of knowledge to the state of anatomical knowledge in the fourth century rather than Aristotle’s lack of education. The results of these contests for professional legitimacy are also determined by the acclamation of an audience, typically in the context of a live performance. Recall for example the innovative appeal of the Hippocratic author of On Joints to his readership and their implied acclamation as surrogates for the adjudication of a live audience. This textual turn is a crucial feature of Galen’s approach to his own professional authority. Galen does not only use writing to preserve his public demonstrations, he leverages textuality to reperform their credentialing functions. Here, as elsewhere, Galen implicitly figures the reader as a member of his retinue. The reader is drawn into the narrative as a participant in Galen’s medical contests—an arbiter, who will ultimately judge Galen their winner. Insofar as neither the text nor its readership are tied to a specific time and place, Galen’s experimental writing allows him to cultivate his intellectual authority and expand his sphere of professional influence far beyond the occasion of a demonstration’s initial and ephemeral public performance. This feature of Galen’s writing practice is strikingly apparent in his epilogue to another debate, this time with an Asclepiadean in On the Power of Cleansing Drugs.35 Galen does not identify his opponent explicitly. In the larger context of the passage, he is arguing that mechanical explanations are inadequate to

35

Galen mentions two main proponents of such mechanical views, who are the primary targets of his ire on this subject: Erasistratus and Asclepiades. And, indeed, he mentions both as holding wrong-headed mechanical views about the nature of purgative drugs earlier in Purg.Med.Fac. 2 (xi.328 K.). On the subject of drug-action, Galen’s focus is generally on Asclepiades. Comments Galen makes in other treatises provide evidence that he has Asclepiadean views in his sights here. Cf. Nat.Fac. 1.13 (SM 3, 131.9–133.10 = ii.41–44 K.).

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explain certain physiological phenomena. In this case, the point at issue is whether purgative drugs draw fluids out of the body indiscriminately or they possess capacities for drawing out select humors. Here Galen takes his opponent to task over the underlying explanation for their effect: Right away he seemed to his fellow Bacchants like the sort of man who spoke well. They began applauding him while he made his exit, leaving me behind in a great rush, since I suppose he knew for certain that he was about to be refuted. The next day I gave his chorus (χορευταῖς) a book, in which there was a refutation of the claim that he had so abruptly made. Since he was at a complete loss (ἀπορῶν) about how to answer its challenges (τὰ προβεβλημένα), the man was never again as credible to them as he used to be. For I wrote the following in the book: “Yesterday you dodged our debate, making like a competitor (ἀγωνιστῇ), but snatching the crown and fleeing before finishing the competition (ἀγωνίσασθαι). But today you will not escape my refutation; for this little book, which has fallen into the hands of the members of the chorus (χορευταῖς) that surrounds you, will follow you. Its argument is something no less for them than it is for you, and for those who did not hear you concede (to me) earlier …”.36 There are striking echoes of the language of second-century sophistic competitions in this passage. The Asclepiadean is at a loss (ἀπορῶν) as to how to respond to the topic of debate proposed to him (τὰ προβεβλημένα). As we have already discussed, these proposed topics of debate (problēmata) are a commonplace of public intellectual competitions in the second century, in which a topic is chosen for the speaker to debate extemporaneously before a gathered crowd.37 The basic social mechanism Galen describes in this passage is similar to what we have seen in other contexts. There is a professional debate. An audi-

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Purg.Med.Fac. 3 (xi.332 K.): παραχρῆμα μὲν οὖν ἔδοξε τοῖς θιασώταις ὁ τοιοῦτος εὖ λέγειν καὶ πάντες ἐπεβόων αὐτῷ καὶ δρόμῳ πολλῷ καταλιπὼν ἡμᾶς ἀπηλλάττετο γιγνώσκων, οἶμαι, βεβαίως, ὅτι μένων ἐξελεγχθήσεται. δοθέντος μέντοι κατὰ τὴν ὑστεραίαν ὑφ’ ἡμῶν τοῖς χορευταῖς αὐτοῦ βιβλίου τινός, ἐν ᾧ τῶν οὕτως ἐξαίφνης ἀποτετολμημένων ἦν ἔλεγχος, οὐκέτ’ οὐδέποτ’ αὐτοῖς ἐκεῖνος ἔθ’ ὁμοίως ἦν πιθανὸς ἀπορῶν διαλύσασθαι τὰ προβεβλημένα. ταυτὶ γὰρ ἐνεγέγραπτο τῷ βιβλίῳ· χθὲς μὲν ἀπέδρας τὸν λόγον ὅμοιόν τι ποιήσας ἀγωνιστῇ τὸν στέφανον ἁρπάσαντι καὶ φυγόντι πρὶν ἀγωνίσασθαι, τήμερον δ’ οὐκ ἐκφεύξῃ τὸν ἔλεγχον· ἀκολουθήσει γάρ σοι τουτὶ τὸ βιβλίδιον εἰς τὰς χείρας ἐμπεσὸν τῶν ἀμφί σε χορευτῶν· οὐδὲ γὰρ ἧττόν τι πρὸς ἐκείνους ὁ λόγος ἐστὶν ἢ πρός σε, τοὺς οὐδέποτε μὲν ἔμπροσθεν ἀκηκοότας σοῦ συγχωροῦντος … See, e.g., Gleason (1995), (2009); Swain (1996); Whitmarsh (2005); and von Staden (1995a), (1997a).

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ence is present to determine the winner of the contest, a determination that would typically confer a degree of professional authority. The Asclepiadean, however, rushes off rather than be refuted. The Asclepiadean’s associates fail in their attempt to adjudicate him the winner. At this point, it is crucial to note that the live demonstration breaks down completely. Galen’s little book does not record, so much as replace it. The treatise chases after the man, extending the space in which the contest takes place beyond the occasion of its initial performance. Galen explicitly figures the followers of the Asclepiadean—now a reading audience—as spectators bearing witness to his arguments and joining in their arbitration. The debate ultimately finds its resolution in the pages of Galen’s little book and in the judgement of its readers. The book and the challenge it presents to Galen’s rival are inescapable, precisely because they require neither time nor place to perform their functions, unlike their live counterpart. Galen presents us with a set of nested frames. At the first level of the narrative, there is a familiar live demonstration; its named audience made up of his rival’s followers. This stage of the contest is interrupted, but perhaps not by the Asclepiadean’s departure. Indeed, in a passage I discuss later Galen departs abruptly, declares the contest done, and himself victorious. Rather, the audience’s verdict is postponed by the intervention of Galen’s book. As we have seen, Galen carries the debate into a written medium—the little book that chases his rival down. Here the named audience is largely the same, unless perhaps Galen means to include a wider circle of the Asclepiadean’s followers. The book after all is a performance, as Galen says, not only for the Asclepiadean but also for his associates, and for any others who did not have the opportunity to hear his rival concede to him. Both the aborted live demonstration and the treatise that completes it, however, are contained in a larger narrative against Asclepiadeans in On the Power of Cleansing Drugs. The reading audience of this treatise ranges far beyond the Asclepiadean and the members of his retinue. Galen’s incremental expansion of the audience for his demonstration encourages the anonymous reader to join in witnessing Galen’s debate and determining him its winner. The nested frames of his narrative draw pointed attention to the capacity for his writing to extend the boundaries of intellectual performance into written spaces and to expand the circles of audiences available to evaluate and confer professional legitimacy.

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Anatomical Procedures

Anatomical performances—more than any of Galen’s other demonstrations— were essential to his professional success at Rome. Certainly they contributed considerable momentum to Galen’s meteoric rise as both physician and intellectual at Rome. Among them, practical anatomical demonstrations—dissections as well as vivisections—depended on the visual experience of an audience for their success. Therefore, insofar as Galen’s written experiments may serve the credentialing functions that I argue they do, it is important that they recreate the agonism and spectacle of their live counterparts. Galen reports many of these demonstrations in Anatomical Procedures, whose tenor is markedly more subdued than that of many other Galenic works. Galen adopts a didactic stance in this text, advising the reader on anatomical morphology, the preparation of subjects for dissection, and on the procedures themselves. However, while Galen’s polemical excursuses are less frequent than in other treatises, they are not wholly absent. Rival physicians, especially Roman ones, are common bêtes noires who figure prominently here as they do elsewhere in Galen’s corpus. Galen’s narrative in Anatomical Procedures is no exception,38 although he is keen to assure the reader that he remains steadfastly above the fray, sometimes obscuring the identity of his opponents in the process. The agonistic gestures common in Greek intellectual prose still occur with some frequency, and bear scrutiny:39 But it is not set before me to refute Lycus or any of my antecedents unless incidentally. For I know that the books of other authors will clearly appear [to be] full of every mistake to everyone who is industrious and eager to discover the truth … He [Lycus] is ignorant of many more of the things that will be stated next, some of which he alone [is ignorant], other things the others along [with him], things which I encourage those who encounter these sorts of writings to judge, becoming eyewitnesses (αὐτόπτας) of anatomical procedures. For I write this work for that reason, so that it can teach those who are industrious if they lack someone to show them the way (τῶν δειξόντων), since my associates (ἑταῖροί) who

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Cf. Praen. 1 (CMG v 8,1 68–74 = xiv.599–605 K.); the first two books of Method of Healing, against Methodists, especially MM 1.1–2 (x.5–7 K.); Lib.Prop. 3 (143–144 B-M = xix.20–21 K.); et passim. Cf. Lloyd’s discussion of marked and prevalent authorial self-reference, which he calls Greek “egotism”, as a product of these agonistic tendencies in Greek intellectual prose (Lloyd 1987: 56–70).

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have encouraged me to write this work as a memorandum will be able to remind themselves of what has been taught to them by me without it, unless they turn to idleness. So I will leave off from refuting my predecessors for the sake of completing this account quickly, relating only true facts.40 Lycus (of Macedon) was a close predecessor (πρεσβύτερος) of Galen and a student of Quintus, perhaps of Pergamum. Elsewhere Galen praises Quintus as the greatest physician of his time.41 Quintus is said to have left no writings. His student Lycus, however, was a prolific author of anatomical works and exegetical Hippocratic commentaries. Indeed, his anatomical writings ran to nineteen books, an abridgement of which Galen wrote in two.42 More to the point, Lycus’ pedigree along with his reputation as a premiere physician and anatomist working in the elite circles into which Galen sought access made him an important intellectual competitor.43 With this point in mind, it is worth lingering over some features of this passage. First, Galen signals to the reader that the main aim of Anatomical Procedures is didactic, although as we have seen the line between instruction and invective in Galen’s writing is not a sharp one. Second, he reiterates a now familiar distinction between two audiences: 1) his associates, who have seen Galen perform these procedures, will read his writing as reminders of what they have learned at Galen’s side. The trope echoes Plato’s warning about the usefulness of writing in the Phaedrus.44 It implies that those who belong to Galen’s inner

40

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AA 4.6 (416–418 Garofalo = ii.449–450 K.): ἀλλὰ γὰρ οὐ πρόκειταί μοι διελέγχειν οὔτε Λύκον, οὔτ’ ἄλλον τῶν πρεσβυτέρων οὐδένα, πλὴν εἰ πάρεργον. οἶδα γὰρ, ὅτι παντὶ τῷ φιλοπονοῦντι καὶ τἀληθὲς εὑρεῖν ἐπιθυμοῦντι παμπόλλων ἁμαρτημάτων φανεῖται μεστὰ τὰ τῶν ἄλλων βιβλία … πολὺ δὲ πλείω τῶν ἑξῆς εἰρησομένων ἀγνοεῖ, τὰ μὲν οὖν αὐτὸς μόνος, τὰ δ’ ἅμα τοῖς ἄλλοις, ἃ παρακαλῶ κρίνειν τοὺς ἐντυγχάνοντας τοῖσδε τοῖς γράμμασιν, αὐτόπτας γιγνομένους τῶν ἀνατομῶν. ἐγὼ γὰρ διὰ τοῦτο τὴν πραγματείαν ἔγραψα ταύτην, ὥστ’ αὐτὴν διδάσκειν δύνασθαι τοὺς φιλοπόνους, ἐὰν ἀπορῶσι τῶν δειξόντων· ὡς οἵ γε παρακαλέσαντες ἑταῖροί με γράφειν αὐτὴν ὑπομνήσεως ἕνεκα, καὶ χωρὶς ταύτης ἀναμιμνήσκειν ἑαυτοὺς δυνήσονται τῶν ὑπ’ ἐμοῦ διδαχθέντων αὐτοῖς, εἴ γε μὴ πρὸς τὸ ῥᾳθυμεῖν ἐκτρέποιντο. παραλείψω τοίνυν ἐξελέγχειν τοὺς πρεσβυτέρους ὑπὲρ τοῦ θᾶττόν μοι περαίνεσθαι τὸν λόγον αὐτὰ τἀληθῆ μόνα διηγουμένῳ. Praen. 1 (CMG v 8,1 70–72 = xiv.602–603 K.). Cf. AA xiv.1 (183 Duckworth). Lib.Prop. 4 (153.4–21 B-M = xix.30 K.). The relevant section was lost until the discovery of the Vlatadon manuscript in 2005, which fills this lacuna in the text. Vlatadon provides the number of books that made up Lycus’ anatomical oeuvre and details about their contents. On Lycus’ anatomical reputation in Rome, see Lib.Prop. 3 (145.9–15 B-M = xix.22 K.). For a brief discussion of Galen’s relationship to Lycus, see Nutton (2013: 217 and 219–221). Plato Phaedrus 274c5–277a4.

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circle are the serious thinkers, who, in Plato’s terms, read his writing for their enjoyment and as reminders of what they already know.45 Galen also acknowledges 2) those who have never seen him perform and have no hope of doing so, a group that likely comprises most of Galen’s readers. If they are industrious they can teach themselves, with the aid of Galen’s written instruction. There is a tension, however, between what one can accomplish through reading alone and what is possible with a teacher, such as Galen. Finally, Galen says that he will leave off from refutations (ἐξελέγχειν) of his predecessors in order to write a more succinct anatomical account. To do so he will discuss only the things that are true (μοι περαίνεσθαι τὸν λόγον αὐτὰ τἀληθῆ μόνα διηγουμένῳ). How is one to take the meaning of Galen’s statement? What are the true things to which Galen will restrict himself? It is possible that Galen is admitting here that he sometimes indulges in misrepresenting his rivals; but it is more likely that he means to restrict himself to matters that he considers to be anatomical fact, without engaging in the many anatomical falsehoods that his rivals propound. As we will see—and may have expected—Galen does not keep to his own interdiction. Galen’s stated restriction to discussions of anatomical facts persists throughout the passage. He enjoins his reader, who is both eager to work hard and eager to discover the truth (τῷ φιλοπονοῦντι καὶ τἀληθὲς εὑρεῖν ἐπιθυμοῦντι), to judge the work of medical authors on their own merits, his own works included, through first-hand experience with anatomical procedures. Galen predicts that the many mistakes in the texts of Lycus and other physicians will be apparent; the books speak for themselves, making their mistakes plain to any discriminating reader (παμπόλλων ἁμαρτημάτων φανεῖται μεστὰ τὰ τῶν ἄλλων βιβλία). Of course, if one can manage to attend these procedures as an eyewitness one should do so (αὐτόπτας γιγνομένους τῶν ἀνατομῶν) in order to determine the truth firsthand. Galen’s conceit is that anatomical facts will straightforwardly present themselves to spectator and reader alike; but for both the witness to anatomical procedures and the reader of Anatomical Procedures, Galen is necessary as a guide. Galen closes this passage as he began it, noting that he will forego criticism of his predecessors except when necessary and in service to

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Cf. Plato Phaedrus 276d1–5: “Rather, as it seems, he will write and plant gardens of letters for his amusement, when he writes, storing up reminders for himself ‘when he comes to forgetful old age’, and for every person who follows in his footsteps, and he will be pleased to see them tenderly blooming”. (ἀλλὰ τοὺς μὲν ἐν γράμμασι κήπους, ὡς ἔοικε, παιδιᾶς χάριν σπερεῖ τε καὶ γράψει, ὅταν [δὲ] γράφῃ, ἑαυτῷ τε ὑπομνήματα θησαυριζόμενος, εἰς “τὸ λήθης γῆρας” ἐὰν “ἵκηται”, καὶ παντὶ τῷ ταὐτὸν ἴχνος μετιόντι, ἡσθήσεταί τε αὐτοὺς θεωρῶν φυομένους ἁπαλούς).

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his stated aim, to enable students who lack teachers to teach themselves. But Galen not only indulges in criticizing Lycus and others, he does so repeatedly.46 Just a few pages later, he writes: Those who wrote on the anatomy of the muscles were mistaken about this [anterior muscle of the scapula], as they also were about many other muscles, just as also Lycus himself was, some of whose anatomical works are extant in our time. I did not get to see him while he was alive, although I associated with the students of Quintus and was not stopped either by the length of the journey or by the sailing trip. But Lycus was a noname among the Greeks, when he was alive. Now that he is dead, some of his books, studied intensively, are widely circulated. About his other works, which I have not come across, I am able to say nothing. About the anatomical works, at least the ones which I have read so far, I have found they have many mistakes. But, as I said earlier, it is not set before me to refute my predecessors—except incidentally—but to write in my treatise

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Cf. AA 1.3 (94–96 Garofalo = ii.227–228 K.), where Galen explains the need for him to write De muscolorum dissectione because Lycus’ work on the subject was unnecessarily long and riddled with mistakes; AA 2.2 (178 Garofalo = ii.283 K.), where Galen praises Marinus for his anatomical work while expressing the need to fill in the gaps left by his obscurity and spotty coverage; AA 3.1 (264–266 Garofalo = ii.343–344 K.), where Galen criticizes Methodists for their lack of interest in anatomy, one of the consequences of which is an increased risk of severing arteries when engaged in surgical procedures. In the same passage, Galen criticizes them for treating only the location of a wound or disease citing the case of a patient who lost feeling far from the location where he had been injured as a consequence of nerve damage; AA 3.5 (324–326 Garofalo = ii.385–386 K.), on seeing what one wants to see in hasty anatomical procedures; AA 3.9 (338–340 Garofalo = ii.395–396 K.), on a physician whose lack of anatomical training led him to sever a nerve rendering the patient insensate in a limb; AA 4.1 (370–378 Garofalo = ii.416–421 K.), on the impractical anatomical interests of some physicians who are more concerned with the pineal gland, the heart bone, and so on. This impractical interest is contrasted with Galen’s own interests and his exposition in Anatomical Procedures, which Galen says is useful for quotidian surgical procedures; AA 4.6 (420 Garofalo = ii.451 K.), where Galen comments on the consequences of sloppy anatomy, mentioning Lycus as an exemplar of such sloppiness; AA 7.13 (684 Garofalo = ii.634 K.), where Galen mentions yet another physician whose anatomical ignorance resulted in arterial hemorrhage and ultimately the death of the patient as a result of infection. Galen contrasts this ignorance with his own expert skill in excising the sternum of a slave and exposing the heart. According to Galen the slave survived; AA 7.14–15 (686–692 Garofalo = ii.636–639 K.), where physicians fail to ligate the pulmonary vein properly. This episode is punctuated by the example of a rival physician whom Galen forces to vivisect ape after ape until he admits he is incompetent. Cf. also, AA 7.16 (694–700 Garofalo = ii.641–646 K.) and 7.16 (704 Garofalo = ii.648 K.).

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only the anatomical procedures, about which Marinus also has written a single large book, unclear in interpretation and defective in observation.47 The passage is peppered with comments that function to underwrite Galen’s own credibility. He reserves judgment on treatises he has not yet read. He contrasts the treatises available in his own time with the larger body of Lycus’ original written work. He underscores his dedication to research, despite the distances involved in pursuing it properly. And, finally, he punctuates the passage with the assertion that his aim in writing is not to criticize. Galen’s account, however, focuses on the ignominy of Lycus’ work in his own lifetime and of its inexplicable popularity in his death. He similarly criticizes Marinus for being obscure and inexhaustive. Galen closes with a reaffirmation of his intention to forego criticism of his predecessors—except incidentally. What is the force of Galen’s continued polemical engagement with Lycus and other opponents given his disavowals of this behavior? Has he simply failed to notice it? Is there a cultural gap in which Galen’s polemicism would have flattened out from the perspective of an audience of his contemporaries?48 Or, does the apparent inconcinnity between his continuous critique and his claims of forbearance arise from some other disconnect between actors and observers? It is plausible that some, if not all, of these speculations are true—and I do not mean to exclude any one of them. It is worthwhile to consider Galen’s polemical stances in these didactic contexts as more than reflections of his personality, however, particularly in light of the prominent function that agonistic engagement performed for a wide-range of Greek and Roman 47

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AA 4.10 (446 Garofalo = ii.470 K.): ἐσφαλμένοι δ’ εἰσὶ περὶ αὐτόν, ὡς καὶ περὶ πολλοὺς ἄλλους, οἱ τὰς τῶν μυῶν ἀνατομὰς γράψαντες, ὥσπερ καὶ αὐτὸς ὁ Λύκος, οὗ νῦν ἐκομίσθη τινὰ τῶν ἀνατομικῶν βιβλίων, ὃν οὐκ ἐθεασάμην μὲν ἐγὼ ζῶντα, καίτοι πᾶσι τοῖς Κοΐντου μαθηταῖς συγγενόμενος, καὶ μήθ’ ὁδοῦ μῆκος ὀκνήσας μήτε πλοῦν. ἀλλ’ οὐκ ἦν ὄνομα Λύκου παρὰ τοῖς Ἕλλησιν, ἡνίκ’ ἔζη· νυνὶ δ’ ἀποθανόντος αὐτοῦ βιβλίων τινὰ περιφέρεται σπουδαζόμενα. περὶ μὲν οὖν τῶν ἄλλων, οἷς οὐκ ἐνέτυχον, οὐδὲν ἔχω φάναι, τὰς δ’ ἀνατομὰς, ἃς γοῦν ἄχρι νῦν ἀνέγνων, ἁμαρτήματα ἐχούσας εὗρον πολλά. ἀλλ’, ὅπερ ἔφην, οὐ πρόκειταί μοι τοὺς πρεσβυτέρους ἐξελέγχειν, ὅτι μὴ πάρεργον, αὐτὰς δὲ μόνας ἐν ὑπομνήμασι γράψαι τὰς ἀνατομικὰς ἐγχειρήσεις, ὑπὲρ ὧν καὶ Μαρῖνος ἓν ἐποίησε μέγα βιβλίον, ἀσαφὲς μὲν τὴν ἑρμηνείαν, ἐλλιπὲς δὲ τὴν θεωρίαν. Cf. Nutton (1991: 21): “At times his ebullient rhetoric, most notably in On prognosis and in Book 1 [of Method of Healing], with its vigorous denunciations of others and its picture of Galen as a saint, a genius and a social celebrity, at home with both peasant and prince, at once arouses suspicion, and any inconsistencies that are found there rightly create doubts. How far is Galen being sincere, how far is he being carried away by his winged words into wildly exaggerated statements?”

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intellectual pursuits. To what extent does Galen’s highly developed agonism play an authorizing role in his experiments and his narratives of them?

4

Agonism and Invasive Anatomical Display

Although a number of the demonstrations that we have discussed thus far are anatomical or physiological in nature, they have been abstract. So, for example, the debate Galen preserves in On Venesection against Erasistratus involves a detailed disquisition on inflammation and its proper treatment. It does so, however, without reference to an animal subject or to an invasive procedure as evidence for Galen’s positions in the treatise. And, indeed, many of these public intellectual displays on anatomical and physiological topics were wholly theoretical. The speaker would discuss a point or engage with an interlocutor without recourse to evidence an audience could see. More practical anatomical experiments and performances are also attested, such as the episode of the disemboweled ape with which I began this chapter. Galen refers to these occasionally, mainly to showcase his anatomical expertise and the ignorance of his opponents. While Galen does not offer many details on the occasion for these live competitions, inscriptional evidence dating to his lifetime survives in Asia Minor for state-sponsored medical contests in which invasive anatomical demonstrations were performed. As I mentioned in the introduction to this book, the events were held yearly at the Great Asclepieia at Ephesus in the early to mid-second century ce. The inscriptions bear the names of four different competitive medical events, along with their winners.49 The events consisted in contests over 1) drug recipes (σύνταγμα), 2) tools—probably their invention or use (ὄργανα), 3) extemporaneous topics of debate—of the sort we have been discussing (πρόβλημα), and finally 4) surgery (χειρουργία). Two of these categories, cheirourgia and problēma, argue for an existing tradition—at least in Asia Minor—both of adjudicated public surgical demonstrations and extemporaneous displays of medical knowledge, these probably more abstract in character.50 A little over a generation before Galen’s time, Plutarch offers further evidence for such public demonstrations as well as one of their aims. As we have seen, he refers to doctors performing surgical or anatomical procedures in theaters as a means to gain business and recruit students: 49

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I.Ephesos iv (IKA 14), 1980: 1161–1169, 4101b and Samama (2003: 210–215 = pp. 334–338). Knibbe (1981–1982: 136 n. 146) dates the inscriptions to the mid-130’s; Samama (2003: 334– 338) places them some time between 138–161ce. See also Nutton (1995: 7–9). See Nutton (2013: 216, with n. 72) and (1995: 7–9).

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It is necessary that censure and disclosure of a mistake be done in secret—as though it were a disgusting disease—neither making a circus or a display piece (ἐπιδεικτικὴν) of it to draw a crowd of witnesses and spectators. For it is the mark of sophistry not friendship to gain glory at the expense of others’ missteps, showing off before an audience like physicians who perform surgical procedures in theaters (οἱ χειρουργοῦντες ἐν τοῖς θεάτροις ἰατροὶ) for the sake of acquiring business.51 One recalls that Galen’s public disemboweling of an ape served a purpose similar to the one described by Plutarch here. As a consequence of his public demonstration, Galen was chosen as physician to the gladiators at Pergamum. His rivals were shown to be surgical failures and were passed over for the post. The same cluster of elements is recognizable in these practical performances as in the range of theoretical demonstrations we have been discussing. Although the Greek text of Galen’s On Recognizing the Best Physician is lost, agōn, epideixis, and shame are all central features of Galen’s narrative—as they are in Plutarch’s. Galen’s approach to these public anatomical displays shows a similar cultivation of spontaneity (αὐτοσχεδιάζειν) to their more abstract counterparts. Extemporaneity was a feature privileged in the writing of late imperial authors who self-identify as rhetorical or sophistic, and for whose sophistic displays spontaneity was a crucial sign of the virtuoso’s natural performance. Indeed, Galen’s account of his competition for the position of chief gladiatorial physician emphasizes the unexpectedness of the challenge—in this case unexpected by his rivals. Comments he makes on preparation for anatomical demonstrations, however, show that their extemporaneity was carefully practiced.52 Galen is explicit about the training involved in preparing for extemporaneous or unexpected medical demonstrations. In book one of Anatomical Procedures, he illustrates this point:

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Plutarch Mor. 70f9–71a5: δεῖ γὰρ ὡς νοσήματος οὐκ εὐπρεποῦς τῆς ἁμαρτίας τὴν νουθέτησιν καὶ ἀνακάλυψιν ἀπόρρητον εἶναι καὶ μὴ πανηγυρικὴν μηδ’ ἐπιδεικτικὴν μηδὲ μάρτυρας καὶ θεατὰς συνάγουσαν. οὐ γὰρ φιλικὸν ἀλλὰ σοφιστικὸν ἀλλοτρίοις ἐνευδοκιμεῖν σφάλμασι, καλλωπιζόμενον πρὸς τοὺς παρόντας, ὥσπερ οἱ χειρουργοῦντες ἐν τοῖς θεάτροις ἰατροὶ πρὸς ἐργολαβίαν. This preparation for extemporaneous performance had deep and abiding roots in Greek performances. Galen’s approach to anatomical performance echoes the “composition-inperformance” that was typical of Homeric rhapsodes, who deployed an arsenal of practiced episodes and formulae in their public performances of Homeric epic. Cf. Nagy (1996: 29–63, but especially 29–36 and 65–73).

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But if you grow confident through reading only, without being accustomed to the sight of the bones of apes, you will not actually take in nor will you retain the memory of the skeleton of a man if you see it unexpectedly. For, the recollection of perceptible phenomena requires frequent association. And for this reason also we recognize those very people whom we often encounter, but we pass by someone seen once or twice after a while has passed, neither recognizing him at all nor even recalling what he looked like before … For it is necessary to see each of the parts in advance, with no rush, in order to recognize what is seen suddenly, preferably in human subjects but if not, at least in animal subjects fairly similar to a human being.53 This passage is aimed at the adventitious anatomical observations made by Empiricists, who eschewed deliberate (and a fortiori, invasive) anatomical observations.54 The quotation bears primarily on the importance of practiced, deliberate, and comparative anatomical research and the inadequacies of the Empiricist approach to empeiria. It is just this inability of the Empiricist to be prepared for emergent medical situations that forms one of the bases for Galen’s critique of the Empiricist attitude toward anatomy. The friction between Galen and Empiricists is brought to the fore, albeit implicitly, in those cases where Galen attempts to show the effectiveness of anatomical knowledge to his readership as well as tell the reader of instances in which anatomical knowledge was effective and necessary for medical practice. However, while here Galen emphasizes the therapeutic relevance of the practical knowledge

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AA 1.2 (90 Garofalo = ii.223–224 K.): εἰ δ’ ἀναγνώσει μόνῃ θαρρήσαις, ἄνευ τοῦ προεθισθῆναι τῇ θέᾳ τῶν πιθηκείων ὀστῶν, οὐκ ἂν οὔτε κατανοήσαις ἀκριβῶς ἀνθρώπου σκελετὸν ἐξαίφνης ἰδὼν, οὔτε μνημονεύσαις. ἡ γάρ τοι τῶν αἰσθητῶν πραγμάτων μνήμη συνεχοῦς ὁμιλίας δεῖται· καὶ διὰ τοῦτο καὶ αὐτῶν τῶν ἀνθρώπων ἐκείνους τάχιστα γνωρίζομεν, οἷς πολλάκις συνεγενόμεθα, τὸν δ’ ἅπαξ ἢ δὶς ὀφθέντα διὰ χρόνου πλείονος θεασάμενοι πάλιν παρερχόμεθα, μήτε γνωρίζοντες ὅλως, μήτε ἀναμιμνησκόμενοι τῆς ἔμπροσθεν θέας … ὁρᾶσθαι γὰρ χρὴ πρότερον ἐπὶ πολλῆς σχολῆς ἕκαστον τῶν μορίων, ἵν’ ἐξαίφνης ὀφθὲν γνωρισθῇ, μάλιστα μὲν ἐπ’ ἀνθρώπων αὐτῶν· εἰ δὲ μὴ, ἀλλ’ ἐπὶ ζῴων παραπλησίων ἀνθρώπῳ. Empiricists held a range of epistemic positions on issues such as the degree to which they were willing to commit to theoretical claims, what acceptable instances of metabasis were, and even the degree to which anatomical information was useful for medicine. So, it may sound as if it runs the risk of being reductive to say that Empiricists eschewed any deliberate anatomical observations. Given the emphatically passive element in what survives of Empiricist case histories (historia) and their principled discomfort with causal explanations, this claim appears representative of the range of Empiricist beliefs. On Empiricists’ approach to observation and on their avoidance of deliberate investigations of the human body, see von Staden (1975: 186–192).

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gained by repeated observations and dissections,55 its epideictic relevance is not lost on him.

5

Prepared Extemporaneity

The demands that sudden and unexpected medical situations place on the physician’s ability to act with quick confidence were as relevant to anatomical displays as they were to emergent medical situations. Galen explains his point by appeal to identical twins, who are indistinguishable to all but those most familiar with them.56 To those who know the twins well, they are no longer indistinct. Galen often uses these figurative examples regarding familiarity in conjunction with an exhortation for the reader to observe and participate in anatomical procedures with Galen, one of Galen’s associates, or one of Galen’s anatomical texts as a guide to anatomical observation. Here it is useful to keep in mind the role of Anatomical Procedures as a guide to anatomical practice and display that is one or two removes away from personal direction. In this sense the treatise serves as a surrogate for direct instruction. The language of Galen’s anatomical exegeses and personal anecdotes in Anatomical Procedures reflects this surrogacy, by situating the reader as a participant in the procedure, looking through the eyes of the anatomist-as-author. It is precisely a lack of experience with anatomical procedures that leaves Galen’s rivals stymied when he disembowels the ape in On Recognizing the Best Physician. Galen frequently exhorts the reader of his works to pursue the right sort of training for medical practice; he also expresses his own good fortune in having received the foundation for this later education in his youth.57 The early education that Galen prescribes for the aspiring physician is effectively the education an elite 55

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This point requires clarification: many of the anatomical experiments that Galen discusses in his work would not have had therapeutic relevance in a Greco-Roman context nor would it have been imaginable to an ancient audience that they could have. Since in the Greco-Roman world there was no model of disease that would have motivated practitioners to attempt to maintain a sterile surgical environment, relatively few mechanisms to deal with blood loss, and no means to counteract infection, truly invasive surgical procedures would have offered little to no chance for patient survival. On Greek and Roman hemostatic techniques, see Salazar (2000: 42–45). Majno (1975: 363–368 and 403–405) also remains useful. That is not to say, of course, that all such anatomical knowledge lacked therapeutic value; some surgical procedures had a reasonable rate of survival. However, Galen’s demonstrations of the physiology of the heart and brain, which I will discuss at length in later chapters of this book, would not have been among them. See AA 3.5 (324 Garofalo = ii.384 K.). See, e.g., Ord.Lib.Prop. 4 (99–100 B-M = xix.58–60 K.).

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Roman man might have experienced, with an emphasis on philosophical— in this context mainly logical—training.58 Galen’s ideal physician is no mere technician, a view of medical practice and the medical practitioner that would potentially have had a far different social response in Rome than in the Greek east. Whereas there were established traditions of medicine as an area of elite pursuit and practice in historically Greek areas of the Roman empire, cultural attitudes in Rome could be far more suspicious of medicine where depictions of its practitioners as subaltern were more common.59 There is certainly a tension in Galen’s work between the status of medicine as either an elite or as a banausic profession, a tension which in all probability reflects the somewhat conflicted social standing of medicine in the Eastern Roman Empire—traditionally identifying as Hellenic—and the Roman West. For this reason among others, Galen is keen to cultivate the image of the physician as pepaideumenos, whose early training would have been recognizable and familiar to elite Romans as their own. Galen’s formulation of the ideal doctor as an elite intellectual, however, may also have opened him to the kinds of charges of fraudulence that we have already seen. Portrayals of Greek intellectuals could be fraught in a Roman context, where suspicion of fraudulence might be compounded with accusations of charlatanry, witchcraft, and poisoning. The upshot of this tension in Galen’s writing is that the ideal physician both had to be steeped in an education that was recognizably elite and simultaneously had to be insulated from criticisms of fakery and dilettantism. One of Galen’s most frequent criticisms of rival physicians—that they lack practical experience—targets them in precisely this way. Galen accuses these rivals of being logiatroi: “book doctors” or “doctors in name only”. Indeed, Galen claims to have ceased his public demonstrations for a time shortly after his public humiliation of Martialius in 163ce,60 on the grounds that his success led rivals to accuse him of charlatanry: From that time I decided not to teach in public any longer nor to conduct public demonstrations, since my good fortune at having been received among the people who became my patients was greater than I could have

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See, e.g., Opt.Med. 3 (289–291 B-M = i.59–61 K.); Lib.Prop. 14 (164–169 B-M = xix.39–45 K.); and Ord.Lib.Prop. 1–2 (90–92 B-M = xix.52–54 K.). See, e.g., Martial Ep. 6.31, 11.71; Juvenal Sat. 3.77; Pliny NH 29.6 and 29.8; and Celsus De Medicina 1.pr.4–5. See also Nutton (1985), (1986), and (2013: 166–170, 259–270). This demonstration is the one I discuss above, in which Galen discusses passages from Erasistratus’ On Bringing Up Blood that are later transcribed as On Venesection against Erasistratus (Lib.Prop. 1, 138.21–139.3 B-M = xix.14 K.).

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hoped for. Since I knew that whenever a physician is praised his professional rivals call him a logiatros out of envy, I wanted to sew their slanderous tongues up in their mouths, saying nothing more than was necessary at the patients’ bedsides, not teaching in public as I had before, and not conducting any public demonstrations. Rather, I would conduct a public demonstration of the training I had in the study of the craft through my actions alone.61 The word is so unusual in Greek that it may have been a Galenic coinage.62 Regardless, the accusation is clear. Just as the sophist is to the philosopher— a binary that Galen inherits from the Platonic tradition—so is the logiatros to the physician. Throughout the corpus Galen accuses his rivals of just this sort of intellectual quackery. Alternatively, he decries their lack of education and intellectual depth. These are the sorts of criticisms that underlie his account of his “interview” for gladiatorial physician in On Recognizing the Best Physician. His counterparts, the elder physicians, were ineffectual precisely because they possessed book learning alone;63 they lacked medical know-how. Had they, like Galen, practiced anatomy in conjunction with their textual studies, they would have been able to suture the ape successfully. They would also be better equipped to judge the truth of the authorities they read. This stance on purely theoretical approaches to medicine is a Galenic bugbear. For example, in the later books of Anatomical Procedures he alludes to a favorite apophthegm:

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Lib.Prop. 1 (139.14–24 B-M = xix.15 K.): ἐξ ἐκείνου δ’ ὥρισα μήτε διδάσκειν ἔτι δημοσίᾳ μήτ’ ἐπιδείκνυσθαι προσδεξαμένης με τῆς κατὰ τοὺς θεραπευομένους εὐτυχίας μείζονος εὐχῆς· εἰδὼς γὰρ τοὺς ἀντιτέχνους, ὅταν ἐπαινῆταί τις ἰατρός, ὡς φθονοῦσιν αὐτὸν λογίατρον ἀποκαλοῦντες, ἀπορράψαι τὴν βάσκανον γλῶτταν αὐτῶν ἐβουλήθην οὔτ’ ἐπὶ τῶν θεραπευομένων φθεγγόμενός τι περαιτέρω τῶν ἀναγκαίων οὔτε διδάσκων ἐν πλήθει, καθάπερ ἔμπροσθεν, οὔτ’ ἐπιδεικνύμενος ἀλλὰ διὰ τῶν ἔργων τῆς τέχνης μόνον ἐνδεικνύμενος ἣν εἶχον ἕξιν ἐν τοῖς θεωρήμασιν αὐτῆς. The concrete noun λογίατρος only appears in Galen’s work, where it is attested six times: MM 8.6 (x.582.14 K.); Purg.Med.Fac. 5 (xi.339.15 K.); HNH 2.16 (CMG v 9,1 81.24 = xv.159.15 K.); Hipp.Prog. 3.15 (CMG v 9,2 344.12–13 = xviiib.258.9 K.) and 3.15 (CMG v 9,2 344.15 = xviiib.258.12 K.); and Lib.Prop. 1 (139.19 B-M = xix.15.10 K.). On the other hand, Philo of Judaea, who was writing just under a century before Galen’s birth, contrasts efficacious medical practice with the uselessness of λογιατρεία (or λογοϊατρεία) in a Roman context (De congressu eruditionis gratia 53.2). He offers this binary as an explanatory comparison for the activity of philosophers versus that of sophists (he refers to them as λογοπῶλαι καὶ λογοθῆραι), who shamelessly engage in empty debate. See Opt.Med.Cogn. 9.4–5 (CMG Suppl.Or.iv 103.10–105.3).

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Whoever does not know this [the number of cranial nerves] is, as the proverbial expression goes, like a seaman that navigates out of a book. Thus he reads the books on anatomy, but he omits inspecting with his own eyes in the animal body the several things about which he is reading.64 trans. duckworth

Galen adopts the topos of the theoretical physician, who is pragmatically illiterate, from an existing strand of medical polemic that dates back to at least the Hellenistic period.65 Galen’s more general position on the limits of writing— there is a clear tension here with his own written practice—echoes similar admonitions in Plato’s work. Galen’s formulation of the point is closer to Aristotle’s, although there is no evidence for the nautical image in Aristotle’s extant writing.66 The proverb is apt and appears to have been used as an indictment of certain medical practitioners from at least its earliest extant use, in the work of Polybius: [Theoretical medicine] takes its starting point mainly from Alexandria, at the hands of those who call themselves Herophileans and Callimacheans. While it is a part of medicine, it takes on a sort of reputation in its presentation and pronouncements such that no one else seems to have mastery over the subject [of medicine]. But when you entrust a patient to them, forcing them to face the truth, they are found out to be as far from usefulness as people who have not read even a single medical treatise. Some patients, who are not terribly sick, put themselves in the care of these doctors, on account of the power of their argumentation. Frequently they put themselves entirely in peril. For these physicians are truly like people who navigate out of a book (εἰσὶ γὰρ ἀληθῶς ὅμοιοι τοῖς ἐκ βυβλίου κυβερνῶσιν). Nevertheless, these people travel to cities with a certain reputation. When they gather together a crowd, they drive those who have given real proof of their works, with a word, to extreme confusion and to contempt from

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AA ix.9 (10 Duckworth). Cf. also AA 1.2 (84ff. Garofalo = ii.220 K.ff.). See Polybius Hist. 12.25d6 and Philodemus P.Herc. 1005 iv.8. Galen mentions the proverb at AA ix.10; Alim.Fac. 1.2 (CMG v 4,2 216.19–21 = vi.480.6 K.); SMT 6.pro. (xi.797.2 K.); Comp.Med.Gen. 3.2 (xiii.605 K.); and Lib.Prop. 8 (158.24–26 B-M = xix.33 K.). Cf. Med.Exp. 9 (98–100 Walzer). On the proverb, see also Boudon-Millot (2004) and Roselli (2002). Cf. Aristotle’s claim at the close of the Nicomachean Ethics (EN 10.9, 1181b2–6) that medical expertise cannot be acquired through reading, which is useful mainly to practitioners who have already received direct instruction.

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the audience. The persuasiveness of their speech often outmatches the proof of their actions.67 The proverb likely preserves an early Empiricist attack against Dogmatists on the grounds of their theoretical excesses.68 If so, it would be pointedly ironic, since Galen repurposes it against the adventitious anatomy of Empiricists.69 Like Galen’s contemptuous accusation that his opponents are logiatroi, the proverb highlights the fraudulence of its targets. Polybius refers to it in order to explain the failings of armchair historians. They are too much “like Dogmatist physicians (καθάπερ οἱ λογικοὶ τῶν ἰατρῶν), who spend their time in libraries and acquire the breadth of their experience exclusively from written records, they persuade themselves that they are in fact qualified for their work …”.70 The anxiety over professional legitimacy that Polybius evokes here is a common theme in Galen’s work, manifest in his frequent comments about quacks and charlatans throughout the narrative of On Prognosis and in the first two books of Method of Healing.71 While a variety of activities can be understood

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Polybius Hist. 12.25d (= fr. 56.7–23 vS): ὃ δὴ πλεῖστον ἀπὸ τῆς Ἀλεξανδρείας ἄρχεται παρὰ τῶν Ἡροφιλείων καὶ Καλλιμαχείων ἐκεῖ προσαγορευομένων, τοῦτο μέρος μέν τι κατέχει τῆς ἰατρικῆς, κατὰ δὲ τὴν ἐπίφασιν καὶ τὴν ἐπαγγελίαν τοιαύτην ἐφέλκεται φαντασίαν ὥστε δοκεῖν μηδένα τῶν ἄλλων κρατεῖν τοῦ πράγματος· οὓς ὅταν ἐπὶ τὴν ἀλήθειαν ἀπαγαγὼν ἄρρωστον ἐγχειρίσῃς, τοσοῦτον ἀπέχοντες εὑρίσκονται τῆς χρείας ὅσον [καὶ] οἱ μηδὲν ἀνεγνωκότες ἁπλῶς ἰατρικὸν ὑπόμνημα· οἷς ἤδη τινὲς τῶν ἀρρώστων ἐπιτρέψαντες αὑτοὺς διὰ τὴν ἐν λόγῳ δύναμιν οὐδὲν ἔχοντες δεινὸν τοῖς ὅλοις πολλάκις ἐκινδύνευσαν. εἰσὶ γὰρ ἀληθῶς ὅμοιοι τοῖς ἐκ βυβλίου κυβερνῶσιν· ἀλλ’ ὅμως οὗτοι μετὰ φαντασίας ἐπιπορευόμενοι τὰς πόλεις, ἐπειδὰν ἁθροίσωσι τοὺς ὄχλους, ἐπ’ ὀνόματος τοὺς ἐπ’ αὐτῶν τῶν ἔργων ἀληθινὴν πεῖραν δεδωκότας αὑτῶν εἰς τὴν ἐσχάτην ἄγουσιν ἀπορίαν καὶ καταφρόνησιν παρὰ τοῖς ἀκούουσι, τῆς τοῦ λόγου πιθανότητος καταγωνιζομένης πολλάκις τὴν ἐπ’ αὐτῶν τῶν ἔργων δοκιμασίαν. Mudry (1977) has argued for a version of this point in his discussion of the medical background for the Polybius passage. Although his focus is on the identity of the Dogmatists targeted in Polybius’ analogy, the basic Empiricist polemic—and their use of craft examples in order to show the superfluity of theoretical knowledge—holds. The attack is echoed in a passage of Galen’s Medical Experience, which survives only in its Arabic translation. Galen presents the Empiricist position against the theoretical demands of Dogmatism by asking rhetorically whether the sailor learns to steer ships on the ocean through his understanding of the logos of nature, of the elements, and the nature of the winds (Med.Exp. 9, 98–100 Walzer). He offers a list of further examples, such as the peasant-farmer, the vine-grower, cobblers, bakers, and so on. Polybius Hist. 12.25.e4: καθάπερ οἱ λογικοὶ τῶν ἰατρῶν ἐνδιατρίψαντες ταῖς βυβλιοθήκαις καὶ καθόλου τὴν ἐκ τῶν ὑπομνημάτων περιποιησάμενοι πολυπειρίαν πείθουσιν αὑτοὺς ὡς ὄντες ἱκανοὶ πρὸς τὴν ἐπιβολὴν … See Praen. 1.1 (CMG v 8,1 68–74 = xiv.601–605 K.), where Galen delivers a diatribe against physicians of his day in Rome. The first two books of Method of Healing are rife with comments on the quackery of Methodist physicians. Cf. MM 1.1–2 (x.5–8 K.) and 8.6 (x.582 K.).

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as satisfying a generic need for practitioners to be invested with professional authority, public anatomical demonstrations were one mechanism by which the physician could show that he was not merely a book doctor. In part to diffuse such criticisms, Galen offers the reader advice on anatomical epideixis: It is better that you train in this order (bones, muscles, arteries, veins, nerves, viscera, etc.). And besides, it is necessary that when performing a public display (ἐπιδεικνύντα) you have gotten prepared to expose and to show the part, which has been proposed to you (τὸ προβληθέν), as quickly as possible in a variety of ways, in this and some other presentation, as I will teach you.72 A few chapters later, Galen writes: Now is the right time to say how one should proceed if one wishes to train oneself and [how to proceed] if one wishes to make a display (δεικνύντα) for someone else, since we have previously demonstrated (ἐπιδείξαντας) the fraud common to all of those who claim to be anatomists …73 Like their more abstract counterparts, practical anatomical demonstrations might have an extemporaneous component. The part of the body to be exposed, put on display, and discussed is proposed (τὸ προβληθέν) to the operator, presumably either by members of the audience or by a process similar to the arbitrary insertion of a stylus in a book roll that we have seen in Galen’s public demonstration of Erasistratus’ On Bringing Up Blood. This emphasis on public display goes some way to explain the number of sections of Anatomical Procedures whose therapeutic value is questionable but whose epideictic value is not.74 Consider, for example, Galen’s discussion of neural anatomy in book ix

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Indeed, it is difficult to cite references in which Galen mentions the Methodists and does not accuse them of charlatanry, often on account of their alleged claim to educate a student medically in under six months. His preoccupation with charlatanry is also apparent in his accusations of logiatreia. AA 1.2 (94 Garofalo = ii.226 K.): γυμνάζεσθαι μὲν οὖν σε τῇδε τῇ τάξει βέλτιον. ἄλλῳ δ’ ἐπιδεικνύντα παρεσκευάσθαι χρὴ τὸ προβληθὲν ὑπ’ αὐτοῦ μόριον ὅτι τάχιστα γυμνῶσαί τε καὶ δεῖξαι πολυειδέστερον, ἄλλοτε κατ’ ἄλλην ἐπιβολὴν, ὡς διδάξω. AA 1.5 (118 Garofalo = ii.243 K.): Ὅπως δ’ ἐγχειρεῖν χρὴ γυμνάζεσθαί τε βουλόμενον αὐτὸν, ἑτέρῳ τε δεικνῦναι, καιρὸς ἤδη λέγειν, ἐπιδείξαντας πρότερον ἀπάτην κοινὴν παμπόλλων ἀνατομικῶν εἶναι προσποιουμένων … Hankinson (1997) also notes the potential probative value that Galen’s anatomical research would have had for his broader teleological beliefs.

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of Anatomical Procedures, his discussion of the recurrent laryngeal nerve in book xi, the gonads and fetus in book xii, and the bulk of books xiv–xv. These demonstrations offer no anatomical information to the reader that could have been used to treat patients directly in the ancient world. Anatomical displays were functionally similar to our contemporary displays of credentials, such as the conspicuous presentation of medical degrees in a pattern along a frequently viewed wall, the physician’s white coat, or the stethoscope—now an emblem of the qualified medical practitioner. Anatomical performances were a display of the practitioner’s knowledge and command of the body. Even if the anatomical knowledge commanded by the performer did not have direct therapeutic application, it nonetheless showed that the performer had command over the domain in which disease was found. Given the frequency of radically invasive procedures in contemporary medical practice, it is perhaps easy to lose sight of how difficult it would have been to put many of these anatomical observations to any therapeutic use in antiquity. What is the aim of Galen’s close observation and discussion of the formation of the embryo in an ancient context except to address the question of what organ appeared first in the development of the fetus, a point of contention between himself and the Peripatos? Equally, what practical purpose could a deep knowledge of cardiac and neural anatomy have served, on the whole, except to discredit cardiocentrists and put the physician’s knowledge of the body on display as a means of establishing one’s credentials? The anatomical procedures I have mentioned above were limited in application. In the main, they were effective as anatomical showpieces or as research into bodily function. Anatomical knowledge of the heart and of the brain, for the most part, and particularly at the depth that Galen engages with it would not have had therapeutic application in a medical world where recovery from open heart or brain surgery was at best very unlikely.75 It is in this context that Galen instructs the reader of Anatomical Procedures. Galen’s directions on how best to prepare for interrupting the intercostal nerves is one such example.

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There is evidence for successful trepanation that predates the historical record, but trepanation does not necessarily involve further invasive procedures conducted on the brain. See Majno (1975: 24–28).

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The Intercostal Nerves

This procedure, involving the intercostal nerves, is one of a series whose root purpose for Galen was to argue for the brain as the hēgemonikon, the control center or source of volition in the body. Galen refers to this series of procedures repeatedly throughout his corpus. The voice experiments powerfully demonstrated not only the medical—if not the therapeutic—value of anatomical knowledge, but also the source of the voluntary nervous system and therefore of volition.76 For Galen, these demonstrations are both the cornerstone and crowning achievement of his anatomical and theoretical work. In brief, the argument that these demonstrations are intended to prove goes as follows. There is some one part of the body, the hēgemonikon, which is responsible for volition. In human beings, the hēgemonikon must be responsible for speech production—one of the paradigmatically rational activities—in virtue of the fact that speech production is voluntary, like the broader category of sound or voice production to which it belongs. Wherever it is located, the hēgemonikon (h) communicates volition to the parts of the body directly through some medium, which has earlier been shown to consist of nerves (n). Therefore, by modus tollens, if the transmission medium n is incapacitated, volition transmitted from h should cease.77 But voice production does not cease when Galen interrupts the nerves of the heart. Nor, for that matter, does it cease as Galen serially interrupts all the vasculature attached to the heart, except insofar as the animal eventually perishes during the process. When Galen interrupts the nerves leading from the brain to the larynx or from the brain to the thorax, however, phonation ceases abruptly. On its own, this only shows that the brain is necessary for voice production, not that it is sufficient for it. Galen argues for the latter claim by un-interrupting the ligated nerves. Upon release, the subject resumes voice production, showing that all other things being equal the brain’s activity—through the medium of the

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See, e.g., AA 8 (710–788 Garofalo = ii.651–706 K.); AA xi.4; xiv.6–8; and UP 4.7 (i.203–206 Helmreich = ιιι.278–281 K.). Galen also discusses this experiment and related procedures in The Doctrines of Hippocrates and Plato, although here he focuses on the philosophical points at issue and far less on the anatomical details of the procedure. See especially PHP 2.6 (CMG v 4,1,2 148–150 = v.262–265 K.). Cf. PHP 2.3 (CMG v 4,1,2 108–110 = v.219–220 K.), 8.1 (CMG v 4,1,2 480 = v.648–650 K.), and 8.1 (CMG v 4,1,2 484–486 = v.655 K.). On the structure of Galen’s formal arguments for the brain as the source of volition, see Barnes (1991: 84–85) and Tieleman (2002). Hankinson (1991b) lays out Galen’s argument in detail and offers helpful discussion of the argument’s relevance to his views on the tripartition of the soul.

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voluntary nervous system—is necessary and sufficient for voice production. Since cardiocentrism just is the location of volition in the heart, establishing that the brain is the only source for volition establishes that the central tenet of cardiocentrism is mistaken. For Galen’s purposes, it is crucial that the proof not only follows logically but that it is also demonstrated through an empirical procedure.78 In some of his versions of the procedure, as I have discussed it thus far, Galen brings the epideictic context of the procedure to the fore, while its agonistic dimensions lie far in the background. Elsewhere, Galen makes it clear that the three voice demonstrations—the interruption of the recurrent laryngeal nerve, the interruption of the intercostal nerves, and the dissection of the intercostal muscles—specifically target cardiocentrists. Galen alludes to this suite of demonstrations in On Prognosis, in which he chronicles the development of his professional career at Rome. Galen’s account is explicit about the cardiocentrist targets of his experiment: I will remind you of the doctors and philosophers who were present at my debate (ἀγῶνα) against the Stoics and Peripatetics and some others along with them, going over how it began in detail first so that if you want to distribute this text (τουτὶ τὸ γράμμα) to anyone of those worthy of sharing in these sorts of arguments (λόγων), he may know the progression of the things that happened and [so that] you may not spend all of your free time explaining the number of things done by me through the works of my medical practice, both the dissections (ἀνατομῶν) and the arguments

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On the need for peira or some empirical proof for general medical claims see, e.g., Pecc.Dig. 3 (CMG v 4,1,1 47 = v.68 K.); SMT 2.1 (xi.459–461 K.); Comp.Med.Gen. 1.4 (xiii.376 K.); and Hipp.Epid. 6.3.20 (CMG v 10,2,2 156 = xviib.61–62 K.). Part One of Tieleman (1996) goes through the arguments against cardiocentrism in PHP carefully. Cf. Temp. 2.2 (50 Helmreich = i.588 K.); on the Dogmatists’ failure to demonstrate their theoretical claims, see MM 1.4 (x.31–32 K.); MM 2.5 (x.107 K.), where Galen cites Herophilus’ dictum that one should begin with what is observable as though it is primary even if it turns out not to be. On the importance of argument from anatomical observation, see, e.g., PHP 2.8 (CMG v 4,1,2 166.20–23 = v.283–284 K.): “Having promised to give an account in this book about the evident features of the heart, why would I need to take up those arguments which take as the basis for their formulation theories and not what is observed from anatomy?” (ὑποσχόμενος γὰρ περὶ τῶν ἐναργῶς φαινομένων ὑπάρχειν τῇ καρδίᾳ τὸν λόγον ἐν τῷδε τῷ γράμματι ποιήσασθαι, τί ἂν ἔτι δεοίμην ἐφάπτεσθαι τοιούτων ἐπιχειρημάτων ὧν δόγματα μᾶλλον, οὐ τὸ φαινόμενον ἐκ τῆς ἀνατομῆς, ἡ ἀρχὴ τῆς συστάσεώς ἐστιν;). On the four different sources for appropriate premises: perception, experience, technical experience, and what is evident to the mind, see PHP 3.8 (CMG v 4,1,2 232.3–12 = v.357–358 K.). All of the premises that Galen admits into legitimate medical argumentation are evident either to sensation directly or are in some sense a priori.

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(λόγων) pursuant to them, when I was refuting the invidious doctors and philosophers.79 This passage is, among other things, another reminder of Galen’s keen sensitivity to the distribution of his own work. Galen maintains the epistolary conceit in which he frames On Prognosis; the details of his debates are well-known to Epigenes, its addressee. His reasons for including them, however, briefly dispel all pretense that he expects—or intends—the treatise to be just a letter (τουτὶ τὸ γράμμα). Galen writes that his narrative is composed for dissemination to a wider audience of suitable readers, who are “worthy of sharing these sorts of arguments”. Galen sets the stage in the passage—so to speak—for the reader to appreciate the consequences of the demonstration for his rivals’ views in this agon. For the reasons I have discussed, his experiments on the recurrent laryngeal nerve and intercostal nerve posed a particular threat to the Stoic and Peripatetic view that the heart was the hēgemonikon—the source of nerves and the control center for the human body. Galen mentions very few anatomical details of the voice experiments in On Prognosis. The procedure is described as two separate events, the first contracted to a few lines of text. They provide just enough information for the reader to understand that the demonstration under discussion involves the recurrent laryngeal nerve, which is responsible for voice production and clearly identifies the procedure: For, I had promised a demonstration of the most minute nerves, that there was a hair-like pair implanted in the muscles of the larynx, on the left side and on the right side, in the cases of which, when they were ligated with a thread or cut the animal became voiceless although nothing caused damage to its life or to its continued function …80

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Praen. 5 (CMG v 8,1 94.24–96.2 = xiv.626 K.): τῶν δὲ κατὰ τὸν πρὸς τοὺς Στωϊκούς τε καὶ Περιπατητικοὺς ἀγῶνα παρόντων καὶ ἄλλων τινῶν ἅμ’ αὐτοῖς ἰατρῶν τε καὶ φιλοσόφων, ἀναμνήσω σε πρότερον ὅθεν ἤρξατο διελθὼν ἵν’ εἰ καί τινων τῶν ἀξίων κοινωνίας τοιούτων λόγων ἐθελήσαις μεταδοῦναι τουτὶ τὸ γράμμα, τὴν ἀκολουθίαν ἅπασαν ἴδοι τῶν γενομένων· καὶ μὴ διὰ παντὸς ἀσχολίαν ἔχοις αὐτὸς διηγούμενος ὅσα διά τε τῶν ἔργων τῆς ἰατρικῆς τέχνης ἀνατομῶν τε καὶ τῶν ἐπ’ αὐταῖς λόγων ἐπράχθη μοι τοὺς φθονεροὺς ἰατρούς τε καὶ φιλοσόφους ἐλέγχοντι. Praen. 5 (CMG v 8,1 96.27–98.4 = xiv.628 K.): δεῖξιν γὰρ ὑποσχομένου μου νευρίων λεπτοτάτων ὡς εἶναι τριχοειδῆ συζυγίαν τινὰ τοῖς τοῦ φάρυγγος μυσὶν ἐμφυομένην, τοῖς μὲν ἐκ τῶν ἀριστερῶν μερῶν τοῖς δ’ ἐκ τῶν δεξιῶν, ἐφ’ οἷς βρόχῳ διαληφθεῖσιν ἢ τμηθεῖσιν ἄφωνον γίνεσθαι τὸ ζῷον οὔτ’ εἰς τὴν ζωήν τι βλαπτόμενον οὔτ’ εἰς τὴν ἐνέργειαν …

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The promise in this passage, however, remained unfulfilled. Galen showcases the behavior of Alexander of Damascus, who Galen had hoped would explain to the gathered audience the inferential process (συλλογίσασθαι) by which the demonstration proceeded to its conclusion (i.e., that the brain rather than the heart was the hēgemonikon). Alexander expressed some doubt on the epistemic warrant of empirical observation, in what Galen refers to as a fit of philoneikia (φιλονεικία).81 At this point, Galen abandoned the demonstration and this “podunk Pyrrhonist” (ἀγροικοπυρρωνεῖος), only to return on another day after the man had been suitably reprimanded by the other elite attendees for his overly-contentious behavior.82 Alexander’s skepticism and Galen’s reaction to it—before the anatomical demonstration could even begin—underscore the abruptness with which a public demonstration could boil over into an intellectual agōn, even one that Galen reports was arranged by friendly

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Philoneikia is a common failing that Galen attributes to other intellectuals, in particular Roman physicians. The word is often translated as ‘disputatiousness’ or something similar. The relevant connotation, in this and many other Galenic contexts, is that it is one’s love of fighting for the sake of fighting. Galen often admits to quarreling with other physicians but also generally characterizes his grudging willingness to quarrel as foisted upon him by the exigencies of the moment. This word, ἀγροικοπυρρωνεῖος, is only attested in Galen. It appears twice, here and in Diff.Puls. 3.4 (viii.711 K.). A further question arises with respect to Alexander’s skepticism. Galen has already mentioned that despite being an expert in the doctrines of Plato and Aristotle, Alexander inclines towards the Peripatos. The skepticism Galen ascribes to him, if genuine, suggests the more skeptical Academy. There seems to be a great inconcinnity in a Peripatetic who doubts the epistemic warrant of sensation. But it is worth remembering Galen’s account of the Asclepiadean in On Cleansing Drugs. Is Galen’s point here that, on realizing the logical consequences—Galen has already singled Alexander out as being present to explain the inferential process of the demonstration—of the laryngeal nerve experiment, Alexander jettisoned his commitment to empirical warrant rather than his cardiocentrism? On the identity of Alexander of Damascus, see Nutton (1979: 189 n. 96,7). Nutton (2020: 33, n. 22) has recently argued that Alexander of Damascus was the father of Alexander of Aphrodisias. The Arabic tradition, which is informed both by writings of Galen’s lost to us and by work attributed to Philoponus, reports that Alexander of Damascus and Alexander of Aphrodisias were the same. The reasons to doubt the identification have to do with chronology and with the skeptical views Galen attributes to this Alexander. Regarding chronology, Alexander of Aphrodisias did not hold a public chair at Athens at the time that Galen had written early versions of On Prognosis, Anatomical Procedures, and The Function of the Parts (ca. 170s). This is no reason to doubt the identification. Galen frequently revised his work. Consider, for example, that all three of these works are known to have existed in two or more versions separated in some cases by more than a decade. Cf. AA 1.3 (104–106 Garofalo = ii.234–235 K.). So, the precise dates of composition for AA and UP are to a certain degree fluid. Regardless of the identification, it is difficult to make sense of the perceptual skepticism Galen ascribes to Alexander as a Peripatetic.

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acquaintances. Galen’s abrupt departure invites comparison with his own criticisms of interlocutors who leave the field, as in the case of the Asclepiadean in On the Power of Cleansing Drugs, which I discussed earlier.83 In that case, Galen sought to prevent his opponent from having the final word in their contest and the onlookers from resolving it, with a written refutation that expanded the audience to include Galen’s readers.

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Galen’s Experiments on the Ureters and Ureterovesical Valves

The physiology of the kidneys was for Galen another subject of theoretical dispute with thinkers who explained their activity in mechanistic terms, such as Erasistrateans and Asclepiadeans. Thus, Galen’s accounts of the kidneys are often a staging point for deeper arguments over the teleological structure of the natural world. On Erasistratus’ view, the kidneys filtered waste from blood that run through them. Blood was separated into a serous fluid in the process of filtration. The weight of different fluids caused them to flow downward into the kidneys, through the ureters, and into the bladder.84 Meanwhile, Asclepiades held that the bladder and kidneys were not connected organs, at least by visible channels. Urinary secretion occurred through a process of evaporation and condensation. Galen reports that later Asclepiadeans, at least, believed the kidneys played no part in urinary physiology and, indeed, that they performed no physiological function at all.85 Ingested fluids vaporized in the body, then pass through imperceptible pores into the bladder, which acted like a sponge or piece of wool (σπογγιᾶς τινος ἢ ἐρίου).86 There they condensed into urine. It is worth remarking, in passing, that Galen is our primary source for both of these views, to which he is hostile. So any close examination of them warrants a degree of interpretative caution. For purposes of the present discussion, however, this rough sketch will be sufficient. At the core of Galen’s dispute with Erasistrateans on renal function is their mechanical account of the separation of urine from blood. Although Galen 83 84

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Purg.Med.Fac. 3 (xi.332 K.). Galen describes two sets of Erasistratean views on kidney function in Nat.Fac. 1.17 (SM 3, 150.20–152.13 = ii.68–70 K.). He attributes the view mentioned here to “those near the time of Erasistratus” (Nat.Fac. 1.17, SM 3, 150.24–25 = ii.68 K: οἱ μὲν δὴ πλησίον Ἐρασιστράτου τοῖς χρόνοις γενόμενοι). Cf. Nat.Fac. 2.8 (SM 3, 181.11–182.11 = ii.110–112 K.). The second view, which Galen attributes to later Erasistrateans, is that urine separates from blood in virtue of properties intrinsic to each of the fluids (Nat.Fac. 1.17, SM 3, 151.25–152.13 = ii.69–70 K.). Nat.Fac. 1.13 (SM 3, 126.14–16 = ii.35 K.). Nat.Fac. 1.13 (SM 3, 122.25–125.12 = ii.30–34 K.)

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attacks Erasistratean views of kidney function in The Natural Faculties, his main targets are the views of Asclepiades and later Asclepiadeans. In particular, Galen takes aim at the Asclepiadean claim that no perceptible channels connect the kidneys to the bladder. Their non-teleological beliefs about the kidneys stand in the background. Galen considers the ureters and the valve function of the ureterovesical junction to be powerful evidence of the body’s goal-oriented structure, and of nature’s providential character:87 Indeed, the manner of the ureters’ insertion into the bladder, and that of the bile-duct into the intestine is beyond all wonders. For they are inserted into them at an angle, and they extend at an angle further until they reach the open space inside, where they cut off as a certain kind of membrane in the organs. The membrane is turned inward and opened by the inward flow of residues, but at all other times it falls back on itself, is drawn shut, and becomes such a precise cover for the opening that it is impossible not only for fluids, but even for air, to make their way back in.88 Galen describes a passive mechanism for the prevention of reflux into the ureters and bile-ducts. On this model, vessels extend from the kidneys to the bladder. These vessels, ureters, pass through the walls of the bladder and penetrate slightly into its interior cavity. As fluids pass into it, the bladder fills and its walls expand. Increased pressure exerted by fluid (or air) on the membranous opening holds it shut. After the passage quoted, Galen appeals to a mundane demonstration of his explanation: The point is made clear by bladders that have been especially inflated and filled with air, then tied tightly at the neck (the urethra). For all the air inside of it is conserved and kept inside, even if someone squeezes the outside of the bladder very hard. For just as [the membrane] is turned

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For Galen’s description of the ureters and the ureterovesical junction, see, e.g., AA 6.13 (606–608 Garofalo = ii.581–582 K.) and UP 5.13 (i.285.4–286.12 Helmreich = iii.389–391 K.). UP 5.13 (i.285.13–24 = iii.390 K.): ὅ γε μὴν τρόπος ὁ τῆς ἐμφύσεως εἰς μὲν τὴν κύστιν τῶν οὐρητήρων, εἰς δὲ τὸ ἔντερον τοῦ χοληδόχου πόρου πάντων θαυμάτων ἐπέκεινα. λοξοὶ γὰρ εἰς αὐτὰ καταφυόμενοι καὶ μέχρι τῆς ἐντὸς εὐρυχωρίας λοξοὶ καὶ προμήκεις διήκοντες, οἷον ὑμένα τινὰ τῶν [ὀργάνων] ἐντὸς ἀποτέμνονται, πρὸς μὲν τῆς ἔσω φορᾶς τῶν περιττωμάτων ἀνατρεπόμενόν τε καὶ ἀνοιγνύμενον, ἐν δὲ τῷ λοιπῷ χρόνῳ παντὶ προσπεπτωκότα τε καὶ προσεσταλμένον καὶ οὕτως ἀκριβὲς πῶμα τῷ πόρῳ γιγνόμενον, ὥστε μὴ μόνον τοῖς ὑγροῖς ἀδύνατον εἶναι τὴν εἰς τοὐπίσω φοράν, ἀλλὰ καὶ τῷ πνεύματι.

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inward by the force of what flows into [the bladder], so, falling back on itself, it closes and is drawn shut against passage.89 Here, Galen adopts a passive mechanical model for the function of the ureterovesical “valves”—he refers to them as membranes (ὑμένες).90 Elsewhere he describes them “as the so-called entry-flaps on dovecotes” (οἷον ἐπὶ τῶν περιστερεώνων οἱ καλούμενοι σκυφῶνες).91 Galen not only explained that the opening of these membranes was caused by force exerted on them, but also that they closed because of similar mechanical forces—those exerted on them by material in the bladder. While his account of the ureters’ valve function is fundamentally mechanical, Galen’s broader explanation of urine secretion is far more invested in goal-oriented explanations, to which the activity of the membranes is subordinate.92 Galen appeals to inflated pig bladders to demonstrate other theoretical claims. In The Natural Faculties, he alludes to a com-

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UP 5.13 (i.285.24–286.5 Helmreich = iii.390–391 K.): δηλοῦται δ’ ἐπὶ τῶν κύστεων μάλιστα τῶν ἐμφυσωμένων τε καὶ πληρουμένων ἀέρος, ἔπειτα δεσμουμένων ἀκριβῶς κατὰ τὸν αὐχένα. φαίνεται γὰρ ἅπας ἐντὸς αὐτῶν ὁ ἀὴρ ἀποστεγόμενός τε καὶ κατεχόμενος, εἰ καὶ πάνυ τις ἰσχυρῶς ἔξωθεν ἐπιθλίβοι τὴν κύστιν. ὥσπερ γὰρ ὑπὸ τῆς τῶν εἰσρεόντων ῥύμης ἀνατρέπεται πρὸς τοὐντός, οὕτως ὑπὸ τῶν ἔσωθεν αὐτῷ προσπιπτόντων πιλεῖται καὶ προσστέλλεται τῷ πόρῳ. Morphologically speaking there are no valves in the lumens of the ureters. At the ureterovesical junction, however, the ureters functionally act as valves. In virtue of its functional attributes, these sections of the ureter are sometimes called the “ureterovesical valves”. AA 6.13 (608 Garofalo = ii.582 K.). Contemporary passive models of the anti-reflux mechanism at the ureterovesical juncture are similar but not identical to Galen’s. On this sort of model, when the walls of the bladder expand they also stretch the length of ureter passing through them. As the sections of the ureters implanted in the bladder are stretched, they form a flap-valve; the sections of the ureters that protrude into the bladder collapse and becomes flush with its walls. Galen may have shared most of this view, but it is hard to make sense of his claim that the membrane falls back on itself and is drawn shut “at all other times”. His comparison of the ureterovesical membrane to the valves of dovecotes may provide an interpretative solution. If the membrane acts as a flap, like a pet door, Galen may merely mean that the ureterovesical valve remains tightly shut in its default position. The membrane prevents reflux in part because of its structure. As Galen’s subsequent examples show, however, the anti-reflux mechanism also requires internal bladder pressure in order to operate effectively. If this interpretation is correct, the example is illustrative of Galen’s attitude toward mechanistic accounts. They may have explanatory value, so long as they are subordinated to goal-oriented structures and processes. For Galen the kidneys are involved in the alteration and preparation of blood for its distribution to the rest of the body through the veins. The manner in which materials, including blood and urine, are drawn into certain organs and conveyed throughout the body is at the heart of one of his physiological disagreements with Erasistrateans. I discuss these points further in chapter six.

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mon childhood game in Ionia involving such bladders, in order to show the difference between natural growth and mere distension.93 The pig bladder is an appeal to what I take to be every-day experience. His contemporary audience’s familiarity with these inflated balls provides the example an explanatory immediacy. The same familiarity indicts Asclepiadeans for their observational failures, since they cannot seem to see evidence that lies before the eyes of everyone. After repeated demonstrations of the anatomy of the ureters fail to convince them, Galen mounts an experimental demonstration on living animals. The set of procedures is described in book one of On the Natural Faculties, and appears to be designed specifically to counter Asclepiadean arguments about renal physiology.94 In the first half of the demonstration, the operator begins by exposing the ureters in a live animal, then ligates them. The animal is bandaged and freed. When enough time has passed, the operator removes the bandages to display the animal’s bladder still empty and the ureters distended with urine nearly to the point of rupture. Galen does not make it explicit in his narrative, but this stage of the demonstration shows that urine does not pass from the kidneys to the bladder as a vapor, contrary to the claims of his Asclepiadean opponents. Galen then releases the ligatures around the ureters. The bladder fills with urine, demonstrating not only that the ureters are channels for the passage of urine from the kidneys to the bladder, but also that they are the only channels for its passage. In the second half of the experiment, Galen takes the same animal—one is advised to act before it can urinate—and applies a tight ligature around its penis. After this is done, he squeezes the bladder all around. Despite the pressure, no urine flows back into the kidneys, demonstrating that urine does not pass out of the bladder through the ureters in a live animal, just as nothing passes through them in a dead one.95

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Nat.Fac. 1.7 (SM 3, 112.23–113.18 = ii.17–18 K.) Nat.Fac. 1.13 (SM 3, 127.10–128.23 = ii.36–38 K.). Nat.Fac. 1.13 (SM 3, 127.24–128.1 = ii.37 K.). Galen also isolates each ureter to strengthen his argument for a causal connection between kidney, ureter, and bladder. When interrupted by a ligature, the isolated ureter becomes distended. Meanwhile, its counterpart remains slack and the bladder fills. Galen ends the suite of demonstrations by dissecting a distended ureter to prove that it is full of urine—the same sort of procedure that he conducts in arterial experiments to show that the arteries contain blood, contrary to the Erasistratean position that arteries contain only pneuma. The suite of demonstrations culminates with the sight of the animal’s abdomen awash with urine while its bladder remains empty, since Galen has severed both ureters. These subsidiary demonstrations are each designed to provide a preponderance of evidence that the ureters are the only pathways between the kidneys and bladder.

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Galen recalls a debates with another Asclepiadean on these points in On the Natural Faculties. Like his counterpart in On the Power of Cleansing Drugs, this Asclepiadean quits the contest with Galen abruptly—with equally disastrous results. The point at issue, once again, is the existence of perceptible channels leading from the kidneys into the bladder: But, in addition to these things, the Asclepiadeans of today try their hands at making rebuttals, although when they wrangle (ἐρίζωσι) about these things they are ridiculed—every time by absolutely everyone who happens to be near them. Thus their sectarian vain-glory (ἡ περὶ τὰς αἱρέσεις φιλοτιμία) is an evil that is difficult to rub off, hard to wash out in these men especially, and more difficult to cure than any itch. So it is that one of the sophists (σοφιστῶν) of our day, well-trained in eristic arguments (περὶ τοὺς ἐριστικοὺς λόγους)—in other arguments too—and clever at speaking (δεινὸς εἰπεῖν), if anyone ever was, got into words with me about these matters. He was so shameless about any of the issues I have mentioned that he even tried to say that he was surprised (θαυμάζειν ἔφασκεν) I would try to upend clearly manifest matters with my frivolous arguments (λόγοις ληρώδεσιν). “For”, he said, “on any day it is clear (ἐναργῶς) to see that any bladder—if one were to fill it up with liquid or air, tie off its neck, then squeeze it on every side—will in no way let anything out but keep everything completely inside itself. And if in fact there were any substantive and perceptible pathways passing into them from the kidneys, the liquid would be completely expelled through those [pathways] when the [bladders] are squeezed, just as it passed into them”. Saying these things and others of this sort, rounding them off abruptly (ἐξαίφνης) with an unflinching and clear voice, he departed after having leapt up to his feet (ἀναπηδήσας), leaving us (ἀπῄει καταλιπὼν ἡμᾶς) as though we were unable to offer some plausible rebuttal.96

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Nat.Fac. 1.13 (SM 3, 125.12–126.8 = ii.34–35 K.): ἀλλὰ καὶ πρὸς ταῦτ’ ἀντιλέγειν οἱ νῦν Ἀσκληπιάδειοι πειρῶνται, καίτοι πρὸς ἁπάντων ἀεὶ τῶν παρατυγχανόντων αὐτοῖς, ὅταν περὶ τούτων ἐρίζωσι, καταγελώμενοι. οὕτως ἄρα δυσαπότριπτόν τι κακόν ἐστιν ἡ περὶ τὰς αἱρέσεις φιλοτιμία καὶ δυσέκνιπτον ἐν τοῖς μάλιστα καὶ ψώρας ἁπάσης δυσιατότερον. τῶν γοῦν καθ’ ἡμᾶς τις σοφιστῶν τά τ’ ἄλλα καὶ περὶ τοὺς ἐριστικοὺς λόγους ἱκανῶς συγκεκροτημένος καὶ δεινὸς εἰπεῖν, εἴπερ τις ἄλλος, ἀφικόμενος ἐμοί ποθ’ ὑπὲρ τούτων εἰς λόγους, τοσοῦτον ἀπέδει τοῦ δυσωπεῖσθαι πρός τινος τῶν εἰρημένων, ὥστε καὶ θαυμάζειν ἔφασκεν ἐμοῦ τὰ σαφῶς φαινόμενα λόγοις ληρώδεσιν ἀνατρέπειν ἐπιχειροῦντος. ἐναργῶς γὰρ ὁσημέραι θεωρεῖσθαι τὰς κύστεις ἁπάσας, εἴ τις αὐτὰς ἐμπλήσειεν ὕδατος ἢ ἀέρος, εἶτα δήσας τὸν τράχηλον πιέζοι πανταχόθεν, οὐδαμόθεν μεθιείσας οὐδέν, ἀλλ’ ἀκριβῶς ἅπαν ἐντὸς ἑαυτῶν στεγούσας. καίτοι γ’ εἴπερ ἦσάν τινες ἐκ τῶν νεφρῶν εἰς αὐτὰς ἥκοντες αἰσθητοὶ καὶ μεγάλοι πόροι, πάντως ἄν, ἔφη, δι’ ἐκείνων, ὥσπερ εἰσῄει τὸ ὑγρὸν

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The episode is useful for examining Galen’s rules of engagement. It also extends Galen’s criticism of Asclepiadeans from their powers of observation to their powers of reasoning. Galen describes the nameless Asclepiadean in terms similar to the ones he uses to describe himself in his agōn with Alexander of Damascus. Like Galen, he is a pepaideumenos, trained in eristic and a variety of argumentative styles; he expresses amazement (θαυμάζειν ἔφασκεν) that his opponent might attempt to overturn what is manifest (τὰ σαφῶς φαινόμενα) with specious arguments (λόγοις ληρώδεσιν); he employs the same language regarding the clarity of inferences drawn from empirical observations (ἐναργῶς … θεωρεῖσθαι). Finally, like Galen and like his own Asclepiadean counterpart in On the Power of Cleansing Drugs, he leaves abruptly (ἀπῄει καταλιπὼν ἡμᾶς) when it seems to him that his opponent cannot manage an effective argument. In many respects, the language in this passage presents the Asclepiadean as Galen’s mirror-image. However, his opponent lacks Galen’s training in logic. The Asclepiadean’s final inference overextends his argument. He assumes— without justification—that a given vessel allows or should allow movement in two directions if it allows it in one direction. So, why does Galen make his opponent appear similar to him? Galen’s Asclepiadean discusses anatomy in hypothetical or counterfactual claims, in sharp contrast to Galen’s own habits in discussing anatomical matters. While Galen routinely refers the reader to what can be seen, to what he himself has seen, or to what the reader will see, the Asclepiadean only offers abstract reasons for renal anatomy. Galen’s report and the language he ascribes to his opponent both figure the Asclepiadean’s argument as a mere thought experiment. Galen articulates these implicit criticisms later in On the Natural Faculties.97 First, a failure in reasoning: from the fact that some liquid may pass through a channel in one direction, one cannot infer that it can pass through the channel in the opposite direction. So, liquid will not in fact flow back into the ureters as it had flowed out of them. This closes the episode and makes the point against which Galen objects. Second, a failure in investigative method: whenever possible, one should verify a theoretical claim empirically. Galen’s segue from his account of the Asclepiadean to his general explanation of the ureters expresses this criticism with characteristic sarcasm, “[i]n this way, those who are slaves to their sects not only know nothing correctly (ὑγιὲς) but they also do not have the patience (ὑπομένουσι) to

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εἰς αὐτάς, οὕτω καὶ θλιβόντων ἐξεκρίνετο. ταῦτα καὶ τὰ τοιαῦτ’ εἰπὼν ἐξαίφνης ἀπταίστῳ καὶ σαφεῖ τῷ στόματι τελευτῶν ἀναπηδήσας ἀπῄει καταλιπὼν ἡμᾶς ὡς οὐδὲ πιθανῆς τινος ἀντιλογίας εὐπορῆσαι δυναμένους. Nat.Fac. 1.13 (SM 3, 126–127 = ii.35–36 K.).

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learn”.98 Galen points to this double failure in his opponent’s reasoning when he criticizes him for anatomical ignorance and for his blindness to the heuristic value of teleology: One has to listen to the reason why liquid can pass through the ureters into the bladder but cannot pass back out again the same way and appreciate nature’s skill. But they cannot abide learning and they are even more insulting, saying over and over again that the kidneys and many other organs are made by nature for no purpose.99 Had the Asclepiadean been more rigorous in his reasoning or had he bothered to carry out the thought experiment he so hastily described, he would have realized that his argument was problematic. The fact that urine does not flow back into the ureters does not imply that the ureters do not exist. Rather, there is good reason to suspect that the flow travels unidirectionally, as Galen goes on to describe in greater anatomical detail. A healthy regard for the teleological structure of the natural world would have prompted the Asclepiadean to expect that the kidneys had a function and seek out an explanation for them.100 Galen’s forensic conduct and the Asclepiadean’s are similar; but, whereas Galen leaves confident in the underlying methodological justifications for his victory, his opponent’s victory lap is premature. In this case, the Asclepiadean’s argumentative, anatomical, and philosophical training are all insufficient for him

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Nat.Fac. 1.13 (SM 3, 126.8–10 = ii.35 K.): οὕτως οὐ μόνον ὑγιὲς οὐδὲν ἴσασιν οἱ ταῖς αἱρέσεσι δουλεύοντες, ἀλλ’ οὐδὲ μαθεῖν ὑπομένουσι. I include “ὑγιὲς” and “ὑπομένουσι” in the body of the text in order to emphasize the effect of Galen’s sarcastic word play as a marker that rounds out his anecdote about the Asclepiadean. The immediate reason for the sentence is a diagnostic summation of this opponent’s failings and about the failings of his opponents more generally. The verb “ὑπομένουσι” plays on the general meaning of the verb and its local meaning in this passage. As the Asclepiadean failed to wait for Galen, so do his opponents fail to wait for learning. Galen’s play on “ὑγιὲς” is more pointed because of the local syntax, which can be taken to mean either that his opponents know nothing about health or have no correct knowledge (ὑγιὲς οὐδὲν ἴσασιν). Nat.Fac. 1.13 (SM 3, 126.10–16 = ii.35 K.): δέον γὰρ ἀκοῦσαι τὴν αἰτίαν, δι’ ἣν εἰσιέναι μὲν δύναται διὰ τῶν οὐρητήρων εἰς τὴν κύστιν τὸ ὑγρόν, ἐξιέναι δ’ αὖθις ὀπίσω τὴν αὐτὴν ὁδὸν οὐκέθ’ οἷόν τε, καὶ θαυμάσαι τὴν τέχνην τῆς φύσεως, οὔτε μαθεῖν ἐθέλουσι καὶ λοιδοροῦνται προσέτι μάτην ὑπ’ αὐτῆς ἄλλα τε πολλὰ καὶ τοὺς νεφροὺς γεγονέναι φάσκοντες. Underlying Galen’s objection is perhaps also an implicit criticism of Asclepiades’ corpuscular theory, whose channels (πόροι) and corpuscles may not be, on Galen’s construal, structurally complex enough to explain one-way motion through channels or vessels. On Galen’s teleological views, see, e.g., Hankinson (1988b), (1989); von Staden (1997b); and Schiefsky (2007).

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to distinguish properly between leaving behind a bested opponent and simply leaving. It is not the departure, as such, that makes the Asclepiadean here and in On Cleansing Drugs lose the competition with Galen so dramatically. Their loss is compounded with an incompetence so gross that they are unaware they have even lost.

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The Implicit Contest with Alexander

After this digression on the gamble involved in declaring oneself the winner of an intellectual contest, let us return to the agonistic context of Galen’s demonstration of the voice in On Prognosis and his own abrupt departure from the contest: When I heard these things [sc. Alexander’s question on the reliability of the senses] I departed leaving (καταλιπὼν) them behind with only a word, namely that I was fooled when I supposed that I had not come into the presence of some podunk Pyrrhonists (εἰς τοὺς ἀγροικοπυ⟨ρ⟩ρων⟨ε⟩ίους), otherwise I would not have come at all.101 The language with which Galen describes himself quitting the competition is very similar to the descriptions I have quoted of his opponents’ abrupt departures. The departure is also followed by a final word meant to explain his absence and to force a victory by fiat. While his opponents also declare themselves victorious, their declarations fall flat. In order to underwrite his own verdict, Galen must coopt the judgement of the audience—much like he turns it against his rivals when it suits his purposes. In Galen’s narrative, the materials were prepared and the audience already gathered—no mean feat. Displays of this sort could last for days and involved the procurement of various animals, assistants, and of course an audience.102 So, when Galen reacts to Alexander’s 101

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Praen. 5 (CMG v 8,1 98.6–11 = xiv.628–629 K.): ἀκούσας δ’ ἐγὼ ταῦτα, καταλιπὼν αὐτοὺς ἐχωρίσθην ἓν μόνον φθεγξάμενος, ὡς ἐσφάλην οἰόμενος οὐκ εἰς τοὺς ἀγροικοπυ⟨ρ⟩ρων⟨ε⟩ίους ἥκειν, ἢ οὐκ ἂν ἀφικνεῖσθαι. ἐμοῦ δὲ χωρισθέντος οἵ τ’ ἄλλοι τοῦ Ἀλεξάνδρου κατέγνωσαν ὅ τ’ Ἀδριανὸς καὶ ὁ Δημήτριος, ἐχθρῶς ἀεὶ διακείμενοι πρὸς τὴν φιλονεικίαν αὐτοῦ, πιθανὴν ἀφορμὴν εἶχον ἐπιτιμῆσαι σφοδρῶς. In fact, Galen stresses the duration of the experiment in just this passage at Praen. 5 (CMG v 8,1 98.16–23 = xiv.629 K.): γινομένης δὲ πλείοσιν ἡμέραις τῆς συνουσίας καὶ δείξαντος ἐμοῦ τὴν μὲν εἰσπνοὴν γίνεσθαι διαστελλομένου τοῦ θώρακος τὴν δὲ ἐκπνοὴν συστελλομένου, δείξαντος δὲ καὶ τοὺς μῦς ὑφ’ ὧν τε διασ⟨τέλλεται καὶ συ⟩στέλλεται καὶ πρὸς τoύτῳ γε τὰ εἰς αὐτοὺς κατεσχισμένα νεῦρα τὴν ἔκφυσιν ἐκ τοῦ νωτιαίου μυελοῦ ποιούμενα καὶ ὡς ἡ μὲν ἀβίαστος ἔξω

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initial question by abandoning the demonstration, the wager he makes is high. As though to draw attention to the stakes involved, Galen details the conspicuously elite status of the audience present at the demonstration. It was organized by Flavius Boethus, the ex-consul and later governor of Syria Palestina who figures so prominently in Galen’s career, and to whom many of Galen’s anatomical works were addressed. Also present were Demetrius of Alexandria and Adrian of Tyre, showing that the variety of attendees for his performance ranged from ultra-elite Roman citizens, to philosophers, and to famous orators:103 And after I left, the others reprimanded Alexander. Adrian and Demetrios, invariably ill-disposed toward his excessive love of argument (πρὸς τὴν φιλονεικίαν), had a credible pretext to rebuke him vehemently. And when this was made known to all of the scholars (τοῖς φιλολόγοις), so many as were in the city of Rome at the time, and to Severus, Paulus, and Barbarus, they all rebuked him vehemently and demanded that the anatomical demonstrations take place with them present, once they had gathered together everyone who was anyone in medicine and philosophy.104 Galen’s correct assessment of the rules of engagement is confirmed by the audience’s reaction to his departure, and their reproach of Alexander’s conduct. The passage completes Galen’s account of the competitive context of the demonstration. What follows is a brief and decontextualized report of the mechanics of the procedure, without many anatomical details. The agonistic details of this passage, however, are rich. Galen not only positions himself as an authority on the rules of the contest, but he also adduces the opinions of two well-known orators, Adrian and Demetrius, as guarantees that the wager he made when departing was a winning bet. Their verdict on Alexander’s behavior supports one of Galen’s key criticisms of his rival interlocutors at Rome. His opponents act in bad faith, motivated by a desire to argue for argument’s sake (philoneikia) rather than for the sake of discovering the truth. After his loss, Alexander fades into the background.

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φορὰ τοῦ πνεύματος ἐκπνοὴν ἄψοφον ἐργάζοιτο, βιαίαν δ’ εἶναι τὴν ἑτέραν αὐτῆς γινομένην μετὰ ψόφου, ἣν ἐκφύσησιν ὀνομάζομεν· On Adrian of Tyre and Demetrius of Alexandria, see Nutton (1979: 190–191 n. 96,16 and 96,17). Praen. 5 (CMG v 8,1 98.11–16 = xiv.629 K.): ἐπεὶ δὲ καὶ τοῖς φιλολόγοις ἅπασιν, ὅσοι κατὰ τὴν τῶν Ῥωμαίων πόλιν ἦσαν, ἐγνώσθη τοῦτο καὶ τῷ Σεβήρῳ καὶ τῷ Παύλῳ καὶ τῷ Βαρβάρῳ, πάντες οὖν σφοδρῶς ἐπετίμησαν αὐτῷ καὶ παρόντων ἑαυτῶν ἠξίωσαν γενέσθαι τὰς ἀνατομὰς, ἀθροίσαντες εἰς ⟨τ⟩αὐτὸ τοὺς ἄλλους ἅπαντας, ὅσοι κατὰ τὴν ἰατρικήν τε καὶ φιλοσοφίαν ἦσαν ἔνδοξοι.

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Galen’s victory is so complete that it gains him the attention and acclaim of a wider and more powerful audience. His resumed demonstration of the intercostal and recurrent laryngeal nerves attracts all of the important intellectuals (τοῖς φιλολόγοις) at Rome, along with a coterie of ultra-elite attendees. To give a better sense of their social weight, the attendees included Cn. Claudius Severus, husband to Marcus Aurelius’ daughter Annia Faustina, suffect consul in 167ce, consul in 173ce, and Peripatetic.105 Also present was L. Sergius Paullus, suffect consul (date unknown), proconsul of Asia (some time between 164–167 ce), consul in 168 ce, and urban prefect (ca. 169–170ce).106 And, finally Galen mentions M. Vettulens Civica Barbarus, consul in 157ce and close friend to the orator Herodes Atticus.107 Galen’s account of the completed demonstration, and the response of this second audience adds another stamp of approval to his earlier departure. His report also cleverly does double duty. First, it shows that Galen’s victory and reputation had spread to a wider local audience, from a small albeit important group of attendees to an audience that belonged to the highest echelons of social and political power in Rome. Second, and on a wider scale, Galen’s written account of his success extends the audience that can reinforce his authority to the readers of On Prognosis. Galen underscores this point in his epilogue to the episode: When I showed these things, all my critics were proven wrong and Boethus begged me to have memoranda of the [demonstrations]. When he sent some trained tachygraphers to me, I dictated to them everything I had shown and argued, without taking into account whether Boethus was going to distribute the material to many people. And even to this day, Epigenes, no one has dared to argue against [what I wrote], although it has since been fifteen years. And despite the many people who talk about arguing against me—only so that they may be heard [saying] that they have argued against me—they do not dare to submit their writing to the judgment of people of intellect.108

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See Nutton (1979: 166, n. on p. 82,6) and CAH Vol. 11: 169. See Nutton (1979: 163, n. on p. 80,15). See Nutton (1979: 165, n. on p. 82,4). For his connection to Herodes Atticus, see Philostratus Vit.Soph. 537–539. Praen. 5 (CMG v 8,1 98.27–100.6 = xiv.630 K.): καὶ τῶν παραφθεγξαμένων ὁπότ’ ἐδείκνυον ταῦτα πάντων ἐλεγχθέντων ὁ Βοηθὸς ἐδεήθη μου σχεῖν αὐτῶν ὑπομνήματα. καὶ πέμψαντός γ’ αὐτοῦ τοὺς διὰ σημείων ἠσκημένους ἐν τάχει γράφειν ὑπηγόρευσα πάντα τά τε δειχθέντα καὶ λεχθέντα μὴ προορώμενος εἰ μέλλοι δώσειν αὐτὰ πολλοῖς. καὶ μέχρι δὲ νῦν, ὦ Ἐπίγενες, οὐδεὶς ἐτόλμησεν ἀντειπεῖν αὐτοῖς ἐτῶν ἐν τῷ μεταξὺ γεγονότων πεντεκαίδεκα καίτοι γε διαβουλευ-

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The episode closes with the widest possible circle of local acclamation— all those engaged with philosophy and medicine, who gathered to witness Galen’s second and completed demonstrations on the voice. It is only with the transcription and dissemination of his anatomical performance, however, that Galen gains an audience whose judgment can authorize his professional legitimacy for years beyond the occasion of his live demonstration. By the close of the passage, the credentialing power of Galen’s written demonstration has altogether supplanted the influence of his live performance; writing and the adjudication of its elite readership become the standard for professional legitimacy. ομένων [γε] πολλῶν ἀντειπεῖν ὅπως ἀκουσθῶσιν αὐτὸ τοῦτο μόνον, ὡς ἀντειρήκασιν, οὐ μὴν τολμώντων γ’ εἰς κρίσιν ἐπὶ φιλολόγων ἀνδρῶν ἀγαγεῖν τὰ γραφέντα.

chapter 3

Magnification and the Elephant My discussion so far has focused on performative aspects of Galen’s live anatomical experiments and their written narratives. One of the main themes I have pursued is that of Galen’s experimental narratives as reperformances of his live demonstrations. In the preceding chapters, this theme has played out in an examination of some of the social functions of live experimentation, which I argue Galen recreates at the level of the text: displays of paideia in the form of sophisticated doxographical exegesis, participation in elite performance culture, and competitive professional credentialing. However, Galen also leverages written narrative and technologies of the book to other more theoretical ends. The potential for the widespread dissemination of his written works throughout the Roman world allowed Galen to engage in theoretical disputes with other intellectuals on a global scale that far exceeded the local limits of live performance. It enabled Galen to ignore other important logistical constraints of in-person demonstrations. Galen is able to show structures to readers of his written narratives that are too minute for most of the members of his live audiences to observe directly. Indeed, some of these structures are perhaps too minute for any audience member to observe directly, becoming visible in Galen’s writing alone. These two uses of writing and the technologies surrounding it are consistent with other social functions of experimental narratives that I have been discussing as credentialing mechanisms. They also allow Galen to do things in his experimental writing that were impossible for him to do in live demonstrations. Here I would like to examine one such important feature of Galen’s written experiments, text as a surrogate for visual experience. Galen’s use of writing and anatomical analogy as sophisticated tools for magnification—to make structures visible to readers that would have been invisible to spectators. To that end, I wish to focus on Galen’s vivid anatomical exegeses of elephants and the argumentative role that they play in his system of anatomy and physiology. At first glance, Galen’s attention to the anatomy of the elephant in his anatomical works—ostensibly about the anatomy of human beings—may seem puzzling. Two episodes involving elephantine anatomy figure prominently in the text of Anatomical Procedures, the first on the gallbladder and the second on the so-called heart bone. These episodes—or very close versions of them—also appear in Galen’s more theoretical anatomical treatise The Function of the Parts. Indeed, a third episode on the structure and function of the

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elephant’s trunk takes center stage in the self-titled Epode, with which Galen brings The Function of the Parts to a close. The trunk of the animal, Galen writes, is a close analogue to the human hand and, therefore, a powerful piece of evidence for the teleological structure of the natural world. Historians of medicine have traditionally mined these episodes and many of Galen’s other experimental narratives for their anatomical accuracy, for what they can reveal about the socio-cultural context of live anatomical demonstrations in the second century, and for the light that they can shed on the epistemological debates that figure so prominently in Galen’s reports of medical sects in the Roman period.1 Galen’s anatomical narratives, however, also contain a wealth of information about philosophical and medical points of friction between him and his contemporary rivals, as well as indirect information about those rivals whom his experiments frequently target. It is worth rehearsing a few crucial points about Galen’s dissections and vivisections. As I have mentioned in the introduction to this book, there is no evidence for the systematic dissection of human beings in the Greco-Roman world outside the anatomical studies of Herophilus and Erasistratus in the first half of the third century bce.2 Later anatomists, such as Galen, who conducted research on human anatomy and physiology might refer to the observations preserved in their writing, but they did not perform dissections on human subjects. The emergence and, more so, the disappearance of human dissection in the Greco-Roman anatomical tradition is a historical phenomenon that con1 The secondary scholarship on the epistemological views of ancient medical theorists and disagreements between them is considerable. Hankinson (1994) offers a helpful overview of some of the philosophical issues at stake for Galen and the place of anatomical demonstration in his broader theoretical system. Von Staden (1982) remains a piece of central scholarship on the driving role of epistemological concerns in the formation of early Hellenistic medical sects. See, also, the papers by Frede and Matthen in Hankinson (ed.) (1988a) and Hankinson (2008a). 2 Aristotle (HA 1.16, 494b19–24) asserts that the internal anatomy of human beings remained unknown in the fourth century because dissection of human bodies was impossible. Indeed, he suggests (PA 1.6, 645a4–17) that systematic dissection of non-human animals was also uncommon, or at least taboo. For claims that some human dissection did take place in the Roman period, see Singer (1956: 244 n. 72), which takes Galen’s comments (regarding the need to practice extensively on apes in the event that the opportunity to dissect a human body should arise) to suggest that at least occasional human dissection was normal in the second century. See AA 3.5 (324 Garofalo = ii.384–385 K.). Also, see May (1958: 409). Dean-Jones (2018) argues partly on the basis of Celsus’ account of the epistemological debate between medical sects in the first century that dissection must have been taking place if the arguments regarding its importance to Dogmatists are to be taken seriously (see De Medicina 1.pr.23–44). Cf. Dean-Jones (2017). Contra this view, see, e.g., the later view of May (1968: 40–41), Scarborough (1971), von Staden (1992: 234–237), and Nutton (2013: 134–138 and 367 n. 110).

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tinues to be a puzzle for historians of ancient medicine. I will do no more than acknowledge the puzzle here.3 For present purposes, it is sufficient to observe that all of the second-century ce anatomical experiments that I discuss were performed on non-human animals. Much of the anatomical information gleaned from these experiments was applied to human bodies analogically from the bodies of oxen, pigs, sheep, and certain monkeys.4 Galen tells us that he also anatomized more exotic animals, such as hippopotamuses and elephants. His discussions of elephantine anatomy are especially detailed; in at least one instance he describes dissecting an elephant’s heart in what seem to be the streets of Rome. Where it seems possible to verify whether or not Galen actually conducted dissections or even passive examination of the internal structure of the elephant, however, the evidence suggests Galen is likely working analogically to human anatomy from oxen, just as he does in his neural anatomy.5 The peculiarities of Galen’s elephant episodes prompt questions about what the purpose of these experimental narratives may have been. Why the elephant? I have already hinted at one answer I propose to this question, related to the visual experience of anatomical demonstration: elephants are massive.

1

Magnification and Analogy

In the later books of Anatomical Procedures, which are preserved mostly in Arabic, Galen offers the reader an ingenious solution to the problem of observing minute structures: [f]or we hold it best to investigate and to study the details that are difficult to see in the bodies of large-sized animals, I mean in oxen, horses, asses, mules and others like those. But even in the elephant, let alone any other

3 For an overview and helpful discussion of the questions involved, see von Staden (1992). Cf. von Staden (1975). 4 For a brief account of Galen’s use of non-human subjects and his extrapolation of their anatomy to human beings, see Rocca (2003: 67–76). 5 Galen’s anatomical accounts of the brain are thoroughly documented in Rocca (2003), where Rocca shows that Galen’s account of the famous retiform plexus (rete mirabile), which plays such a central role in Galen’s overall physiology, derives from necropsies performed on oxen. Of course, it is also well known that a number of Galen’s accounts of human anatomy are ultimately based on the anatomy of animals commonly available to him (e.g., cows, oxen, pigs, sheep, the rhesus monkey, and the Barbary ape). For an abbreviated list of some of Galen’s anatomical claims that are not extrapolated to human beings accurately, see May (1968: 42).

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animal, we have never found arteries at the side of these veins [minute veins, in particular the vein leading to the testicles].6 trans. duckworth

Crucially, Galen does not suggest that it is possible for him to augment the image of these anatomical structures through the use of a lens or a similar tool for visual magnification. Galen’s silence on the matter of magnification tools should not be taken, on its own, as dispositive. There is an interesting technological puzzle here. Plano-convex pieces of glass of the sort that could have been used as magnifying lenses survive from antiquity. It is unclear, though, whether these objects were used for visual magnification and, if so, by whom. There is evidence, for example, that convex glass objects and rockcrystals were used in antiquity as tools for kindling fires and as decorative pieces.7 Archaeological evidence, however, for the use of these objects in the Greco-Roman world to magnify images is inconclusive—the objects survive, but without context for their historical application.8 The literary evidence is mainly silent on this point. In his Natural Questions, Seneca alludes to mirrors (specula) that reflect enlarged images. Then he tantalizingly notes that objects placed inside glass bowls filled with water appear larger, magnified by the water in the bowl; writing placed under the bowls presents a similar optical phenomenon.9 Seneca’s discussion of amplified images, however, centers exclusively around the magnificatory properties of water. He gives no indication that magnification of this sort might have a practical application. Medical writing and, more broadly, science writing are completely silent on the subject. Even if these lenses were used to amplify images by some people in antiquity, all 6 AA xiii.8 (171 Duckworth). 7 See, e.g., Aristophanes Nub. 766–768; Theophrastus Ign. 73; and Pliny NH 36.199, 37.29 (which contains a reference to medical uses of these fire-starting lenses for cauterization). 8 See, e.g., Sines and Sakellarakis (1987); Plantzos (1997); Lascaratos and Marketos (1997); and Enoch (1998). Enoch (1998: 282, fig. 3) offers a 12th century crucifix as an example that illustrates the difficulty nicely. The centerpiece of the crucifix is a plano-convex glass piece. Absent the artifact in which it is placed—as a decoration—one might be tempted to conjecture that the glass was a magnifying lens. 9 Seneca QN 1.6.5: “I have said already that there are mirrors which augment every body that they reflect. I will add this point, that everything is far bigger to those seeing it through water. Letters, however minute and obscure are seen larger and clearer through a glass ball filled with water. Fruits seem more beautiful than they are, if they are floating in a glass”. (Dixi modo fieri specula quae multiplicent omne corpus quod imitantur. Illud adiciam omnia per aquam videntibus longe esse maiora. Litterae quamvis minutae et obscurae per vitream pilam aqua plenam maiores clarioresque cernuntur. Poma formosiora quam sunt videntur, si innatant vitro). Cf. Strabo Chr. 3.1.5.

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of our indirect evidence points to the puzzling conclusion that science writers did not apply this technology to their investigations of the natural world. In the absence of magnificatory technology with which he might produce augmented images of anatomical structures, or at least a precedent for its use in medical practice, Galen adopted a different method for making minute observations. He would locate a structure in a large creature that he took to be analogous to the structure he wished to observe in a smaller creature. He would then make inferences from the larger and more visible structure to its smaller and less visible counterpart. So, he says in the later books of Anatomical Procedures: [w]e must then try to learn the conformation of that which is hard to observe in any one type of animal, whichever this may be, in other animals where that can be found and thoroughly investigated, I mean those animals in which such details are in their nature larger and more massive than those which in this [smaller] type are hard to see.10 trans. duckworth

This solution to the problem of magnification has its roots as early as Plato’s famous analysis of the soul by analogy to its larger counterpart, the polis, in the second book of the Republic.11 In order to explain the motivation for the citysoul analogy, Plato first poses a challenge, and then his answer to it. Natural vision is not keen enough to see justice in the soul directly, but perhaps justice in the city is sufficiently conspicuous that it would assist one in discerning its more evasive counterpart in the soul.12 If one were asked to read minute letters from a distance, he writes, it would be a great help to have first read those same letters, enlarged and on a larger surface. Galen was of course well aware of Plato’s Republic, and there are further reasons to suppose that this method of analogy informs his own. Galen’s inferential move from the larger to the smaller animal similarly requires the structures—or letters—in each subject to be analogous in relevant respects. And, indeed, Galen held this exact view on observation by analogy, although he was sensitive to its potential methodological pitfalls. Immediately following the passage I have quoted, Galen explains how he approaches investigations of the first cervical vertebra in human beings to illustrate his point. In human beings and apes, he says, the first and second cervical vertebrae are too

10 11 12

AA xv.2 (228 Duckworth). For the city-soul analogy, see Plato Republic 368c–369d. Plato Republic 368d8–369a4.

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small to observe well directly. In larger animals—generally larger carnivores— the first and second vertebrae are very large, large enough to be seen easily. Consequently, they allow for direct observation, from which Galen believes the structure of these vertebrae in smaller mammals can be inferred. He justifies the inference on the grounds that “you will observe that the structure of the bodies of the animals with whose organic parts you have a sound acquaintance as a result of your dissections resembles the structure of the human body in some degree”.13 Yet, it is not that Galen considers mere resemblance “in some degree” sufficient grounds for establishing structural analogy across animal kinds. While discussing observational challenges to direct examination of certain neural anatomy in Anatomical Procedures, Galen writes that he has not been able to see whether the terminations of the olfactory tract are perforated.14 He can, however, infer that they are—a manner of observation that Galen refers to as perception through reason (λόγῳ θεωρητός). While necessary in some cases, such as these, Galen considered that analogical inferences about anatomy were inferior to direct observation as a method of inquiry: [n]evertheless it is not my purpose here to derive the knowledge of the nature of the things which I wish to understand from analogy; for this is not the aim of anatomy. Rather I am simply trying to give an account of those things which manifest themselves to the eyesight.15 trans. duckworth

There is a bit of tension between Galen’s commitment to direct empirical observation and his use of analogical reasoning as a heuristic tool. After all, the remarks on human anatomy in Anatomical Procedures are based mainly

13 14

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AA xv.2 (227 Duckworth). It is important for Galen’s system of physiology that the olfactory bulb be perforated, like the area of the skull now known as the “cribriform plate”. During respiration pneuma is transmitted to the brain through these perforations. See, e.g., UP 8.6 (i.471.20–472.21 Helmreich = iii.650–651 K.). Galen writes that the nature of the olfactory tract entails that it is permeable. He draws the inference in part from the regular discharge of mucus through the nasal cavities, which he conceives of as coming from the brain. In order to travel from the brain to the nasal cavities, the olfactory tract and cribriform plate must be permeable. The perforations in the cribriform plate, which are visible, support his conclusion about the olfactory bulb. See AA ix.7 (4 Duckworth) and UP 8.6 (i.470.22–471.20 Helmreich = iii.649–650 K.). On Galen’s anatomy and physiology of the anterior ventricles, see Rocca (2003: 119–128). AA ix.7 (4 Duckworth).

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on anatomical information derived analogically from non-human animals. Indeed, the subject under description in this passage is an ox. It is, therefore, difficult to make sense of Galen’s claim here about the place of direct observation in anatomy, especially when taken in conjunction with his repeated emphasis on the importance of direct observation throughout the rest of his writing. What were the principles according to which Galen determined different degrees of anatomical and physiological analogy between any given animal kinds? What determines the degree of resemblance that he believed justified his anatomical inferences?

2

Analogy, Classification, and the Ancient Anatomical Tradition

Galen believes that some structures exist universally across animal kinds on a combination of theoretical and empirical grounds. For example, he argues that morphological similarities observed among the smallest known creatures (e.g., “birds, fish, snakes, worms, wasps, midges, flies, fleas, and all other similar creatures”),16 are strong evidence for anatomical analogy across even the most apparently disparate animal kinds. He considers these similarities powerful support for the view that animal bodies are teleologically structured. In turn, the teleological structure of the natural world informs his view that animal kinds are analogous to one another. In support of the first claim, Galen notes that sensory organs are located in the heads of all these animals, that they all possess a thorax, some means of locomotion, and a system for the evacuation of waste.17 Galen’s choice of examples owes a great deal to the hierarchy of activities Aristotle considers essential to animal life in De Anima, Parts of Animals, and elsewhere. All animals, on Aristotle’s construal, possess the power of sensation, are capable of locomotion, take in nutrition, and evacuate their waste.18 Galen’s list also includes the thorax, however.

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AA xv.2 (227 Duckworth). See AA xv.2 (227–228 Duckworth). Duckworth’s translation of the Arabic includes “feet [limbs]”, which I have glossed as “a means of locomotion”. It is difficult to make sense of Galen’s assertion that all of these animals have feet when he has just adduced snakes and worms as examples. That having been said, Galen is capable of making occasional generalizations of this sort that are manifestly inconsistent with his examples. His main point is that certain organs, whose physiological function and deeper structure are identical, for all intents and purposes, appear across a very wide range of animal kinds even if their appearances may belie such anatomical similarities. Cf. Aristotle DA 2.2–3 and 3.12; PA 2.10, 655b29–32; and Iuv. 2, 468a13–17.

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The thorax had special significance in Galen’s physio-anatomical system, whose three main organic and physiological systems were neural, cardiopulmonary, and hepatic.19 The sensory organs are connected to the control center of human sensation and volition, the hēgemonikon, which Galen places in the head. This faculty and its corresponding organ—the brain—occupy a tremendous amount of Galen’s time and energy throughout his writings.20 Sensory and motor nerves ramify from the brain and spinal cord to all the parts of the body. The thorax contains the organs of respiration (non-cutaneous) and is itself involved in breathing. Along with the lungs, the heart is for Galen part of the respiratory system, as it was for most other Greco-Roman anatomical theorists. The arteries branch out from left ventricle of the heart through the aorta. They are responsible for passing pneumatized blood to the rest of the body, and thus for maintaining cardiac heat. Finally, the liver is the source of the venous system and, along with the veins, is responsible for blood production. On Galen’s model, these three systems should exist across all air-breathing animal kinds. Furthermore, they should be structurally analogous. At this point of specificity, it becomes more difficult to determine Galen’s remaining criteria for analogical similarities across animal kinds.21 Indeed, other cases suggest that Galen’s distinctions may not have been so tidy. For example, Galen implies that gallbladders exist across some kinds for reasons teleologically associated with the liver and his humoral theory. But, he is not committed to the existence of gallbladders across all animal kinds possessing livers and a full complement of humors, an important point to which I will return. Similarly, human beings, elephants, and simians all possess a tool-using appendage for reasons associated with their intelligence. It is unclear, however, why Galen thinks that they do while otherwise similar kinds do not. It may help to approach this issue from the opposite direction as well—from the perspective of animal kinds rather than organs. For Galen, not all animal kinds are structurally intersubstitutable; therefore it may be illuminating to examine cases in which Galen discusses disanalogies between classes of animals. For example, Galen advises the reader of Anatomical Procedures to study 19

20 21

While non-airbreathing creatures and creatures whose bodies contain no blood, such as fish, do not require pulmonary or hematopoietic systems, they do possess analogues to them. Galen sometimes refers to the brain when discussing the hēgemonikon and vice versa, presumably by metonymy. On ancient criteria for structural analogy across kinds, although on the subject of taxonomy more than analogical reasoning, see Lloyd (1983: 7–57). For a discussion of relevant issues in Aristotle’s system of classification, from which Galen’s at least partially depends, see, e.g., Lennox (1980), (2001: 156–157, n. 642b34–35); and Pellegrin (1986).

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the skeletal structure of human subjects if at all possible and, failing that, of apes that most resemble human beings. He cautions the reader to avoid apes with elongated jaws and canines.22 He adds that, in the absence of apes, one should choose other animals on the basis of their external similarity to human beings.23 These animals and their differences from human beings are fleshed out in book six, where Galen articulates the kinds of animals that are anatomically analogous to human beings into six classes:24 1) apes (πίθηκοι), 2) bears (ἄρκτοι), 3) saw-toothed carnivores (καρχαρόδοντα), 4) pigs (ὕες/σύες), 5) singlehooved animals (μονώνυχα), and finally 6) ruminants (μηρυκάζοντα).25 The six classes, beginning with apes, deviate anatomically from human beings in progressive stages, although Galen is vague about the ways in which they do so.26 He does not say, for example, whether each successive class differs more from human beings in all anatomical respects or only in certain ones. Galen writes that this schema was anticipated by his anatomical predecessors, unnamed ancient authors who insisted that dissections should be conducted on animal subjects that are most similar in nature to human beings: Apes (πιθήκους) first and foremost, and of those the ones most like human beings … and after these bears (ἄρκτους); then carnivores (καρχαρόδοντα), pigs (σύες), and those animals called single-hooved (μονώνυχα); and, in

22

23 24 25

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See AA 1.2 (88.8–11 Garofalo = ii.222 K.): “choose from among the monkeys the ones most similar to human beings; these are the ones whose jaws are not long and whose so-called canines are not large”. (ἔκλεξαι δὲ ἐκ τούτων τῶν πιθήκων τοὺς ὁμοιοτάτους ἀνθρώπῳ. τοιοῦτοι δ’ εἰσὶν, ὧν οὔθ’ αἱ γένυες προμήκεις, οὔθ’ οἱ κυνόδοντες ὀνομαζόμενοι μεγάλοι). See AA 1.2 (94.17–20 Garofalo = ii.226–227 K.). AA 6.3 (560.3–10 Garofalo = ii.548 K.). Also, cf. AA 4.3 (390.5–392.7 Garofalo = ii.430–431 K.), which contains a slightly different list along with a possible textual crux. The list omits pigs and bears, replacing them with lynxes and other kinds of apes. Singer (1956: n. 83) expresses some unease with rendering λύγκες as lynxes. Indeed, it seems out of place in this passage as one might expect lynxes to belong to the class of carnivores. If one of Galen’s primary motives for articulating the class of polydactyls in the way that he has is to establish a system for anatomical analogy to human beings, the presence of the lynx here may just reflect a lack of interest in anything more than distinguishing human beings from apes and apes from other polydactyls. This is the Greek that contains the reference at AA 4.3 (390.19–23 … 30–31 and 392.1–3 Garofalo = ii.430–431 K.): ἁπάντων γὰρ τῶν ζῴων ὁ ἄνθρωπος ἔχει βραχυτάτην τὴν γένυν ὡς πρὸς τὴν ἀναλογίαν δηλονότι τοῦ παντὸς σώματος, εἶθ’ ἑξῆς ἀνθρώπῳ πίθηκος, εἶτα λύγκες, καὶ σάτυροι, κᾄπειθ’ ἑξῆς κυνοκέφαλοι … ἐφεξῆς δὲ τούτων τὸ τῶν ἄρκτων γένος, εἶθ’ οἱ ὕες, εἶθ’ ἑξῆς τὰ καρχαρόδοντα καλούμενα· κᾄπειτ’ ἄλλα δύο γένη ζῷων, τὸ μὲν κερασφόρον καὶ δίχηλον καὶ μηρυκάζον, τὸ δὲ ἄκερόν τε καὶ ἄχηλον, ὁπλαῖς μονοφυέσιν ἐπερειδόμενον. On Galen’s use of homology between animal kinds, see Hankinson (1997). On the six classes of animals specifically, see Garofalo (1991b).

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addition to all of these a sixth class, the ruminants (μηρυκάζοντα). It seems to me that the ancients (οἱ παλαιοί) hint at these same classes of animals each time they ask that the anatomical arguments that they have written should be confirmed on animals that possess a nature that does not deviate much from the nature of human beings (ὅσα μὴ πολὺ διεστῶσαν ἀνθρώπων ἔχει τὴν φύσιν).27 To what ancients is Galen referring and what is the nature of these six classes? Typically when Galen refers to antiquity or to the ancients (οἱ παλαιοί), he is referring to some author of the Hellenistic or Classical Period and he invariably does so with a sign of approval. At first blush, Aristotle is a plausible and perhaps probable candidate for this reference, given his interests in the structure and classification of animals. Indeed, there are certain linguistic parallels in this passage with Aristotelian usage. Galen’s phrasing, for example, in his report of how these ancients asked that their accounts be confirmed—on animals whose nature did not deviate much from human beings—bears affinities to Aristotle’s comments in Parts of Animals on how to classify animals as similar in kind—on the grounds that they have a common nature and their formal features deviate only a little (ἔχει τε μίαν φύσιν κοινὴν καὶ εἴδη ἐν αὐτῳ μὴ πολὺ διεστῶτα).28 Moreover, the word that Galen uses for ruminants, μηρυκάζοντα, appears almost exclusively in Aristotle’s biological writing.29 Likewise, singletoed animals are characteristic of Aristotelian groupings. As Galen suggests, however, his six classes are not laid out as such in Aristotle’s writing, or in the writing of any other surviving author from the Classical and Hellenistic period.

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AA 6.3 (560.3–5, 8–16 Garofalo = ii.548 K.): ⟨ἐπὶ⟩ πιθήκων μὲν πρώτων καὶ μάλιστα, καὶ τούτων αὐτῶν ὅσοι μάλιστα ἐοίκασιν ἀνθρώπῳ … τούτων δ’ ἐφεξῆς ἄρκτους· εἶθ’ ἑξῆς τά τε καρχαρόδοντα καὶ τοὺς σύες* καὶ τὰ μονώνυχα προσαγορευόμενα· καὶ πρὸς τούτοις ἅπασιν ἕκτον τί⟨θει⟩ γένος, τὰ μηρυκάζοντα. ταῦτα γὰρ αὐτὰ τὰ γένη τῶν ζῷων αἰνίττεσθαί μοι δοκοῦσιν οἱ παλαιοί, κελεύοντες ἑκάστοτε τοὺς ἀνατομικοὺς λόγους, οὓς αὐτοὶ γεγράφασιν, ἐπ’ ἐκείνων ἐξετάζεσθαι τῶν ζῴων, ὅσα μὴ πολὺ διεστῶσαν ἀνθρώπων ἔχει τὴν φύσιν. Garofalo prints μῦς instead of σύες here, but translates it “porci” in accordance with his emendation of μῦς to σύες (556.9 Garofalo = ii.545 K.) a few pages earlier. For that reason, I have printed σύες. The emendation rests on a gloss in the Greek manuscript of Anatomical Procedures removed by Caius. See Garofalo (1991a: 557, n. 19). Aristotle PA 1.4, 644b3–4. More generally, see PA 1.4, 644b1–9. Aristotle HA 2.17, 507a34–36. The word appears twenty-one times in extant Greek writing before Galen. Nineteen of those instances occur in Aristotle’s work. Aristotle uses it as a gloss for animals that have horns and only a single row of teeth (ὄσα μή ἐστιν ἀμφώδοντα). These animals maintain a fairly different diet from human beings, which is reflected in their internal anatomy. Their stomachs are partitioned into sections; they have single rows of teeth, and they often have horns.

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In his Historia Animalium, Aristotle also asserts that, when dissected, the internal organs of apes most resemble those of human beings.30 The other five groups in Galen’s classification of anatomical analogues all fall under the extensive kind “live-bearing quadrupeds” (ζωοτοκοῦντα τετράποδα) in Aristotle’s classification of animal kinds. In some contexts, Aristotle articulates fourlimbed creatures, among which he sometimes includes human beings, into three further subcategories. The subcategories ramify according to the number of digits their members possess. These are animals with many digits (πολυσχιδῆ), cloven-hooved animals roughly corresponding to ruminants (διχάλα), and single-hooved or single-toed animals (μώνυχα).31 Animals with many digits include human beings, apes, bears, and other carnivores.32 Galen attributes his general schema to Aristotle more securely in a larger discussion on the perfection of different animal kinds relative to their divinity in The Function of Parts: The difference between the natures of animals is considerable, as Aristotle has shown at great length. Some are a single remove from plants; they are the most incomplete animals, since they only possess one sense, touch—such are most of the testacea or bivalves, which not only lack a sensory organ, but also have no differentiated limbs or internal organs. But they are little different from plants. Further removed from these are those animals that are able to taste, and further still those that also possess an olfactory organ. And, even further are those that have an auditory organ in addition. The ones that have these organs and a visual organ also are near to being complete—such are fish, although they have neither hands nor feet. But lions and dogs not only have feet, but in a way they have hands; and even further from these are bears and apes. Finally, human beings alone have hands, insofar as they also have the power of reasoning with which to use them. There is no power more divine for mortal animals.33 30

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Aristotle HA 2.9, 502b25–27: τὰ δ’ ἐντὸς διαιρεθέντα ὅμοια ἔχουσιν ἀνθρώπῳ πάντα τὰ τοιαῦτα. It is also possible that τὰ τοιαῦτα refers to live-bearing quadrupedal animals. The Greek admits of both readings, in my view. The broader reading is plausible, since the species under the general kind live-bearing quadrupeds would differ only in degree—by the more and the less. See, e.g., Aristotle HA 2.1, 499b6–15. For a very useful chart that lays out these classes in a single place, see Manuli and Vegetti (1977). For Aristotle’s principles of classification, see Lennox (1980), (2001: 156–157, n. 642b34–35); and Pellegrin (1986). UP 14.6 (ii.298.7–299.2 Helmreich = iv.160–161 K.): ἔστι γὰρ δὴ τῶν ἐν τοῖς ζῴοις φύσεων, ὡς

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Galen is referring here to Aristotle’s so-called scala naturae, according to which organisms are organized along a spectrum in virtue of the increasing complexity or sophistication of their parts. The particular reference appears to be to another passage from the Historia Animalium where Aristotle describes the differences between inanimate objects, plants, and other animals in incremental terms.34 While Galen’s emphasis on prehension in The Function of the Parts has certain Aristotelian valences, it is not an axis of classification that is clear in Aristotle’s writing. Limbs and digits do play a dominant classificatory role in Galen’s work, however. I will return to this point on the importance of the hand and its fingers in due course in my discussion of the significance of the elephant and its trunk to Galen. Although Galen does not mention later sources for his classification, there is strong evidence that a version of it existed at least a generation before him. Rufus of Ephesus employs a very similar schema in his treatise On the Names of the Parts of the Body: It is necessary, pais (ὦ παῖ), to name these visible [i.e., external] parts along with the bones that lie beneath them in this way. But we will endeavor to name the internal parts by dissecting this ape (τὸν πίθηκον). For it is [the animal] closest in nature (ἐγγυτάτω γὰρ τὴν φύσιν) to the bones, muscles, internal organs, arteries, veins, and nerves of human beings. The second closest are the other animals with many digits on their feet (τὰ πολυσχιδῆ). Third are the cloven-hooved animals possessing double rows of teeth (τὰ ἀμφώδοντα τῶν διχήλων). Finally, those animal subjects that are single-hooved and possess a single row of teeth (τὰ δὲ μὴ ἀμφώδοντα καὶ μώνυχα) are most different from human beings.35

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Ἀριστοτέλης ἐπὶ πλεῖστον ἐδείκνυεν, οὐ σμικρὰ διαφορά. τὰ μέν γε πρῶτον ἀποκεχώρηκε τῶν φυτῶν καὶ ἔστιν ἁπάντων ζῴων ἀτελέστατα μίαν αἴσθησιν ἔχοντα τὴν ἁφήν, οἷα δὴ τὰ πλεῖστα τῶν ὀστρέων ἐστίν, οἷς οὐ μόνον αἰσθήσεως ὄργανον οὐδέν, ἀλλ’ οὐδὲ κῶλον ἢ σπλάγχνον ὑπάρχει τι διηρθρωμένον, ἀλλ’ ἔστιν ὀλίγου δεῖν φυτά. τούτων δ’ ἐπὶ πλέον ἀφέστηκεν, ὅσα γεύεσθαι πέφυκε, καὶ τούτων ἔτι μᾶλλον, οἷς καὶ τὸ τῶν ὀσμῶν ὄργανον ἐγένετο, καὶ πολὺ δὴ τούτων ἔτι μᾶλλον, οἷς καὶ τὸ τῆς ἀκοῆς. ἐγγὺς δ’ ἥκει τῶν τελέων, οἷς καὶ ταῦτα καὶ τὸ τῆς ὄψεως ὄργανον ὑπάρχει. τοιοῦτοι μὲν δὴ καὶ οἱ ἰχθύες, ἀλλ’ οὔτε πόδες εἰσὶ τούτοις γε οὔτε χεῖρες. ἀλλὰ λέοντες καὶ κύνες οὐ μόνον πόδας, ἀλλὰ καὶ οἷον χεῖρας ἐκτήσαντο, καὶ τούτων ἔτι μᾶλλον ἄρκτοι τε καὶ πίθηκοι. τελέα δὲ χεὶρ ἤδη μόνοις τοῖς ἀνθρώποις ἐστίν, ὥσπερ γε καὶ ὁ χρησόμενος αὐτῇ λογισμός, οὗ θειότερον οὐδὲν ἐγγίγνεται ζῴῳ θνητῷ. Aristotle HA 8.1, 588b4–23. Cf. Aristotle’s association of hand and foot in HA 2.1, 499b7–9. Rufus of Ephesus Onom. 127: τὰ μὲν οὖν ἐπιφανῆ, ὦ παῖ, σὺν τοῖς ὑποκειμένοις ὀστοῖς οὕτω χρὴ καλεῖν τὰ δὲ ἔνδον τουτονὶ τὸν πίθηκον ἀνατέμνοντες, ὀνομάζειν πειρασόμεθα· ἐγγυτάτω γὰρ τὴν φύσιν ἀνθρώπου καὶ τοῖς ὀστοῖς, καὶ τοῖς μυσὶ, καὶ τοῖς σπλάγχνοις, καὶ ταῖς ἀρτηρίαις, καὶ ταῖς φλεψὶ, καὶ τοῖς νεύροις· δεύτερα δὲ τὰ ἄλλα τὰ πολυσχιδῆ· τρίτα τὰ ἀμφώδοντα τῶν διχήλων· τὰ δὲ μὴ ἀμφώδοντα καὶ μώνυχα, προσωτάτω. The referent of the vocative ὦ παῖ is not clear. It

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Rufus was active under Trajan (98–117ce) or perhaps a generation earlier.36 His treatise On the Names of the Parts of the Body is a rare and useful point of comparison for Galen’s anatomical writing. Like Galen, Rufus’ system organizes animal subjects by their proximity in nature to human beings (or their parts). Rufus, however, lists only four classes of animals suitable for analogical inquiry into the human body: 1) apes (οἱ πίθηκοι), 2) animals with many digits on their feet (τὰ πολυσχιδῆ), 3) cloven-hooved animals with teeth on their upper and lower jaws (τὰ ἀμφώδοντα τῶν διχήλων), and finally 4) single-hooved animals with a single row of teeth in their jaws (τὰ δὲ μὴ ἀμφώδοντα καὶ μώνυχα). There are clear points of difference between Galen’s classification and the one Rufus reports, but they overlap considerably. Moreover, Rufus’ system of classification bears a clear and close resemblance to the Aristotelian material I have been discussing. There are two points, in particular, I wish to note. The first is that Rufus’ text represents very strong evidence of an existing pattern in Greco-Roman medical writing for the classification of animal subjects for purposes of analogical inquiry—or demonstrations—of internal human anatomy. Rufus makes no claim to originality on this point in On the Names of the Parts of the Body, and gives the impression that he is merely reporting the received anatomical practice of his day. There is a historical puzzle here, which is interesting in its own right: what are the origins of this system? It seems to derive, in some way, from the works of Aristotle. It is unclear, however, how and when it was further developed except to say that it was more or less fully formed by the Imperial Period. For our purposes, however, the importance of Rufus’ report lies in the second and related point I wish to discuss: Galen makes no mention of Rufus. Indeed, he offers no indication that his method of classification and analogical inquiry drew on any source other than Aristotle and Greek antiquity. Galen was, of course, a voracious and wide-ranging reader—in particular of earlier medical writing. And, as he tells us, his reading included Rufus’ work. It is implausible that Galen would have been unaware of the method of classification that Rufus reports.

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is tempting to construe παῖ as somehow referring to Rufus’ anatomical model. Indeed, he tells us explicitly that the model for his demonstration of the external parts of the body is a slave at the opening of On the Names of the Parts of the Body (Onom. 9). Rufus’ language in both passages is very similar. In context, however, it is difficult to identify the pais with the second person singular addressee of Rufus’ writing. If the vocative does refer to his model, perhaps it is an interjected stage direction letting his subject know to depart. This reading is of course highly speculative. I have no satisfactory explanation, and have therefore left ὦ παῖ untranslated. See Pormann (2008: 4) and Nutton (2008: 139).

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Galen’s silence on Rufus and any other post-Aristotelian authors who may have developed and transmitted a system for the classification of animal subjects allows him to present himself as a more direct intellectual heir to Aristotle. Moreover, Galen’s filiation to Aristotle grants him not only an Aristotelian pedigree, but also the cachet more broadly proffered by association with Greek antiquity. Rufus also provides us with important evidence that suggests Galen’s approach to analogical anatomy did not merely reflect second-century anatomical practice, or a standard later interpretation of animal classification in Aristotle’s work. Rufus for his part cleaves very closely to Aristotle’s language and the divisions he draws between live-bearing four-limbed animals in the Historia Animalium, although Rufus does seem to treat the classification as more taxonomic than current scholarship views Aristotle’s project in the biological works. Furthermore, the most striking axis of distinction in Rufus’ four-fold categorization of animals is the number of digits their extremities possess. The axis is present in Aristotle’s division of live-bearing four-footed animals,37 and is well-represented in Galen’s classification of anatomical analogues. In light of Rufus’ fidelity to Aristotelian language and categorization, Galen’s divergences from him and from Aristotle are all the more noteworthy. The way in which Galen’s accounts of these subcategories—apes (πίθηκοι), bears (ἄρκτοι), saw-toothed carnivores (καρχαρόδοντα), pigs (ὕες/σύες), singlehooved animals (μονώνυχα), and ruminants (μηρυκάζοντα)—differs from Aristotle’s divisions is perhaps explained by Galen’s interest in subdividing polydactyls in the first place. Galen’s aim is to find animal subjects whose bodies approximate the structure and function of human bodies as closely as possible. Insofar as reasoning is an activity characteristic of human beings, and prehension for Galen exists in virtue of our capacity for reason, those animals who have extremities most similar to human hands will be most similar to human beings in important physio-anatomical ways. Galen does not appear to have been concerned with more theoretical questions about animal classification; consequently, he shows very little interest in some categorizations that are prominent in Aristotle’s biological writings. For example, he only mentions cross-categorical animals or dualizers (ἐπαμφοτερίζοντες) once in regard to apes.38 Moreover, he only does so in The Function of the Parts, in a clear ref-

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For Aristotle, locomotion is an activity characteristic of animal life. Since organisms possess morphological features in virtue of their life activities, it seems likely that division according to modes of locomotion partly motivated Aristotle’s division of animals by number of limbs. For Aristotle, dualizers share features characteristic of two different classes, being intermediate between them. See, e.g., Aristotle PA 4.10, 689b31–34 and 4.13, 697a29–b4.

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erence to Aristotle’s anatomical work.39 Galen also does not engage with questions of whether human beings belong to the class of blooded, live-bearing, and four-limbed animals or constitute a distinct animal class. His primary concern is to determine the physio-anatomical similarity of animal subjects to human beings. It is crucial, therefore, when considering Galen’s analogical arguments to recognize how many degrees away from human beings—more precisely from the relevant part of the human body—the animal under discussion falls. So, for example, Galen argues in various places that the chambers of the heart do not vary from one animal to the next. Galen’s six classes of anatomical analogues are all blooded air-breathing animals. Since they all engage in respiration, they will also all possess the same respiratory organs—for teleological reasons I will discuss further in due course. Galen also frequently observes that the hearts of some animals, such as fishes, have only one ventricle. Fish do not fall into any of the six classes that Galen considers structurally analogous to human beings. Since they do not breathe air but engage in an activity analogous to breathing, they will possess organs analogous to respiratory organs but not structurally identical to them.40 In this case, they do not possess a four-chambered heart because their hearts benefit from the cooling effects of ambient water. Air breathing animals possess a four-chambered heart to stoke and cool the body’s vital cardiac heat.41 The gradation of Galen’s articulation of animals into classes of anatomical analogues to human beings shows that he was sensitive to the dangers of false anatomical analogy, at least in principle.42 Even if in practice Galen

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UP 15.8 (ii.367 Helmreich = iv.251 K.). For Aristotle, members of different species that belong to the same broader class differ physio-anatomically by degree (“by the more and the less”—τῷ μᾶλλον καὶ ἧττον). When grouped in this way, Aristotle considers organs in different species fundamentally to be the same. The bodies of animals belonging to different classes differ more qualitatively. Animals belonging to different classes may have a common capacity—for let us say locomotion. Consequently, they will have organs with which they realize this capacity. On Aristotle’s analysis, these organs are similar by analogy (κατ’ ἀναλογίαν). So, for example, lungs in air-breathing animals have an analogue in the gills of water-breathing ones. Galen and most other ancient authors—Herophilus is a notable exception—conceptualize the heart as having two chambers, our left and right ventricles. They consider both atria as belonging properly to the vascular system; this conceptualization contributes to their identification of these structures as the auricles or “ears” (ὦτα) of the heart. I talk about the heart as four-chambered from a contemporary point of view to avoid confusion. Since “analogy” and “analogous” can have technical meaning in scholarly discussion of Aristotle’s system of classification, I avoid using either in contexts where I am discussing Aristotle’s work. I am less cautious when discussing Galen’s work, and do not intend my usage to be taken as technical in those contexts.

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runs afoul of unwarranted anatomical analogies, his system of classification differentiates according to anatomical commensurability and—importantly— to incommensurability with the human body. Galen’s six classes, however, still do not offer us a clear metric by which to determine in what way, and to what degree the anatomy of a given animal in his classification will differ from the structure of human bodies. One can say, for example, that among the classes he has enumerated apes will be anatomically most similar to human beings, but this claim neither tells us what features of the two classes will be analogous nor how close the analogy holds. Galen’s beliefs about the teleological structure of the natural world—especially the bodies within it—may offer at least provisional solutions to this puzzle. Since Aristotle’s work is a model for Galen on these subjects, it will also be helpful to maintain Aristotle’s discussions of animal classification in the background. Galen’s views on analogy across animal kinds depend on a combination of his commitment to the robust goal-oriented structure of the world, and from brute observation of the anatomies of non-human animals. The anatomical similarities that Galen observes across certain animal kinds move him to conclude that they cannot be accidental, and that the teleological structure of the natural world can be inferred from empirical observations. From these conclusions, he supposes that analogical relationships hold between the bodies of all animals. Indeed, the highly goal-oriented structure of the natural world allows Galen to put his teleological beliefs to heuristic purpose. For example, Galen argues on the basis of teleological considerations that one can expect that the anatomy of creatures too minute to study—such as worms, wasps, midges, flies, fleas, and smaller creatures—will be similar in relevant respects to the anatomy of all other animals.43 A feature of an ideally structured world is that any given natural structure is de facto ideally structured, with an important caveat. Galen’s organizing principle or demiurge works to organize materials that are already present in the world. It cannot create a structured world ex nihilo. Consequently, it is constrained by the nature of the causal principles and the materials with which it works. This notion is not original to Galen. Aristotle’s teleological views also suppose certain practical constraints on the structures found in the world, which he calls hypothetically or contingently necessary (ἀναγκὴ ἐξ ὑποθέσεως).44

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See, e.g., AA xv.2 (227 Duckworth). Cf. AA 6.1 (544–546 Garofalo = ii.537–538 K.). Cf. Aristotle PA 1.1, 639b21–640a9, 642a1–13, and 642a31–b4. See also, Hankinson (1989), which discusses Galen’s teleological views as well as the role that hypothetical or material necessity plays in them.

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From the claim that all natural structures are end-oriented, Galen concludes that there is a primary end in relation to which each kind of structure is directed. Insofar as they are more complex structures, organs often perform more than one function or activity. As we will see, the elephant’s trunk is a ready example of this phenomenon. In virtue of the teleological character of the world, Galen can say of a given structure not only that it is ideally structured but also that its structure is the ideal structure for the function it performs. Aristotle’s teleological views are less restrictive, and in certain cases he is explicit that a given organ is suboptimal in its structure or position.45 While both Aristotle and Galen considered that the material out of which a structure was composed could place constraints on its activities, Galen is less prone to discussing anatomical structures as imperfect for their ends. Galen supposes that once he has seen an organ in operation on a number of occasions—he does not offer more than a vague quantification—he can determine its function(s). After having done so, he can work retrospectively from a given biological activity to the organ(s) that carry it out. Since he believes that an activity is performed by a structure whose morphology is ideal for that end, Galen concludes that he can expect to find the same activity performed by structurally and functionally analogous organs in different animals. As we have seen, Galen’s approach was perforce comparative in virtue of the fact that dissection of human cadavers was not systematically practiced in the second century.46 The risk of false analogy notwithstanding, Galen’s solution elegantly addressed the technological and social constraints of his time.

3

Elephants

When the need arose for Galen to consider structures that were especially minute in humans and other similarly sized animals, elephants were the largest anatomical analogues available to him. Furthermore, elephants had already figured in earlier anatomical writing, although not as enlarged analogues of human anatomy. Scarborough has conjectured that the emergence of anatomical accounts of the elephant in the fourth century bce was likely a result of Alexander’s conquests, which seems plausible even if, as he admits, not cer-

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See, e.g. Aristotle’s comments on the poor position of the windpipe in air-breathing animals at PA 3.3, 664a35–665a26, or the position of the ears in human beings at PA 2.10, 656b26–31. Cf. Aristotle PA 2.11, 657a11–17. See pp. 104–5 and notes.

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tain.47 Aristotle makes anatomical claims about elephants in at least three treatises.48 His near contemporary Mnesitheus of Athens also wrote on elephantine anatomy, although Mnesitheus’ work is unfortunately lost.49 In the passage from Anatomical Procedures with which I began this chapter,50 Galen makes two points pertinent to this discussion: the elephant offered up a level of anatomical amplification far beyond that of his standard fare (e.g., oxen, horses, mules, and asses) and it was a very unusual specimen. If one accepts Galen’s view that organs (or at least certain organs) are structurally analogous across animal kinds, anatomical evidence derived from the elephant’s larger anatomy presents Galen with directly observable examples of structures that would hitherto have been unobservable, or hidden (ἄδηλα) in the more technical sense that one finds in the medical and philosophical debates still current in the second century.51 Galen considers the activity of the elephant’s trunk to be further evidence of the deep teleological structure of the natural world. And, it is this structure that underwrites his belief in the fundamental analogy between the internal organs of different animal kinds. Galen’s attempts to make these structures observable are unlikely to have swayed certain opponents. Medical Empiricists, in particular, denied the validity of inferences made from observable phenomena to things that were imperceptible or hidden (ἄδηλα).52 Besides this epistemological objection, they also denied that dissection was therapeutically useful on the grounds that inferences from the dead and their organs to the living and theirs

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Scarborough (1985a: 127). See, e.g., Aristotle PA 2.16 and 2.17, 25–29; and variously throughout HA and GA. Very little is known about Mnesitheus of Athens, except that he was active in about the fourth century bce. Galen mentions him elsewhere and notably praises him for being second to none in his systematic pursuit of the medical art. See, e.g., MMG 1.1 (xi.3 K.) The claims about the elephant that Galen ascribes to him here are mirrored in Aristotle HA 2.15, 506b1–4. It is unclear whether one of the two authors influenced the other or this information is derived from an independent source. On Mnesitheus, see Bertier (1972), which contains a collection of the testimonia. AA xiii.8 (171 Duckworth). Cf. AA xv.3 (236 Duckworth): “As for the veins and arteries themselves, you cannot clearly see the conjunction and union of the nerves with them, unless the animal itself is of very large size as for instance the ox, horse, mule, camel, or elephant”. On medical and philosophical debates over inference from observable signs to hidden ones, see, e.g., Allen (2001: 87–146); Ebert (2005); and Pellegrin (2005). On the issue of sign inference more generally, see, e.g., Allen (2001) and Sedley (1982). For Galen’s approach to sign inference, see Hankinson (2008b) and Tieleman (2008). On some of the epistemological views of medical Empiricists, see Edelstein (1967b); Frede (1987b), (1987c), (1990); and Hankinson (1995).

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were unreliable. Regardless, however, of the Empiricist’s response to Galen’s arguments, his investigation of structurally analogous but larger anatomical structures cleverly attempts to meet a demand that he himself placed on medical epistemic claims: the empirical confirmation of objects of belief. In that Galen comes to investigate these smaller structures by first observing larger versions of them on an enlarged surface, his heuristic method bears affinities with Plato’s method of inquiry into the parts of the human soul in the second book of the Republic, as I have suggested earlier in this chapter. Furthermore, two of Galen’s three anecdotes about the elephant have special relevance to his reading of Plato’s physio-anatomical beliefs. In addition to his discussion of the elephant’s prehensile trunk, Galen’s accounts of the elephant aim at magnifying the comparably minute structure of the human liver and heart, the organs where Plato traditionally located the desiderative (epithumētikon) and spirited (thumoeides) parts of the soul.53 On Galen’s reading, these organs were of crucial importance to Plato’s analysis of the soul as tripartite—along with the brain, which was the seat of the rational (logistikon) part of the soul. As I will argue, Galen’s elephantine examples, in particular the heart bone and gallbladder episodes, are muted attacks against cardiocentrists. Given the importance of the liver and heart to Plato’s tripartite analysis of the soul, it would be both very clever and tidy of Galen to use a cluster of allusions to the Republic in defense of encephalocentrism. These episodes also target thinkers whose views of the body did not share Galen’s commitment to the deep teleological structure of the world, in particular Erasistratus, Erasistrateans, and Aristotle himself.

4

Aristotle, Teleology, and the Elephant’s Trunk

In the last book of The Function of the Parts, Galen recounts the story of his first encounter with an elephant. The episode belongs to a section of what Galen himself calls an Epode (ἐπῳδός) to the treatise.54 The last book of The Func-

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In the Timaeus, Plato situates the rational (logistikon) part of the soul in the brain (44d3– 6), the spirited (thumoeides) in the chest between the mid-riff and the neck (69d6–70a2), and the desiderative (epithumētikon) between the mid-riff and navel (70d7–71e2). While Plato does discuss both the heart and liver in these contexts, he does not explicitly identify the organs as the seats of the respective parts of the soul. The association of the desiderative part with the liver becomes more fixed in the later reception of the Timaeus. Galen strongly connects the two throughout his writing. UP 17.3 (ii.451.20–27 Helmreich = iv.365–366 K.): ὁ λόγος οὗτος ὥσπερ ἀγαθός τις ἐπῳδὸς

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tion of the Parts, he says, is like a hymn to the structure of the natural world sung before the altars of the gods. Both book division and title are Galen’s, who writes: “I have given this treatise the name of [Epode] metaphorically, likening it to [an epode]” (ἐκείνῳ τοίνυν εἰκάσας τὸν λόγον τόνδε τὴν προσηγορίαν αὐτοῦ μετήνεγκα). While there are other wrought sections of the book, Galen’s experience with the elephant is its centerpiece.55 Galen begins with his reaction to the animal’s trunk: at first the organ seems ungainly and useless to him, that is, until he sees that it is prehensile. Galen’s anecdote about the elephant’s trunk and its prehension forms a ring composition with the opening of The Function of the Parts, which, like Anatomical Procedures begins with the anatomy of the hand. The position of Galen’s discussion of the hand is deliberate and significant. Galen’s anatomical treatises broke with the more traditional ordering of earlier anatomical writing that proceeded from head to foot (capite ad calcem). They also broke with the earlier anatomist Marinus’ innovative arrangement of his anatomical work, which began with the skin and moved inward.56

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ἐξηγεῖται. λέγω δ’ ἐπῳδὸν οὐ τὸν ἐπῳδαῖς χρώμενον· ἀλλ’ ἴσμεν γάρ, ὡς [ὁ] παρὰ τοῖς μελικοῖς ποιηταῖς, οὓς ἔνιοι λυρικοὺς ὀνομάζουσιν, ὥσπερ στροφή τίς ἐστι καὶ ἀντίστροφος, οὕτω καὶ τρίτος ἐπῳδός, ὃν ἱστάμενοι πρὸ τῶν βωμῶν ᾖδον, ὥς φασιν, ὑμνοῦντες τοὺς θεούς. ἐκείνῳ τοίνυν εἰκάσας τὸν λόγον τόνδε τὴν προσηγορίαν αὐτοῦ μετήνεγκα. Cf. Aristotle PA 1.5, 644b21–645b14. On Galen’s rhetorical style and strategies in The Function of the Parts, see Flemming (2009) and Petit (2018: 163–209). Petit examines Galen’s claim that he intends the final book of the treatise to be an epode, as though completing a hymn to the gods. She argues that the work as a whole may be read as a prose hymn, comparable to those of Aelius Aristides, and therefore part of a literary vanguard in the Imperial period. In this vein, Petit draws attention to the ekphrastic features of Galen’s anatomical prose in The Function of the Parts—this can observation can be extended to Anatomical Procedures—as appealing to the cultural sensibilities of second-century elite intellectuals in Rome. See Petit (2018: 207): “Ce faisant, Galien rattache consciemment son œuvre non seulement à une tradition médico-philosophique bien établie et renommée, mais aussi à l’ univers de la Seconde Sophistique: l’éloge du corps humain, chef d’ œuvre du démiurge, est assimilée à un objet d’art, un objet d’émerveillement dont la perfection échappe au langage— mais que le discours permet d’ériger en témoignage de piété, en offrande spectaculaire a un dieu invisible, la Nature. Le principe même d’ un ‘hymne en prose’, genre nouveau que Galien a probablement en tête quand il écrit le De usu partium, montre le rôle particulier de ce morceau d’éloquence épidictique. De nouveau, le spectre de l’ enargeia se profile à l’arrière-plan du De usu partium: ici, l’art des hommes n’est pas au centre du discours comme il peut l’être chez Philostrate, mais il sert de comparant, de faire-valoir à l’art véritable, l’art divin du démiurge. Si l’homme est le chef d’ œuvre de la Nature, alors le De usu partium est le chef d’œuvre de Galien, celui qui réunit sa piété, son savoir, son art rhétorique. C’est donc aussi un chef d’œuvre (négligé) de la Seconde Sophistique”. For further discussion of Galen’s choice of the hand as a starting point for his anatomical

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For Galen, as for Aristotle, the hand was an organ whose activity was a sign not only of human intelligence but also of the goal-directed structure of the natural world.57 Galen adopts and repurposes Aristotle’s treatment of the hand in more ways than this. Like Aristotle, Galen invokes the hand as a pointed illustration of his disagreement with theorists who rejected his teleological analysis of the natural world: Thus human beings are the cleverest of animals, and thus also hands are the appropriate tool for a clever animal. For it is not the case that human beings are the cleverest in virtue of the fact that they have hands, as Anaxagoras is accustomed to say. It is the case, rather, that human beings have hands in virtue of the fact that they are most clever, as Aristotle quite rightly says.58 Galen’s placement of the hand at the start of his work foregrounds the importance of his teleological commitments to anatomical research. As in the case of the hand that ushers in Galen’s account of the function(ality) of the parts of the body, the elephant’s trunk brings the work to a close as a proof of the goaloriented structure of the natural world. For all of its personal detail, however, Galen’s account of the elephant’s trunk also appears to be an Aristotelian inheritance. It appears to have been based, at least in part, on Aristotle’s accounts of the elephant’s trunk in Parts of Animals and Historia Animalium. For example, Aristotle writes: “Elephants have a long and powerful nostril; and they use [the nostril] as a hand (χρῆται αὐτῷ ὥσπερ χειρί). For, unique among animals, the elephant reaches and grabs with its nostril and draws wet and dry food towards its mouth”.59 This is an abbreviated version of his longer account in Parts of Animals, which stresses the prehensile character of the elephant’s trunk:

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work, as well as earlier organizational systems in Greek and Roman anatomical writing, see Flemming (2007: 241–277). See UP 1.4 (i.6.15–17 Helmreich = iii.9 K.). UP 1.3 (i.3.25–4.5 Helmreich = iii.5 K.): Οὕτω μὲν σοφώτατον τῶν ζῴων ἄνθρωπος, οὕτω δὲ καὶ χεῖρες ὄργανα πρέποντα ζῴῳ σοφῷ. οὐ γὰρ ὅτι χεῖρας ἔσχε, διὰ τοῦτο σοφώτατον, ὡς Ἀναξαγόρας ἔλεγεν, ἀλλ’ ὅτι σοφώτατον ἦν, διὰ τοῦτο χεῖρας ἔσχεν, ὡς Ἀριστοτέλης φησὶν ὀρθότατα γιγνώσκων. The hand as evidence of human intelligence and of the teleological tendencies of the natural world is an Aristotelian topos. See, e.g., Aristotle PA 4.10, 687a7–22. Aristotle HA 1.11, 492b17–21: τοῖς δ’ ἐλέφασιν ὁ μυκτὴρ γίνεται μακρὸς καὶ ἰσχυρός, καὶ χρῆται αὐτῷ ὥσπερ χειρί· προσάγεταί τε γὰρ καὶ λαμβάνει τούτῳ καὶ εἰς τὸ στόμα προσφέρεται τὴν τροφήν, καὶ τὴν ὑγρὰν καὶ τὴν ξηράν, μόνον τῶν ζῴων.

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Relative to other animals, this organ [i.e., its nose or trunk] in the elephant is very peculiar; for it is prodigious in size and power. The trunk is the organ with which it bears dry and wet food to its mouth, as though it were using a hand (καθάπερ χειρὶ χρώμενος). And when it winds its trunk around branches and pulls them down (περιελίττων ἀνασπᾷ), it also uses its trunk as if it were a hand.60 Aristotle also compares the elephant’s trunk to the breathing machines used by Greek divers who remain submerged in water for extended periods of time: … Nature made the length of their nostrils something of this sort (i.e. a form of snorkel) for elephants. So, if ever they make their way through water, they breathe by raising their nostrils up through the water (ἀναπνέουσιν ἄραντες ἄνω διὰ τοῦ ὕδατος τὸν μυκτῆρα). For, just as I said earlier, the trunk is a nose for elephants.61 From this comparison two points emerge: First, the trunk is like a hand; second, it is used to breathe when the elephant is submerged in water.62 That Galen’s account of the elephant’s trunk in The Function of the Parts draws from Aristotle is made more convincing by the following numbered passages, which are continuous with one another in Galen’s text. They are taken from the Galen’s account of his first encounter with an elephant in the so-called Epode of The Function of the Parts:

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Aristotle PA 2.16, 658b33–659a2: Ὁ δ’ ἐλέφας ἰδιαίτατον ἔχει τοῦτο τὸ μόριον τῶν ἄλλων ζῴων· τό τε γὰρ μέγεθος καὶ τὴν δύναμιν ἔχει περιττή. μυκτὴρ γάρ ἐστιν ᾧ τὴν τροφὴν προσάγεται, καθάπερ χειρὶ χρώμενος, πρὸς τὸ στόμα, τήν τε ξηρὰν καὶ τὴν ὑγράν, καὶ τὰ δένδρα περιελίττων ἀνασπᾷ, καὶ χρῆται καθάπερ ἂν εἰ χειρί. The full account runs from PA 2.16, 658b27–659a36. Aristotle PA 2.16, 659a11–15: … τοιοῦτον ἡ φύσις τὸ τοῦ μυκτῆρος μέγεθος ἐποίησε τοῖς ἐλέφασιν. διόπερ ἀναπνέουσιν ἄραντες ἄνω διὰ τοῦ ὕδατος τὸν μυκτῆρα, ἄν ποτε ποιῶνται δι’ ὑγροῦ τὴν πορείαν· καθάπερ γὰρ εἴπομεν, μυκτήρ ἐστιν ἡ προβοσκὶς τοῖς ἐλέφασιν. May (1968: 725 n. 3) takes these passages and their surrounding context as a clear indication that Galen has used Aristotle as a source for the centerpiece of his Epode. Scarborough (1985a: 129–130 & notes) follows suit and asks the further question, “[w]hy has Galen chosen to base his description of the anatomy and function of the elephant’s trunk upon Aristotle?”. And while May does not include what exactly in these passages makes it clear to her that Galen has based his account on them, Scarborough appeals to sections of the two Aristotelian tracts, from which I have excerpted the passages above. Cf. Scarborough (1985a: 129): “Shrewd reasoning by analogy, as well as careful reading of Aristotle’s texts on comparative anatomy, led Galen to generally accurate conclusions about the elephant, even though ‘dissections’ might not have been performed. Therefore, one can be suspicious also of the purported ‘dissections’ of various exotic animals and birds as listed …”.

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(1) At any rate, let me detail what I felt when I first witnessed (ἐθεασάμην) the elephant. This will be apparent to those who have seen the animal already and for those who have not seen, this will not be at all difficult if they apply their mind to what they are about to read … this thing [the trunk] seemed bizarre and useless to me when I first witnessed it (ἐμοὶ θεασαμένῳ). But when I saw (εἶδον) the animal using it, just as a hand (ὥσπερ χειρί), then it did not appear useless any longer as the function of the part was linked to the function of the action. For the function of a part becomes plain in the midst of its use in action (φαίνεται). The elephant manipulates everything with that part at the end (of the trunk), enfolding what it grabs, even the smallest coins, which it then gives to those who are seated on it by stretching the trunk up to them. For this is how they call this aforementioned part.63 In passage (1) Galen primarily uses verbs of seeing to tell the reader about the elephant: when he first witnessed its trunk (πρῶτον ἐθεασάμη), how useless it appeared at first (τοῦτ’ ἐμοὶ θεασαμένῳ τὸ πρῶτον ἔδοξεν εἶναι περιττόν τε καὶ ἄχρηστον), and how he came to change his mind when he saw it in action (ἐπεὶ δ’ ἐνεργοῦν αὐτῷ τὸ ζῷον εἶδον). As the passage progresses, his language still seems to describe visual experiences: that the part was not useless became clear (ἐφάνη) and then its use became apparent (φαίνεται). It becomes increasingly more ambiguous, however, whose visual experiences Galen is reporting. At the end of passage (1), Galen simply describes the elephant’s ability to hand coins to its riders. He does not say whether this information comes to him from firsthand experience, anecdote, or some other source, but the detail bears affinities with Aristotle’s account of the elephant’s trunk in Historia Animalium: [The elephant] has a nose of such a sort and such a length that it possesses it in the place of hands. For it drinks and eats by passing things to its mouth with it, and it [hands things up] to its rider (καὶ τῷ ἐλεφαντιστῇ

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UP 17.1 (ii.438.9–439.3 Helmreich = iv.348–349 K.): ἐγὼ γοῦν, ὅπερ ἔπαθον, ὅτε πρῶτον ἐθεασάμην ἐλέφαντα, διηγήσομαι, τοῖς μὲν ἑωρακόσι τὸ ζῷον ἑτοίμως νοηθησόμενον, ὅσοι δ’ οὐκ εἶδον, εἰ πρόσσχοιεν τὸν νοῦν τοῖς λεχθησομένοις, οὐ πάνυ χαλεπῶς … τοῦτ’ ἐμοὶ θεασαμένῳ τὸ πρῶτον ἔδοξεν εἶναι περιττόν τε καὶ ἄχρηστον. ἐπεὶ δ’ ἐνεργοῦν αὐτῷ τὸ ζῷον εἶδον ὥσπερ χειρί, τότ’ οὐκέτ’ ἄχρηστον ἐφάνη, συναφθείσης τῷ τῆς ἐνεργείας χρησίμῳ τῆς χρείας τοῦ μορίου· διὰ μέσου γὰρ τοῦ κατὰ τὴν ἐνέργειαν χρησίμου τὸ τοῦ μορίου χρήσιμον φαίνεται. ὁ γοῦν ἐλέφας ἐκείνῳ τῷ μορίῳ κατὰ τὸ πέρας ἅπαντα μεταχειρίζεται περιπτυσσομένῳ τοῖς λαμβανομένοις ἄχρι καὶ τῶν σμικροτάτων νομισμάτων, ἃ καὶ τοῖς ἐπικαθεζομένοις αὑτῷ δίδωσιν ἀνατείνων τὴν προνομαίαν ἐπ’ αὐτούς· οὕτω γὰρ ὀνομάζουσι τὸ προκείμενον ἐν τῷ λόγῳ μόριον.

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[ἀνορέγει ἄνω]) and also pulls trees [toward its mouth] with it and when it walks through water it breathes with it.64 While Galen’s description of the tip of the trunk engulfing coins to handle them seems similar in important respects to Aristotle’s description of the trunk handing things to its rider(s), the similarity may simply reflect the routine nature of the behavior under description: elephants use their trunks to manipulate things, to feed themselves, and to pass things. Although hardly conclusive, the basic structure is the same as Galen’s account in passage (1): The trunk is observed to function as a hand. It enfolds and draws things in. It hands things to its riders. The similarities become more striking, though, when considered in the aggregate and alongside the remainder of Galen’s account: (2) And when I learned (προσεπυθόμην) that whenever the animal wades through a deep river or lake and its body is completely submerged it breathes through its trunk after extending it upwards, not only did I come to know (ἔγνων) that nature was provident because it fashions every single part of the animal, but also because it teaches the animal how to use the parts. A fact that I pointed out at the beginning of this whole treatise.65 In passage (2) Galen says that he has come to know nature’s providential character through what he has learned about the elephant’s trunk. Galen’s language (προσεπυθόμην) suggests that this information about the elephant’s activities comes to him secondhand;66 gone is any indication of what he has seen for himself. The details of passage (2) should recall Aristotle’s comments on the elephant’s use of its trunk as a snorkel.67 The passage from The Function of the Parts offers not just the same vivid example of the elephant breathing while 64

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Aristotle HA 2.1, 497b26–29: ἔχει δὲ μυκτῆρα τοιοῦτον καὶ τηλικοῦτον ὥστε ἀντὶ χειρῶν ἔχειν αὐτόν· πίνει γὰρ καὶ ἐσθίει ὀρέγων τούτῳ εἰς τὸ στόμα, καὶ τῷ ἐλεφαντιστῇ ἀνορέγει ἄνω τούτῳ καὶ δένδρα ἀνασπᾷ, καὶ διὰ τοῦ ὕδατος βαδίζων τούτῳ ἀναφυσᾷ. UP 17.1 (ii.439.17–440.3 Helmreich = iv.349 K.): ἐπεὶ δὲ προσεπυθόμην, ὅτι, κἀπειδὰν διὰ ποταμοῦ βαθέος ἢ λίμνης ὁδοιπορῇ τὸ ζῷον, ὡς ἤδη κατακρύπτεσθαι πᾶναὐτοῦ τὸ σῶμα, τὴν προνομαίαν ταύτην ἀνατεῖνον εἰς ὕψος ἀναπνεῖ δι’ αὐτῆς, ἔγνων οὐ μόνον τῷ κατασκευάζειν ἅπαντα καλῶς τὰ μόρια τοῦ ζῴου προνοητικὴν τὴν φύσιν, ἀλλὰ καὶ τῷ διδάσκειν αὐτὸ τὴν χρῆσιν αὐτῶν, ὅπερ ἐδείχθη μοι καὶ κατὰ τὴν ἀρχὴν ὅλης τῆς πραγματείας. To my knowledge the earliest comment on Galen’s language in this passage is May (1968: 725 n. 3). Hankinson (1988b: 148–150) fleshes out May’s observation. He interprets Galen’s language as evidence of his eclectic or syncretic epistemological views on medical methodology. He takes this passage as being sympathetic to Empiricist views without the added skepticism regarding anatomy and analogy. Aristotle PA 2.16, 659a11–15.

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underwater through its extended trunk, but also serves to illustrate a similar teleological point about the part. Here the example is more clearly parallel to Aristotle’s discussion of the elephant’s trunk in both Parts of Animals and Historia Animalium, since the circumstances required for the observation Galen mentions are far more specific: The elephant wades into water, extends its trunk upward into the air, and uses the trunk to breathe. Galen’s examples of the elephant’s trunk as evidence for the teleological structure of the natural world are reducible to two activities: prehension and respiration.68 These activities are illustrated by (1) manipulating everything with the trunk and handing things to riders, and by (2) extending its proboscis to breathe air while wholly submerged in water, as though through a snorkel. Hankinson has argued that in the Epode the trunk is emblematic of Galen’s zero-sum teleological commitments and what he calls the “No Redundancy Assumption”, according to which the world is structured with and only with the parts necessary for a given set of activities.69 I agree with Hankinson’s main thesis—that the episode of the elephant’s trunk in The Function of the Parts is an expression of Galen’s teleological commitments—and would like to add something to it, which takes its genesis from two passing comments in the same article. The first involves Aristotle’s weaker teleological commitments.70 The second is the observation that elephants seem to attract quite a bit of anecdotal attention, which Hankinson conjectures may be due to their unusual size and their rarity.71 For Galen the elephant’s size is a crucial factor in its usefulness as an anatomical example, although not only because of the awe that the creature’s size inspires. Rather, its usefulness is due to what its great size—when taken in conjunction with a system for anatomical analogy—can show about the human body to those who witness the larger anatomy of the elephant on display, in person or in print. Galen concludes his example of the elephant trunk with an account of what he discovered upon his dissection of it. The anecdote further

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Aristotle includes a further example of the elephant using its trunk as a hand, to rip up trees, at HA 2.1, 497b27. Hankinson (1988b: 146) and (1989: 225) formally lay out Hankinson’s explanation of what I am calling Galen’s zero-sum teleological commitments. In brief, the argument is that there will be no superfluities in nature if there is a benevolent and skillful creator. There is such a creator therefore there are no superfluities, which is to say that the world is very strongly teleologically structured. For the related “No Redundancy Assumption” and its corollary “Principle of Creative Economy”, see Hankinson (1988b: 153–154). Hankinson (1988b: 137–138). Hankinson (1988b: 138 n. 9) and (1988b: 148 n. 28) respectively.

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echoes passages in Aristotle’s writing and suggests a subtle criticism that Galen may be making of his cardiocentrism: (3) But later, when I saw (ἰδών) that it was pierced at the tip and when I learned (ἐπιμαθὼν) that the animal breathes through these holes as sorts of nostrils, I came to know (ἔγνων) quite clearly that the part was also useful for this [use]. And when an elephant died, after cutting (ἀνατεμὼν) open the two channels, which stretch from the very orifices to the base of the part, I discovered (εὗρον) two terminus points, as in us; one went so far as the brain itself and the other passed through into the mouth. I was even further amazed (ἐθαύμασα) at nature’s craftsmanship.72 Galen’s claim about the points of termination for the channels of the elephant’s trunk has special relevance to his theory of respiration, and by extension to his beliefs about the physiology of the brain. It is on this final point, in particular, that Galen finds great fault with Aristotle and later cardiocentrists. We can pass over the second channel that Galen mentions as passing into the mouth; it is the windpipe. The first, however, reflects Galen’s belief that during respiration a small amount of an important air-like substance called “pneuma” passed through perforations in the skull above the nasal cavity.73 During its passage, this material is elaborated into psychic pneuma, a substance with which Galen explained sensory-motor and rational function in animals. Cardiocentrists denied that the brain was responsible for these physiological processes, which they assigned to the heart. And, indeed, this point of theoretical difference was one of the main flashpoints for debate between Galen and his cardiocentrist rivals. In the larger context of the Epode, Galen’s language reveals that he has taken some care in distinguishing between those views he has encountered through historia and views he holds on the basis of anatomy and autopsia. What Galen comes to know (or confirm) by this combination of anatomy, autopsia, and historia, is that nature is in a very robust sense demiurgic. On this point it is unsurprising that Galen may have drawn more than just inspiration from Aristotle’s 72

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UP 17.1 (ii.439.8–17 Helmreich = iv.349 K.): ὕστερον δὲ καὶ ὡς τέτρηται κατὰ τὸ πέρας ἰδών, ἐπιμαθὼν δὲ διὰ τῶν τρημάτων τούτων οἷα μυκτήρων ἀναπνεῖν τὸ ζῷον, ἔγνων δηλονότι καὶ κατὰ τοῦτο χρήσιμον ὑπάρχον τὸ μόριον. ἐπεὶ δὲ καὶ τεθνεῶτος ἐλέφαντος ἀνατεμὼν ἄχρι τῆς ῥίζης τοῦ μορίου τοὺς ἐκ τῶν τρημάτων ἀνατεινομένους πόρους εὗρον αὐτῶν ὁμοίως τοῖς ἐν ἡμῖν διττὴν τελευτήν, μίαν μὲν εἰς αὐτὸν ἀνήκουσαν τὸν ἐγκέφαλον, ἑτέραν δ’ εἰς τὸ στόμα συντετρημένην, ἔτι καὶ μᾶλλον ἐθαύμασα τῆς φύσεως τὴν τέχνην. This area of the skull is now known as the “cribriform plate”; its perforations allow the passage of olfactory nerves from the brain to the nasal cavity.

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biological writing. Aristotle was, perhaps more than any other ancient author, associated with teleological accounts of the natural world. Galen’s account of the elephant’s trunk aligns him with Aristotle’s authority and demonstrates his sophisticated engagement with Aristotle’s work. Galen’s account of the elephant’s trunk, however, deviates from Aristotle’s in important ways. In passage (3), the final piece of evidence he adduces for his belief is that the elephant’s trunk is structurally and functionally analogous to the human nose because its channels are involved in the elaboration and distribution of pneumatic material to the brain. After showing the reader that he is well-aware of Aristotle’s writing on the subject, Galen issues a subtle but important corrective of his work.74 The observations I have made regarding Galen’s approach to magnification, anatomical analogy, and the views of rival theorists are an important point of contact between his account of the elephant’s trunk, his curious account of its gallbladder, which I discuss presently, and the so-called heart bone, which I discuss in chapter four. Galen’s discussion of the trunk restricts itself mainly to external and non-invasive observations. His accounts of the gallbladder and heart-bone, however, involve the elephant’s internal anatomy. In addition to Aristotle, they bring his criticism to bear on Erasistratus and contemporary Erasistrateans for their commitments to teleological explanation, while they further develop Galen’s critical engagement with Aristotle and second-century cardiocentrists for their views on the primacy of the heart as the control center of the body.

5

Teleology, Humoralism, and the Elephant’s Gallbladder

The only testimony that survives for the writing of Mnesitheus of Athens on the anatomy of the elephant is a passage in Galen’s Anatomical Procedures about its gallbladder:75 All blooded animals possess all of these organs (i.e., alimentary), not just the six classes; and they all possess a liver. And whichever animals have a liver, these also, in all cases, have a spleen and bile ducts. But not all of these animals have a gallbladder, which draws off yellow bile, attached to [the liver]. Those who have written on all [the animals] that they claim 74 75

As we will see, this model of intellectual engagement is typical of Galen and his use of doxographical exegesis to undercut rival theorists. See p. 120, n. 49.

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lack [a gallbladder], like Mnesitheus on the elephant, do not tell the truth. For this animal has a gallbladder attached to the liver, which is analogous in size to the entire organ (ἀνάλογον ἔχουσα τὸ μέγεθος ὅλῳ τῷ σπλάγχνῳ). And there is a single position for the animals that have a gallbladder in every case, in the largest lobe of the liver.76 Galen’s claim at the outset of this quotation is an example of the sort of argument that his robust teleology allows him to make about certain organs. The bodies of blooded animals all perform certain biological functions in virtue of being blooded, especially those processes that are closely associated with the brain, cardio-pulmonary system, and the liver (e.g., respiration, digestion, hematopoiesis, the production of humors, etc.).77 Where functions are the same, Galen argues that the organs performing those functions will also be the same in structure. Consequently, he can say of all blooded animals that they have alimentary organs, a liver, spleen, and bile ducts in virtue of the fact that they digest food. The phlegm that results from digestion is produced in the stomach. Blood is produced in the liver. The spleen draws black bile from the blood, while the bile ducts draw yellow bile from it.78 76

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AA 6.8 (590.5–17 Garofalo = ii.569 K.): ἅπαντ’ οὖν ταῦτα πᾶσι τοῖς ἐναίμοις ὑπάρχει ζῴοις, οὐ μόνοις τοῖς ἓξ γένεσιν. ὑπάρχει δ’ αὐτοῖς καὶ τὸ ἧπαρ ἅπασιν. οἷς δ’ ἧπάρ ἐστι, τούτοις καὶ σπλήν ἐστι πάντως, καὶ πόροι χοληδόχοι. κύστις δ’ οὐ πᾶσιν ἐπ’ αὐτῷ πέφυκεν, ἀθροίζουσα τὴν πικρὰν χολήν. οὐ μὴν οὐδὲ ἀληθεύουσιν οἱ γράψαντες ἐπὶ πάντων, οἷς οὐκ εἶναί φασιν αὐτὴν, ὥσπερ καὶ Μνησίθεος ⟨περὶ⟩ ἐλέφαντος. ἔστι γὰρ καὶ τούτῳ κύστις ἐπὶ τοῦ ἥπατος, ἀνάλογον ἔχουσα τὸ μέγεθος ὅλῳ τῷ σπλάγχνῳ. καὶ θέσις γε μία τοῖς ἔχουσιν αὐτὴν ζῴοις ἐστὶ διαπαντὸς, ἡ κατὰ τὸν μέγιστον τῶν λοβῶν τοῦ ἥπατος. For the testimonium in Bertier (1972), see p. 225. For Galen’s six classes of animals: humans, apes, bears, carnivores, swine, single-hooved animals, and ruminants, see AA 6.3 (558–560 Garofalo = ii.547–548 K.), Garofalo (1991b), and my discussion earlier in this chapter. I will return to this point shortly. Galen gives a brief account of the production of the four humors and the organs responsible for their purgation at At.Bil. 8 (CMG v 4,1,1 89.11–23 = v.139–140 K.): “I have demonstrated that the phlegmatic humor arises from phlegmatic foods during the first stage of digestion (pepsis) in the stomach, just as the yellow-bilious humor and the black-bilious one come to be in the liver. Since the phlegmatic humor changes into blood during a process of digestion in this organ—for this reason—there is no individual organ for the purgation of phlegm like both bladders (i.e., the gallbladder and urinary bladder) and the spleen. The former are for the purgation of yellow bile and serous waste, while the spleen is for the purgation of black-bilious humor. What is produced in the stomach is carried out by the humors that arise from food and liquids when they are conveyed to the liver, and it becomes blood after it is concocted along with them. But what is left behind in the spaces in the stomach is expelled through the lower part of the stomach after being flushed out by the bile flowing from the liver to them”. (δέδεικται δὲ ἡμῖν ὁ μὲν τοῦ φλέγματος χυμὸς ἐκ τῶν φλεγματικῶν ἐδεσμάτων κατὰ τὴν πρώτην ἐν τῇ γαστρὶ πέψιν γενόμενος, ὥσπερ ὁ πικρόχολός τε καὶ ὁ μελαγχολικὸς ἐν ἥπατι, μεταβάλλων τε κατὰ τὴν

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Galen refers to an unnamed group of authors (οἱ γράψαντες), who he says make false claims about which animals lack a gallbladder. While he has named Mnesitheus in similar contexts, Aristotle also writes about the elephant and its lack of gallbladder. In a long section of his Historia Animalium, on the animals that possess a gallbladder and those who do not, Aristotle writes: The elephant also has a liver without a gallbladder (ἄχολον) attached, although when a cut is made around the place where a gallbladder is attached (οὗ τοῖς ἔχουσιν ἐπιφύεται ἡ χολή)79 in those who have one, a little or a lot of bilious fluid flows out.80 It is very likely that Galen would have read this passage, given the extent of his engagement with Aristotle on biological issues in Anatomical Procedures, his attention to Aristotle’s discussions of the elephant’s trunk, and the time he specifically devotes to Aristotle’s description of the heart and elephantine heart elsewhere in Historia Animalium. I believe that Galen has Aristotle’s account in his mind and in his sights here.81 What, then, accounts for Galen’s surprising difference of opinion, especially as Aristotle and Mnesitheus turn out to be right? The elephant has no gallbladder.82 It is possible that Galen simply mistook some structure attached to an elephant’s liver for a gallbladder. But, the answer seems unlikely. The elephant’s liver is truly immense. To put the size of the organ in perspective, it helps to

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ἐν τούτῳ πέψιν καὶ ὁ φλεγματικὸς εἰς αἷμα καὶ διὰ τοῦτο μηδὲν γεγονὸς ἴδιον ὄργανον εἰς κάθαρσιν τοῦ φλέγματος, ὥσπερ αἵ τε κύστεις ἀμφότεραι καὶ ὁ σπλήν, αἱ μὲν τοῦ τε πικροχόλου καὶ τῶν ὀρρωδῶν περιττωμάτων, ὁ δὲ σπλὴν τοῦ μελαγχολικοῦ χυμοῦ. τὸ μὲν γὰρ ἐν τῇ γαστρὶ γεννώμενον συναναφέρεται τοῖς εἰς ἧπαρ ἀναδιδομένοις ἐκ τῶν ἐσθιομένων τε καὶ πινομένων χυμοῖς, ἅμα δὲ τούτοις πεττόμενον αἷμα γίνεται· τὸ δὲ ὑπολειπόμενον ἐν τοῖς κατὰ τὴν γαστέρα χωρίοις ὑπὸ τῆς καταρρεούσης ἐξ ἥπατος εἰς αὐτὰ χολῆς ἀπορρυπτόμενον ἐκκρίνεται διὰ τῆς κάτω γαστρός). The word I have rendered as “gallbladder” here is χολή, which is ambiguous in Aristotle’s writing. It can mean “bile” as well as “gallbladder” (see Lennox 2001: 288–289 and Kullmann 2003: 27, n. 25). In this passage and its surrounding context, Aristotle makes it clear that he is discussing animal organs rather than fluids such as bile. On χολή as referring to the gallbladder here, see Kullmann (2007: n. 676bn25 ff., p. 617). Aristotle HA 2.15, 506b1–3: ἔχει δὲ καὶ ὁ ἐλέφας τὸ ἧπαρ ἄχολον μέν, τεμνομένου μέντοι περὶ τὸν τόπον οὗ τοῖς ἔχουσιν ἐπιφύεται ἡ χολή, ῥεῖ ὑγρότης χολώδης ἢ πλείων ἢ ἐλάττων. For Galen’s access to and likely reading of Aristotle’s biological works, see Moraux (1985). It is, of course, possible that Galen simply misattributed this account of the gallbladder to Mnesitheus on the basis of some similarity with Aristotle’s. Given the exiguous nature of Mnesitheus work, it is impossible to gauge how (un)likely it would be for Galen to have conflated his work with Aristotle’s. See Fowler and Mikota (2006: 301); Sikes (1971: 100).

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realize that elephant’s liver is roughly the size and weight of a human being.83 Indeed, Aristotle singles out the elephantine liver for its great size, claiming that it was four times the size (τετραπλάσιον) of the liver of an ox: “[the elephant] has viscera similar to the viscera of swine, except that its liver is four times larger than that of an ox (likewise with its other organs); but its spleen is disproportionately smaller”.84 I am not suggesting that Aristotle measured the livers of either the elephant or the ox. One notes, however, that the massive size of the organ is not only unsurprising from a modern point of view, but also from an ancient one—with which Galen is known to have been acquainted. As Scarborough has argued, there is no structure attached to the elephant’s liver that may counterfeit as a gallbladder.85 Galen, like Aristotle, had every reason to expect the viscera of the elephant to be massive and, in fact, more massive than the viscera of an ox by a significant degree of difference. If Galen had observed the truly gargantuan size of an elephantine liver, surely he must not only have expected to see a gallbladder but, as he says, a gallbladder of equally immense proportions (ἀνάλογον ἔχουσα τὸ μέγεθος ὅλῳ τῷ σπλάγχνῳ).86 Let us put aside questions of whether Aristotle and Mnesitheus were right about the absence of the elephant’s gallbladder for observational reasons. It is more important to note 1) that Galen was mistaken about the organ’s presence, 2) that his mistaken claim runs counter to the received opinion of these ancient authorities, and 3) that it seems likely his mistake was not due to observational error, but due to a lack of observation. This last point, given its implicit conflict with Galen’s frequent criticisms of rival anatomists—for a failure to generalize from observations or to make firsthand observations at all—prompts one to wonder what to make of this episode, and others like it that involve the elephant.

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In an average African elephant, of the sort that would have been available in the Roman world, the liver typically weighs 40.5kg/90lbs in cows and 63.5kg/140lbs in bulls. See Sikes (1971: 99). Aristotle HA 2.17, 507b37–508a2: καὶ τὰ σπλάγχνα ἔχει παραπλήσια τοῖς ὑείοις, πλὴν τὸ μὲν ἧπαρ τετραπλάσιον τοῦ βοείου καὶ τἆλλα, τὸν δὲ σπλῆνα ἐλάττω ἢ κατὰ λόγον. Scarborough (1985a: 127): “… the bile duct is rather wide and long and displays a large duodenal ampulla (a terminal bile pouch), certainly a clear indication of a different structure and arrangement that one might perceive with a true gall bladder”. AA 6.8 (590 Garofalo = ii.569 K.).

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Analogy and Teleology

I have argued that Galen’s use of elephantine anatomy elegantly solves a technological problem. This solution is not only elegant but, so long as it holds, argumentatively powerful. For that reason alone, it is tempting just to say that Galen uses the elephant to display structures too small to be seen, grounding his inferences to these invisible structures on the explanatory power of his teleology and observations conducted on larger subjects. Indeed, magnification through comparative anatomical observation is a regular feature of Galen’s anatomical practice. Consider, example, his advice to the reader on how to conduct research on human reproductive anatomy: Let us now describe how to dissect the reproductive organs of male animals. We say that in order for you to secure that the animal which you are dissecting resembles a man, you must take for that dissection an ape. But in order to achieve the effect of clarity in the appearance of such of those organs as are small and hard to see, then you must take a he-goat, a ram, a bull, a horse or a male donkey for your dissection, because that animal must necessarily possess a scrotum.87 trans. duckworth

Galen makes the same claim about the heuristic value of the elephant’s anatomy in regard to the cardiac structure of smaller air breathing animals, a point on which I focus throughout chapter four. Galen’s solution to the problem of magnification depends, however, on the commensurability between structures in certain animals for its effectiveness. This similarity is also important to Galen for teleological reasons. It is crucial for Galen’s comparative anatomy that organs, wherever they exist, are structurally identical across kinds that belong to a set class—either on an Aristotelian model or one very similar to it. It is all the more important that organs whose activities elephants and humans have in common be organically analogous in the relevant respects, especially if Galen’s interest in the elephant’s anatomy is motivated by the animal’s heuristic value as a magnified analogue of smaller air-breathing animals. For theoretical reasons, Galen’s elephant must have a gallbladder.

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AA xii.7 (123 Duckworth). See also AA xii.7 (127 Duckworth). Cf. AA ix.6 (2 Duckworth), xiii.8 (171 Duckworth), xiv.4 (196 Duckworth), xiv.6 (204 Duckworth), and xv.3 (236 Duckworth).

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Aristotle did not need to engage with most of these worries. Since he was not a humoral theorist in Galen’s mold, Aristotle did not have the same theoretical pressures to expect that the production of yellow bile and the organ in which it was contained would be among those features present by necessity in animals whose internal anatomy was closely similar to that of human beings.88 Moreover, Aristotle’s teleological commitments were not nearly so thoroughgoing as Galen’s.89 As a consequence of this difference in their teleological commitments, Galen can and perhaps must make structural analogies much more forcefully than Aristotle. Galen is committed to the homology of organs across the six classes of animals that he considers anatomical analogues to human beings.90 For Aristotle, on the other hand, bile does not play the central physiological role in blooded creatures that it does for Galen. Therefore, the question of whether an animal has or lacks a gallbladder is also of less theoretical importance. Indeed, on Aristotle’s view bile (χολή) is a waste-product (περίττωμα):91 But bile is in all likelihood either a residuum or a waste product, as when it arises in any other part of a body; so, bile near the liver (ἡ ἐπὶ τῷ ἥπατι χολὴ) [is probably] a superfluity (περίττωμα) and serves no purpose (οὐχ ἕνεκά τινος) just like what accumulates in the belly and in the intestines. Sometimes nature uses even leftovers (περιττώμασιν) for some benefit but it is not necessary on these grounds to seek out the purpose in everything. Rather, when some things are of a certain sort, many other things occur by necessity as a consequence of them.92

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Aristotle did not believe that bile was present in all human beings (PA 4.2, 676b29–35). He explicitly denies the presence of a gallbladder in elephants (ΗΑ 2.15, 506b1–4). See Hankinson (1989) and von Staden (1997b). Cf. Hankinson (1997). I have translated χολή as “bile” throughout this passage, as do Lennox and Kullmann. The phrase ἡ ἐπὶ τῷ ἥπατι χολὴ may suggest that Aristotle means the gallbladder in this clause (cf. Galen At.Bil. 9, CMG v 4,1,1 93.17 = v.147 K.: ἡ ἐπὶ τῷ ἥπατι κύστις), and it is possible to read the phrase this way as a number of translators have. Aristotle does not always distinguish clearly between bile and the gallbladder. The issue need not overly concern us here. For purposes of the present argument, it is sufficient to note that Aristotle is committed to the claim that bile is a residue and to the claim that not all blooded animals possess a gallbladder (see HA 2.15, 506a20–506b24). Aristotle PA 4.2, 677a11–18: ἀλλ’ ἔοικεν ἡ χολή, καθάπερ καὶ ἡ κατὰ τὸ ἄλλο σῶμα γινομένη περίττωμά τι εἶναι ἢ σύντηξις, οὕτω καὶ ἡ ἐπὶ τῷ ἥπατι χολὴ περίττωμα εἶναι καὶ οὐχ ἕνεκά τινος, ὥσπερ καὶ ἡ ἐν τῇ κοιλίᾳ καὶ ἐν τοῖς ἐντέροις ὑπόστασις. κατάχρηται μὲν οὖν ἐνίοτε ἡ φύσις εἰς τὸ ὠφέλιμον καὶ τοῖς περιττώμασιν, οὐ μὴν διὰ τοῦτο δεῖ ζητεῖν πάντα ἕνεκα τίνος, ἀλλά τινων ὄντων τοιούτων ἕτερα ἐξ ἀνάγκης συμβαίνει διὰ ταῦτα πολλά.

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In Aristotle’s biological works, a perittōma is a product of a goal-directed process that does not contribute to the goal of that process; perittōmata are effectively by-products or left-overs. Some may contribute to other biological processes, such as the menses or semen. Others are wholly useless. For example, in the passage above Aristotle compares bile to the feces that accumulate in the stomach and intestines. The waste products of digestion are products of alimentary processes. They do not, however, contribute to nutrition or to any other biological processes. Aristotle considers bile to be a perittōma of this sort. It is waste produced by impurities in the blood, which are found in animals that possess bitter livers. Indeed, Aristotle not only believes that bile serves no purpose, but also that the lifespans of creatures are shortened in proportion to its presence in their bodies.93 In this context, it is useful to recall the general constraint that both Aristotle and Galen place on their organizing principles. Although the world is teleologically structured, the materials out of which the world is organized are themselves haphazard or, if that is too strongly put, simply a brute fact about the world. Aristotle treats certain products of teleological activity as the necessary but useless remainders of the interaction between goal-directed structure imposed on the available materials in the world. Galen’s far more expansive view of the teleological structure of the natural world leaves little to no room in it for these superfluities. Galen’s theoretical differences with Aristotle’s teleological views presented a problem for him. He could not—as he does with Erasistratus—claim that Aristotle’s teleological views were merely insincere, a pretense masking his rejection of goal-directed explanations of the natural world. Aristotle’s cachet as an ancient authority on this score was unimpeachable; but it was theoretically important for Galen to inveigh against less complete teleological systems than his own. This is perhaps another reason why Galen names Mnesitheus but is rather more silent about Aristotle. Finally, Aristotle’s claim that bile is a useless residue (perittōma) implicitly rejects the humoral system found in Nature of the Human Being, in which Galen grounds his own humoral theory.94 However, although I expect that his teleological and humoral commitments are a powerful driving force behind his belief in the

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See Aristotle PA 4.2, 677a19–b10. Kullmann (2007: n. 677b7ff., p. 622) remarks that Aristotle’s views in PA 4.2 are an implicit rejection of humoral views that take bile to be a constituent element in the body, such as those found in Diseases 4 and Nature of the Human Being: “Dies ist eine grundlegende Absage an die Viersäftelehre der hippokratischen Medizin, die im Schleim und der Galle neben dem Blut und dem Wasser (De morbis iv) bzw. der schwarzen Galle (De natura hominis) konstituierende Körpersäfte sah”.

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existence of the elephant’s gallbladder, Galen’s account of the organ should not simply be reduced to a false analogy that arises from his teleological commitments or his humoralism. Galen’s objections to Aristotle’s account of the gallbladder can target a range of rivals, against all of whom he inveighs for their belief in non-teleological and mechanistic explanations of the body. It is a source of some surprise, then, that Galen readily accepts that some animals have livers and lack gallbladders in The Function of the Parts: “in some animals there is no gallbladder at all, but channels alone draw off bile from the liver to the small intestine”.95 Galen expands on his claim in the short treatise On Black Bile, where he also provides a helpful example of such an animal: [t]hose people are absurd who think, on the grounds that there is no organ that stores black bile somewhere in the body, such as the gallbladder attached to the liver [stores] yellow bile, that this fact is evidence that black bile, the humor, does not at all exist in very healthy bodies. For then they would have to agree that there is no phlegm in us just as [they would have to agree that] there is no yellow bile in pigeons. For [pigeons] do not have a gallbladder attached to their liver, just as some other animals do not.96 Galen’s choice of example is fortuitous.97 Although he is not explicit about his criteria for distinguishing the degree of structural similarity between animal kinds, his casual reference to the pigeon suggests that he is adapting Aristotelian distinctions for his system of classification. On an Aristotelian construal, Galen’s six classes of anatomical analogues to human beings all belong to the broad class (megiston genos) of four-footed, live-bearing, blooded animals. Pigeons and other birds, on the other hand, belong to a separate broad or extensive class of animal. The species under a given extensive class will differ anatomically by degree (by the more and the less), while species belonging to different megista genē will exhibit potentially significant anatomical differences. Differences between classes will be more profound at higher levels of the classification. On this analysis, blooded and non-blooded creatures 95 96

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UP 4.12 (i.218.21–23 Helmreich = iii.298 K.): ἐπὶ δέ τινων ζῴων οὐδ’ ὅλως ἐστὶν ἡ κύστις, ἀλλ’ οἱ πόροι μόνοι τὴν χολὴν ἐξοχετεύουσιν ἐκ τοῦ ἥπατος εἰς τὸ λεπτὸν ἔντερον. At.Bil. 8 (CMG v 4,1,1 93.16–22 = v.147 K.): γελοῖοι δέ εἰσι κἀκ τοῦ μηδὲν εἶναι περὶ τὸ σῶμα περιεκτικὸν μελαίνης χολῆς ὄργανον, οἷον ἡ ἐπὶ τῷ ἥπατι κύστις ἐστὶ τῆς ξανθῆς χολῆς, ἡγούμενοι τεκμήριον ὑπάρχειν τοῦτο τοῦ μηδόλως ἐν τοῖς ἀκριβῶς ὑγιαίνουσι σώμασι τὸν μελαγχολικὸν εἶναι χυμόν. οὕτω γὰρ οὐδὲ τὸ φλέγμα συγχωρήσουσιν ἐν ἡμῖν εἶναι, καθάπερ οὐδὲ ἐν ταῖς περιστεραῖς τὴν ξανθὴν χολήν· οὐ γὰρ ἔχουσι τὴν ἐπὶ τῷ ἥπατι κύστιν, ὥσπερ οὐδ’ ἄλλα τινὰ ζῷα. See the passage quoted earlier at AA 6.8 (590 Garofalo = ii.569 K.).

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will differ structurally from one another far more than kinds under the category of blooded will differ from other members of the same class. Viviparous, oviparous, and ovoviviparous kinds will exhibit greater structural differences from members of the other two classes than they will from the other members of their own class, and so on. Consequently, the six classes Galen identifies as anatomical analogues to human beings would differ structurally far less from one another than they might from, for example, birds. If this interpretation of Galen’s organizational methodology is correct, then internal organs in his six classes of human anatomical analogues will be homologous with their counterparts in human bodies. They will be fundamentally the same, but they may differ by degree. One should expect far more similarity between humans and apes, for example, than between humans and elephants. Apes, like humans, are polydactyl, while elephants are single-hooved. The same cannot be said for animals like pigeons and other birds, which do not belong to the same broad class of animal as human beings. Consequently, one should expect the organs that perform the same essential life functions for human beings and for birds to be analogous but not fundamentally the same. Galen does not need to expect that the same structure draws yellow bile from the liver to the small intestine in human beings and pigeons, only that there be some broadly analogous structure that does so (in the case of the pigeon, bile ducts rather than a gallbladder).98 It is unsurprising, on the one hand, to find that Aristotle’s biological works lie in the background of Galen’s conceptualization of animal physiology and anatomy, and to discover that Aristotle’s method of classification informs his own. At first glance, however, it is puzzling to note that Galen is sometimes keen to associate his own work with Aristotle by name, and at other times passes him over in silence. Galen’s silent engagement with ancient authors, like Aristotle, often occurs in contexts where he is critical of their views. In instances such as these, Galen sometimes omits any reference to the author(s) of the views he is criticizing. At other times, Galen attributes the view under attack to another author, who held similar views to these.

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The argument here proceeds by modus tollens, by which Galen shows that an organ for the storage of a given humor is not a necessary condition for the production of that humor. If it were, he argues, they would have to concede that humans do not produce phlegm and pigeons do not produce yellow bile.

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Aristotle and Surrogate Targets

Antiquity is relevant here. With certain exceptions, Galen deflects his criticisms of these ancient authors (palaioi) to later ones (neōteroi). Both the passage from On Black Bile and the episode in Anatomical Procedures, for example, take as their starting point an unnamed group, which Galen has picked out for special opprobrium. Context in this case suggests that Galen is arguing against a spectrum of anti-humoralists, in particular Erasistratus and Erasistrateans who, he claims, deny the existence of black bile—or at least of black bile as a nonpathological fluid in the body.99 Galen cites Asclepiadeans, Erasistrateans, and Methodists as some of the most captious opponents of humoral theory. Most of Galen’s arguments in On Black Bile, however, are trained on Erasistrateans. Galen’s account of Erasistratus’ views on humors is tendentious. While Erasistratus did not hold the same humoral views as Galen, which were very close to the humoral view expressed in On the Nature of the Human Being, it is not at all clear that he rejected humoralism tout court. Galen’s criticisms of Erasistratus become more pointed when one considers him, what von Staden has called, a “surrogate target” for Aristotle and his less thorough-going teleology.100 We have seen Galen’s critical stance toward Aristotelian teleology already in his engagement with Aristotle’s anatomy of the elephant, his claim that the gallbladder is a useless organ, and the notion that yellow bile is a perittōma. Aristotle’s rejection of bile as a useless perittōma stands in the background of Galen’s attack against Erasistratus also, as an affront to Galen’s humoralism as much as a challenge to his teleological views. This is not to suggest that Galen cannot be targeting Mnesitheus or Erasistratus along with Aristotle. Given Galen’s polemic promiscuity, there is every reason to suppose that his critique can include multiple targets in its area of effect. Consider, for example, Aristotle’s argument that all blooded animals possess hearts in Parts of Animals: Consequently the heart exists in all blooded animals. The reason for this fact was also mentioned earlier. For it is clear that it is necessary for blooded creatures to have blood. And it is necessary that a vessel exist since blood is a fluid, for which reason it appears that nature fashioned

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Cf. At.Bil. 1 (CMG v 4,1,1 71 = v.105 K.). See, e.g., Nutton (2013: 137–139). See von Staden (1997b: 197): “Refracted through the prism of Galen’s radically comprehensive teleological perspective, any limited teleology is likely to appear non-teleological. At times it is hard to avoid the impression that, on this point at least, Galen uses Erasistratus as a surrogate target, i.e., that although Galen’s teleological cannons are explicitly aimed at Erasistratus, they are tacitly trained on the Aristotelian versions of teleology”.

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veins. And it is necessary that there be a single source of these veins (for as far as is possible, one is better than many); and, the heart is the source of the veins.101 Aristotle makes the same kind of argument that Galen derides in On Black Bile (i.e., that the presence of a fluid entails the existence of a container for it). Indeed, the Erasistratean argument in On Black Bile is just the contraposed form of Aristotle’s here: ‘if there exists some fluid inside the body f, then there must be a container c that contains f ’. Galen’s attack in On Black Bile explicitly targets an Erasistratean position; it is also an indirect attack against Aristotle, motivated in part by Galen’s rejection of the cardiocentric claim at the end of the passage: that the heart is the source of the veins. Galen is particularly galled, as we have seen, by theorists whose beliefs in the teleological structure of the natural world are less complete than his own. With von Staden’s surrogate target in mind, consider the following criticism that Galen makes of Erasistrateans and, to a lesser extent, of Erasistratus for an inconsistency between their views on perittōmata and their professed teleological commitments in On the Natural Faculties:102 But, wisest of men, Erasistratus himself used to posit that nature was a craftsperson and providential for animals; but he also used to say that bilious fluid (τὸ χολῶδες ὑγρὸν) was completely useless (ἄχρηστον) for all animals. These claims are inconsistent with one another.103 There is no clear consensus on Erasistratus’ theoretical commitments on this score. Von Staden has argued that Erasistratus is likely to have held a teleological view of the natural world that was compatible with mechanistic explanations, one which was largely taken over from Aristotle, Theophrastus, and pos-

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Aristotle PA 3.4, 665b9–16: καρδία μὲν οὖν ἅπασιν ὑπάρχει τοῖς ἐναίμοις· δι’ ἣν δ’ αἰτίαν, εἴρηται καὶ πρότερον. αἷμα μὲν γὰρ ἔχειν τοῖς ἐναίμοις δῆλον ὡς ἀναγκαῖον· ὑγροῦ δ’ ὄντος τοῦ αἵματος ἀναγκαῖον ἀγγεῖον ὑπάρχειν, ἐφ’ ὃ δὴ καὶ φαίνεται μεμηχανῆσθαι τὰς φλέβας ἡ φύσις· ἀρχὴν δὲ τούτων ἀναγκαῖον εἶναι μίαν• ὅπου γὰρ ἐνδέχεται, μίαν βέλτιον ἢ πολλάς. ἡ δὲ καρδία τῶν φλέβων ἀρχή. The longer critique runs from Nat.Fac. 2.2 (SM 3, 157–159 = ii.78–80 K.). Nat.Fac. 2.2 (SM 3, 157.21–25 = ii.78 K.): ἀλλ’, ὦ σοφώτατοι, προνοητικὴν τοῦ ζῴου καὶ τεχνικὴν αὐτὸς ὁ Ἐρασίστρατος ὑπέθετο τὴν φύσιν. ἀλλὰ καὶ τὸ χολῶδες ὑγρὸν ἄχρηστον εἶναι παντάπασι τοῖς ζῴοις ἔφασκεν. οὐ συμβαίνει δ’ ἀλλήλοις ἄμφω ταῦτα. Cf. Ven.Sect.Er. 4 (xi.158 K.), which repeats the same language regarding provident and artisanal nature: θαυμάσεις μὲν γὰρ τὴν φύσιν, ὡς τεχνικήν τε ἅμα καὶ προνοητικὴν τοῦ ζῴου …

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sibly Strato of Lampsacus.104 But, as von Staden notes, the “historiographical prism” through which Galen viewed other intellectuals with less thoroughgoing teleological beliefs than his own often resulted in accusations that the views of these theorists were goal-directed in name only; their accounts were purely mechanistic, dressed up in teleological garb. This accusation lies squarely at the heart of Galen’s critique of Erasistratus and Erasistrateans for their views on black bile in On Black Bile and his criticism of Erasistratus on the same subject in On the Natural Faculties above. Besides drawing attention to the way in which Galen can blur the distinction between groups such as Erasistrateans and Peripatetics for polemical purposes, one upshot of the passage in On Black Bile is to show that the gallbladder is not one of the organs to whose existence Galen is committed across kinds in all blooded animals, although it seems as though it ought to be found in the six classes of animals that he considers suitable anatomical analogues for human beings. Aristotle, on the other hand, only mentions elephants in the context of his discussion of the gallbladder to note the organ’s absence. As I have mentioned, on Aristotle’s view yellow bile was the consequence of goal-directed processes in the body, but it did not serve a physiological end itself. In Galen’s system of physiology, such conditional necessities are far rarer. Moreover, while yellow bile is indeed a residue of blood production, it serves a further physiological purpose for Galen: its bitter qualities contribute to the elimination of waste in the intestine. Both the humor and the organs associated with its production, retention, and elimination occupy an important place in the physiology of human beings—and the classes of animals anatomically comparable to humans.105 Galen can accept that some animals do not require an organ for 104

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On the teleological views of Erasistratus and Erasistrateans, see von Staden (1997b). Von Staden proposes that Erasistratus may have had teleological views compatible with mechanistic explanations (see especially pp. 205–206). For present purposes, the upshot of von Staden’s account is that teleological commitment for Galen is something of a zero-sum proposition (pp. 197–199). Galen, therefore, is likely to be undercutting Erasistrateans and Peripatetics in the gallbladder episode. For an older account that sees teleology and mechanism as exclusive, see Lonie (1964) but specifically Lonie (1964: 441 n. 53). Briefly, Lonie argues that the Erasistrateans of Galen’s day if not Erasistratus himself may have maintained an immanent teleology, which was not intelligently purposive. Lonie believes that this view may trace back to Strato’s Peripatos rather than Aristotle’s and is, in a sense, a view of structure as reducible to necessity (ἀναγκή) rather than an intelligent engineer (νοῦς). Lonie resolves the apparent conflict between Strato’s traditionally mechanistic view of nature and the immanent teleology that Galen and the Erasistrateans ascribe to Erasistratus by way of Stoic influence in the second century. On the activity and importance of the gallbladder, see, e.g., Nat.Fac. 3.5 (SM 3, 215.6–17 = ii.157–158 K.) and 3.9 (SM 3, 229.23–230.7 = ii.177–178 K.); UP 4.12–13 (i.217.13–228.10 =

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retaining yellow bile, although bile ducts are necessary for conveying it to the intestine in all animals. It is far more difficult, however, for him to reconcile the absence of a gallbladder in a member-species of one of his six classes with the teleological demands of his physiological theory. Aristotle had less reason to be concerned over its absence. For Galen, the elephant should not only possess viscera essentially similar to that of human beings; these organs should be suitably larger than their human counterparts. To the degree that Aristotle’s description of the elephant’s viscera does not maintain this analogical relationship, it would, if true, undermine Galen’s use of the elephant as an ideal enlarged analogue of internal human anatomy. This last point involves a concomitant feature of Galen’s approach to anatomical magnification through the observation of organs in larger animal subjects of the right sort, as for example in the quotation from Anatomical Procedures xiii.8 with which this chapter began. There Galen recommends to the reader to investigate details that are too difficult to observe in the bodies of smaller animals in the bodies of oxen, horses, asses, mules, and similar animals including the elephant. Galen’s claim about the structural similarities of organs responsible for performing the same physiological functions across animal kinds are far stronger than Aristotle’s. He is committed to the view that every feature of the natural world, and therefore every part of an animal, is goaldirected. Insofar as organs are ideally structured under material constraints for the functions that they perform, Galen is committed to the claim that where such a function is to be performed, the organ performing that function is also the best one to do so, barring the very rare exception. Hankinson makes the case for a way to reconcile Galen’s commitment to a deep directed teleology with available empirical counterevidence.106 He argues that Galen can be “carried away by his own rhetoric”. Galen’s demiurge, in this respect like Plato’s, is constrained by available materials and is therefore capable of making mistakes, albeit rarely. As a methodological rule, one should expect to be able to analyze a given part functionally while accepting that in very rare cases things may go wrong: “[y]ou don’t have to show, heroically and implausibly, that this world is absolutely the best of all logically or conceptually possible worlds; you simply have to establish that it’s pretty nearly the best of

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iii.296–311 K.); and PHP 6.4 (CMG v 4,1,2 384.23–386.16 = v.534–536 K.). On the role of yellow bile in Galen’s humoralism, see, e.g., Hipp.Elem. 9 (CMG v 1,2 138.18–140.1 = i.492 K. and 140.1–14 = i.492–493 K.); Nat.Fac. 2.9 (SM 3, 194–197 = ii.129–133 K.); and PHP 8.4 (CMG v 4,1,2 498.17–504.2 = v.671–677 K.). On its genesis from innate heat in the blood vessels, see Nat.Fac. 2.8 (SM 3, 186.10–187.8 = ii.117–118 K.). Hankinson (1989: 224–227).

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all causally possible worlds”.107 Galen makes this general point in The Function of the Parts: But just as Homer put into verse the self-moving constructs of Hephaestus and his bellows, which as soon as the master gave the command, ‘pour[ed] forth its well-tempered, manifold blast’, and those golden handmaidens that moved on their own like their creator. So it is, as far as I am concerned. And understand that in the body of an animal there is nothing that is either without function (ἀργὸν) or motion (ἀκίνητον); rather, that all the parts perform (ἐνεργοῦντα) a well-tempered, manifold function (ἐνέργειαν) in conjunction with a suitable structure (μετὰ τῆς πρεπούσης κατασκευῆς), since the creator has granted certain divine faculties (δυνάμεις) to [the parts].108 Once again, not only are organs structurally the same across kinds that belong to classificatory groups like Galen’s six classes of animals anatomically analogous to human beings, they ought to be on the grounds that they are ideally structured (μετὰ τῆς πρεπούσης κατασκευῆς).109 For a given biological activity there is a single or a small group of structures that can do the job. And, in this case, the scaling size of animals from human to elephant brings along with it a scaling need for organs as support systems.110 Therefore, the gallbladder, to the extent that in Galen’s view it is responsible for bile storage and to the extent that, for teleological reasons it is ideally suited for bile storage, must be attached to the elephant’s liver. Likewise, a smaller version must be attached to the human liver. Although Galen appears to have adopted a modified form of Aristotelian animal classification for his own purposes, his claims about the elephantine gallbladder are an expression of his own thoroughgoing teleology as well as a sharp corrective of Aristotle.

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Hankinson (1989: 225). UP 4.2 (i.196.14–23 Helmreich = iii.268 K.): ἀλλ’ ὥσπερ Ὅμηρος ἐποίησεν αὐτοκίνητα τὰ τοῦ Ἡφαίστου δημιουργήματα καὶ τὰς μὲν φύσας εὐθὺς ἅμα τῷ κελεῦσαι τὸν δεσπότην “παντοίην εὔπρηκτον ἀϋτμὴν ἐξανιείσας”, τὰς δὲ θεραπαίνας ἐκείνας τὰς χρυσᾶς ὁμοίως αὐτῷ τῷ δημιουργῷ κινουμένας ἐξ ἑαυτῶν, οὕτω μοι καὶ σὺ νόει κατὰ τὸ τοῦ ζῴου σῶμα μηδὲν ἀργὸν μηδ’ ἀκίνητον, ἀλλὰ πάντα παντοίην εὔπρηκτον ἐνέργειαν ἐνεργοῦντα μετὰ τῆς πρεπούσης κατασκευῆς θείας αὐτοῖς τινας δυνάμεις τοῦ δημιουργοῦ χαρισαμένου … As with Aristotle, Galen believes that goal orientation has as its target a single end. As far as I know, neither Galen nor Aristotle considers the possibility that there could be multiply realizable ends, none inferior to the other and with no realizable end superior to them. This point figures strongly in my analysis of Galen’s reasons, taken over largely from Aristotle, for the presence of an os cordis in the elephant’s heart.

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On Galen’s account, Aristotle’s claim that the elephant does not possess a gallbladder is suspect, not only on teleological grounds but also on observational ones. It is also necessary to consider the gallbladder’s role in bile storage. Teleological commitments aside, Galen was a humoral theorist. Yellow bile, along with the other humors produced by the human body, are explanatorily essential to Galen’s system of human physiology. Since he locates the storage of yellow bile in the gallbladder, the organ plays an important role in the process of this humor’s production, distribution, retention, and elimination. Insofar as the organ is ideally suited to perform this important physiological function and is found in at least some of the animal kinds in his six classes, it would follow for Galen that it ought to be found in all of the animal kinds belonging to his six classes. And, indeed, the organ is found among some of the animal kinds in his six classes. The presence of the organ in smaller blooded animals and its absence in larger ones would be difficult for Galen to explain, when taken in conjunction with his notion of a scala naturae that exhibits larger viscera in larger anatomically analogous animal kinds. Moreover, recognizing that the gallbladder was not present in certain larger animals (e.g., members of the six classes of viviparous animals) runs the risk of admitting that the gallbladder was not necessary (or functionally and structurally ideal) for its task. Galen’s elephant must have a gallbladder. Here the body of the elephant becomes both a tool for anatomical inquiry and a battleground on which Galen contends with ancient authorities and contemporary rivals for professional legitimacy. The body of Galen’s elephant confirms the deep teleological structure of the natural world, it substantiates the importance of his humoral system, and it reveals the theoretical inadequacies of his rivals. In this instance, Galen’s account of the elephant’s gallbladder obliquely attacks Aristotle, first for having failed to observe the organ, and then for a failure to adhere to his own teleological commitments, which on Galen’s view should have alerted him to the need for such an organ in the first place. Of course, the irony here is that the elephant possesses no gallbladder. Galen could not have observed such an organ.

chapter 4

Fighting with the Heart of a Beast: Galen’s Use of the Elephant’s Cardiac Anatomy against Cardiocentrists In his discussion of the heart’s structure and function, Galen interrupts his narrative to recount an aggressive confrontation with rivals in the streets of Rome over the existence of a bone at the center of the elephantine heart.1 Throughout this digression, he denounces contemporary physicians alongside medical theorists past and present for their theoretical and empirical inadequacies, especially their claim that the elephant’s heart lacked a bone. Galen concludes the episode by drawing attention triumphantly to a massive bone recovered from this elephant’s heart. The bone, he says, sits on his desk while he writes, proof to visitors of his medical acumen and of his rivals’ anatomical failures. Although this bone, the os cordis, is found in the hearts of certain ruminants, Galen could not actually have seen what he claims to have seen, let alone had the os cordis of an elephant on his desk. The bone, like the gallbladder, does not exist in elephants. Galen recounts the episode in the seventh book of Anatomical Procedures, in a section devoted to cardiac anatomy.2 He also alludes to this episode and his broader debate over the structure of the elephant’s heart in book six of The Function of the Parts, which focuses on the physiological functions of the heart.3 While Galen’s accounts of the elephant’s heart bone may appear to be mere historical curiosities at first glance, they should be considered in the context of a foundational debate in ancient Greco-Roman science and medicine. Cardiac structure and function bore directly on two prominent claims over the physical basis for volition in the post-Aristotelian biological tradition. So-called cardiocentrists situated the voluntary faculty (to hēgemonikon) in the heart, while encephalocentrists such as Galen placed it in the brain. Galen and the doxographical tradition bear witness to the debate from the Classical through the Late Imperial Period.4 For Galen, affiliation with either camp often assumed 1 2 3 4

An earlier, limited version of the present chapter was published as Salas (2014). AA 87.10 (662–666 Garofalo = ii.619–621 K.). UP 6.19 (i.365.14–366.13 Helmreich = iii.502–503 K.). For the debate between cardiocentrism and encephalocentrism, see Rocca (2003: 31–47); Tieleman (2002: 254–273) and (1996: xix–xx and 38–65); Hankinson (1991a: 15–29); and Mansfeld (1990: 3056–3229).

© Luis Alejandro Salas, 2020 | doi:10.1163/9789004443860_006

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further commitments to epistemological positions on the nature of observation, verification, and on the role of empiricism in generalizations about the world. Therefore, to the extent that philosophical claims about volition depended on one’s anatomical claims about the hēgemonikon, undermining the latter undermined the former. While scholars have discussed the performative and political dimensions of Galen’s live anatomical displays,5 they have not focused on Galen’s engagement with rival theorists through his accounts of these demonstrations.6 Aristotle had accurately described the existence of a bone in the hearts of certain animals and denied its presence in the elephantine heart in both his History of Animals and Parts of Animals.7 In the previous chapter, we saw that Galen criticized Mnesitheus explicitly—and Aristotle implicitly—for denying the existence of a gallbladder in the elephant. Galen follows a similar pattern of criticism in his narrative of the heart bone. While his attacks on contemporary cardiocentrists are overt, he indirectly calls into question their ancient sources, in particular Aristotle. Galen accepts Aristotle’s functional analysis of the bone as a structural support in the hearts of some ruminants, even apparently taking this account as the basis for his own. As in the case of the gallbladder, however, his more thoroughgoing teleological commitments require him to argue against Aristotle for the presence of a heart bone in the elephant. I argued that Galen turned to the internal anatomy of larger animal subjects such as the elephant in order to magnify, as it were, structures that were too minute to observe directly in smaller subjects. In this chapter, I argue that Galen uses written accounts of live anatomical demonstrations to extend the magnificatory power of these anatomical analogues. In particular I argue that Galen uses the elephant’s cardiac structure not only as a tool for magnification, but also as a persuasive literary spectacle in a larger skirmish against Stoic and Peripatetic cardiocentrists.

1

The Os Cordis

The heart bone or os cordis is a bone found in some mammals, mostly ruminants, between the aorta and atrioventricular openings near the meeting point 5 See von Staden (1995a: 48–67) and, more general in scope, von Staden (1997a: 33–54). Also see Gleason (2009: 85–114). 6 Hankinson (1988b: 135–157) examines Galen’s discussion of the elephant’s trunk in the socalled Epode (UP 17.1, ii.438–440 Helmreich = iv.348–350 K.) in a paper on the philosophical commitments underlying Galen’s teleological claims. However, Hankinson is mainly interested in how Galen’s account of the trunk illuminates his teleology rather than his anatomical method. 7 Aristotle HA 2.15, 506a9–10 and PA 3.4, 666b17–667a6.

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of the interatrial and interventricular septa. This area is called the fibrous trigone (trigona fibrosa). It is formed of tough connective tissues and is part of the fibrous skeleton of the heart, also known as the cardiac skeleton. Galen and Aristotle appear to refer to the fibrous trigone; Galen goes so far as to describe its tissues as neuro-cartilaginous (νευροχονδρῶδες σῶμα), cartilage (χόνδρος), and cartilaginous bone (χονδρῶδες ὀστοῦν).8 Contemporary terminology maps onto Galen’s: fibrocartilage, hyaline cartilage, and bone.9 The os cordis appears as a small bone-like ring segment to the naked eye; in the ox it is only about ten millimeters in length.10 The similarities between these ancient and modern accounts of the os cordis should give the reader a sense of just how much Galen and Aristotle knew about its structure and function from a contemporary perspective. In light of this knowledge, Galen’s account of the elephant’s heart is striking in its strangeness. A well-known fact about Galen’s anatomical method may, however, be illuminating. Galen is known to have based large parts of his anatomical exegesis in Anatomical Procedures on comparative work with oxen, which do possess an os cordis. Julius Rocca has argued persuasively that Galen posits at least one other structure theoretically important to his system of human physiology and psychology by analogy from the ox, namely the retiform plexus (rete mirabile).11 Given his regular and frequent use of ruminants for anatomical research, Galen would also have been well acquainted with the os cordis in oxen and sheep. If his account in Anatomical Procedures is based on firsthand evidence, what could Galen have seen and how could he have mistaken it for an os cordis? Extrapolation from the anatomy of the ox may go some of the way in explaining Galen’s description of the elephantine heart. But if Galen’s description was derivative on accounts such as Aristotle’s, why deviate from earlier accurate accounts on this point? Despite the importance of the heart to physiological and philosophical debates in the second century ce, Galen’s departure from the accounts of cardiac anatomy in the Peripatetic tradition has not attracted much scholarly attention, even among historians of medicine.12 John Scarborough, who has 8

9 10 11 12

AA 7.10 (662 Garofalo = ii.619 K.). I adopt Garofalo’s reading of νευροχονδρῶδες σῶμα, following the Arabic. The Greek here is corrupt. See Garofalo (1991a: 663 n. 59). The Arabic reading is supported by the language of Galen’s parallel account in The Function of the Parts. See UP 6.19 (i.366.6 Helmreich = iii.502 K.). The point here stands regardless. See Gopalakrishnan, et al. (2007: 518). For a general account of the os cordis and discussion of its length, see James (1965). Throughout Rocca (2003), but especially at 67–78, 202–208, 249–253. Mattern (2013: 151–152) mentions this episode in passing as does Nutton (2013: 237–238). Veterinary scientists have remarked on the elephant’s lack of os cordis. See Bartlett (2006: 317) in Fowler and Mikota (2006), which draws on Sikes (1969). See also Sikes (1971: 123).

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written on this point, concluded that some of Galen’s anatomical claims about elephants were not based on dissection. He cites Galen’s detailed description of the elephant’s gallbladder in book six of Anatomical Procedures,13 another organ that we have seen the animal does not possess.14 In comparing Galen’s description of the elephant’s gallbladder with Aristotle’s and Mnesitheus’ accurate accounts, Scarborough suggests that Galen’s commitment to biological analogy moved him to deny their claims; I have made a similar argument. Since Scarborough was unaware that the elephant lacks a heart bone, he did not have reason also to question Galen’s dissection of the elephantine heart or his vivid first-person narrative.15 Scarborough argues, as one might and as Galen did, that Aristotle’s joint commitments to teleology and biological analogy led him to believe in the existence of this bone in larger animals. Aristotle, however, explicitly denies the existence of the bone in all but a few ruminants.16 As we have seen, Galen’s views on teleology and analogy could be critical of Aristotle’s. Together with the polemical stance Galen takes against cardiocentrists, these points offer some purchase in explaining his departure from the Peripatetic material.

2

The Agōn over the Heart

While digressing from his general account of the heart in book seven of Anatomical Procedures, Galen reduces his rivals’ denials of the os cordis to observational failure.17 They compound their error, he writes, by generalizing from these mistaken observations to the anatomy of other animals. Galen’s focus on their observational failures stems from his belief that empirical observation must underpin theoretical medical claims. In the case of minute structures, his criticism hinges on making otherwise unobservable structures apparent by appeal to subjects that are larger and anatomically analogous.18 On this view, 13 14

15 16 17 18

AA 6.8 (590 Garofalo = ii.569 K.). Scarborough (1985a: 127–128, 130). Scarborough questions Galen’s dissection on the grounds that his account of the elephant’s trunk is derivative of Aristotle’s at HA 2.15, 506a30–b4 (128–130) and on the grounds that practical difficulties in the dissection of such a large animal would have been prohibitive (123). Scarborough (1985a: 130). Scarborough (1985a: 124–126). For Aristotle’s restriction of the heart bone to only a few ruminants, see PA 3.4, 666b17–21 and HA 2.15, 506a9–10. AA 7.10 (660–662 Garofalo = ii.618–619 K.). Cf. AA xv.2 (227–228 Duckworth, but especially 228): “[w]e must then try to learn the conformation of that which is hard to observe in any one type of animal, whichever this may be, in other animals where that can be found and thoroughly investigated, I mean those

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structures such as the heart bone will be proportionately larger and more visible in suitable larger animal subjects; the failure to recognize them is proportionately more damning. Galen evokes a vivid anatomical debate to illustrate the point: And why do I mention the larger? Indeed, after an elephant was slaughtered recently in Rome many doctors gathered together for its dissection to determine whether the [elephant’s] heart possesses one or two apices and two or three ventricles. And, even before its dissection, I insisted that the structure of its heart would be found to be the same as in all the other animals that breathe air, which became clear when [the heart] was opened. I also easily found the bone in the heart when I, along with my associates, inserted my fingers. But those who were untrained assumed that not even the elephant’s heart contains a bone, expecting to find that what was unobservable [to them] in the cases of other animals [would also be unobservable] in the large one. So, I was about to show it to them but I stopped the demonstration when my associates, laughing, begged me not to conduct a demonstration for people whom they saw as insensate on account of their ignorance of the region. After the heart was removed by Caesar’s cooks, I sent one of my associates, trained in these matters, to ask the cooks to let him excise the heart bone. And so it happened, even now it is beside me. It is massive in size and induces in those who see [it] a state of wide-eyed disbelief that a bone so huge eluded these doctors. So even the biggest structures in animals elude the untrained and it is not at all unbelievable that Aristotle both was mistaken about many other anatomical matters and thought that the heart had three ventricles in large animals, nor ought one to be surprised that he stumbled regarding the discovery of structures seeing as he was untrained in anatomical matters. And it is appropriate to excuse him, since those who have dedicated their entire lives to this pursuit, as Marinus did, were apt to make many mistakes. What is one to think would happen to those who pursue it all of a sudden, and to those who are so convinced by things that they do [not]19 see at first that they no longer look to try their hands at it a second time?20

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animals in which such details are in their nature larger and more massive than those which in this [smaller] type are hard to see”. Garofalo (1991a: 666), expunges οὐκ with the Arabic translation. Despite Garofalo’s reading, I retain the Greek text for contextual reasons. Galen criticizes his rivals precisely for failing to see a structure. AA 7.10 (662–666 Garofalo = ii.619–621 K.): καὶ τί λέγω τὰ μείζω; μεγίστου γοῦν ἐλέφαντος

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Galen pivots from the claim that rival anatomists fail to see smaller structures because of their insufficient training, to amazement that they fail to see those structures even in the bodies of larger animals. Galen answers in medias res, as though questioned by the reader. The rhetorical question is wrought. It closely parallels the language of Galen’s segue into his dispute with the Asclepiadean over the function of the ureters in On the Natural Faculties, discussed in chapter two: “And why do I mention the position of the bladder, peritoneum, and thorax?” (καίτοι τί θέσεως κύστεως καὶ περιτοναίου καὶ θώρακος μνημονεύω;).21 The genitive absolute that follows in Anatomical Procedures is elegantly constructed, and Galen scrupulously avoids hiatus throughout the whole of the episode.22 Unlike his accounts of the elephant’s gallbladder and indeed his vivid anecdotes about its trunk, Galen introduces a series of expressions that incorporate the reader into the situational context of his debate. In this way, the episode is distinct from the otherwise situationally neutral narrative surrounding it. Adverbs locate the reader in a specific space and time: the elephant is

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ἔναγχος ἐν Ῥώμῃ σφαγέντος, ἠθροίσθησαν μὲν ἐπὶ τὴν ἀνατομὴν αὐτοῦ πολλοὶ τῶν ἰατρῶν ἕνεκα τοῦ γνῶναι, πότερον ἔχει δύο κορυφὰς ἢ μίαν ἡ καρδία, καὶ δύο κοιλίας ἢ τρεῖς. ἐγὼ δὲ καὶ πρὸ τῆς ἀνατομῆς αὐτοῦ διετεινόμην, εὑρεθήσεσθαι τὴν αὐτὴν κατασκευὴν τῆς καρδίας ταῖς ἄλλαις πάσαις τῶν ἐξ ἀέρος ἀναπνεόντων ζῴων· ἅπερ ἐφάνη καὶ διαιρεθείσης. εὗρον δὲ ῥᾳδίως καὶ τὸ κατ’ αὐτὴν ὀστοῦν, ἅμα τοῖς ἑταίροις ἐπιβαλὼν τοὺς δακτύλους. οἱ δ’ ἀγύμναστοι μὲν, ἐλπίζοντες δὲ εὑρίσκειν, ὡς ἐν μεγάλῳ ζῷῳ, τὸ μὴ φαινόμενον ἐπὶ τῶν ἄλλων, ⟨dopo aver a lungo cercato, non lo trovarono, e⟩* ὑπέλαβον οὐδὲ τὴν ἐλέφαντος καρδίαν ἔχειν ὀστοῦν. ἐγὼ δ’ ἐμέλλησα μὲν αὐτοῖς δεικνύειν, τῶν δ’ ἑταίρων γελώντων ἐφ’ οἷς ἑώρων ἀναισθήτους ἐκείνους διὰ τὴν ἄγνοιαν τοῦ τόπου, παρακαλεσάντων δὲ μὴ δεικνύειν, ἐπέσχον τὴν δεῖξιν. ἀρθείσης μέντοι τῆς καρδίας ὑπὸ τῶν τοῦ Καίσαρος μαγείρων, ἔπεμψά τινα τῶν γεγυμνασμένων ἑταίρων περὶ τὰ τοιαῦτα παρακαλέσοντα τοὺς μαγείρους ἐπιτρέψαι τὸ κατ’ αὐτὴν ὀστοῦν ἐξελεῖν· καὶ οὕτως ἐγένετο. καὶ παρ’ ἡμῖν ἐστι νῦν, οὐ σμικρὸν μὲν ὑπάρχον τῷ μεγέθει, θαυμαστὴν δὲ παρέχον ἀπιστίαν τοῖς ὁρῶσιν, εἰ τηλικοῦτον ὀστοῦν ἐλάνθανε τοὺς ἰατρούς. οὕτως ἄρα καὶ τὰ μέγιστα τῶν ἐν τοῖς ζῴοις μορίων λανθάνει τοὺς ἀγυμνάστους. καὶ θαυμαστὸν οὐδὲν, ἄλλα τε πολλὰ κατὰ τὰς ἀνατομὰς Ἀριστοτέλη διαμαρτεῖν, καὶ ἡγεῖσθαι, τρεῖς ἔχειν κοιλίας ἐπὶ τῶν μεγάλων ζῴων τὴν καρδίαν. ὅτι μὲν οὖν ἀγύμναστος ὢν ἐν ταῖς ἀνατομαῖς ἐσφάλη περὶ τὴν τῶν μορίων εὕρεσιν, οὔτε θαυμάζειν χρή, καὶ συγγινώσκειν αὐτῷ προσήκει. ὅπου γὰρ οἱ τὸν ὅλον ἑαυτῶν βίον ἀναθέντες τῇ θεωρίᾳ ταύτῃ, καθάπερ ὁ Μαρῖνος, ἥμαρτον πολλὰ, τί χρὴ νομίζειν συμβαίνειν τοῖς ἐξαίφνης μὲν ἐπ’ αὐτὴν ἐλθοῦσι, πεισθεῖσι δ’ οἷς πρῶτον [οὐκ] εἶδον, ὡς μηκέτι ἐπιχειρῆσαι δεύτερον ἰδεῖν; *Garofalo finds a lacuna between ἐπὶ τῶν ἄλλων … ὑπέλαβον, which he fills with a translation. There is no note here, but the reading presumably comes from the Arabic text of Anatomical Procedures. Garofalo’s insertion leads to a slightly different translation of the sentence: “But the untrained people, supposing they would be able to find in a big animal what was not visible in other cases, after looking for a long time, did not find it and then assumed that the elephant’s heart did not possess a bone”. I have let the text stand, since the insertion does not materially affect my translation or the sense of the passage. Nat.Fac. 1.13 (SM 3, 124.24–125.1 = ii.33 K.). On Galen’s avoidance of hiatus, see Nutton (1979: 153, n. 3) and Marquardt (1884: l–lv).

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slaughtered in Rome (ἐν Ρώμῃ). The bone is retrieved from the kitchens of the emperor’s cooks.23 Galen demurs from a public demonstration at the behest of his hetairoi, who pressure him not to debate with clods. Although Galen abstains from a confrontation with his rivals in the streets of Rome, the contest and his victory play out for the reader. In the first italicized passage, Galen reports his expectation of the heart bone’s discovery and then its discovery through direct observation. The second italicized passage serves no heuristic purpose. It reframes the episode in Galen’s present, fostering intimacy with the author and his narrative as well as distance from his rivals. The episode begins with the elephant’s slaughter, shortly before (ἔναγχος) the confrontation. Galen shifts from that past event (καὶ οὕτως ἐγένετο) into his present (καὶ παρ’ ἡμῖν ἐστι νῦν), populated by the visits of passersby, whom the reader is invited to join in marveling at Galen’s benighted rivals. The episode ends in Galen’s study, far from these rivals in time and place.24 In the otherwise technical narrative of Anatomical Procedures, the temporal markers and stylized narrative of this passage are unusual. Moreover, the bone that Galen describes sitting beside him, massive and awe-inspiring, does not exist in the elephant’s heart. Before the dissection, Galen alludes to the teleological grounds on which he could reliably expect the presence of a heart bone in the elephant: structural analogy across kinds arising from the robust goal-directed structure of nature.25 Only later in this quotation does direct observation come into play and, then, as ancillary evidence. As with the gallbladder, Galen’s teleological commitments are one likely explanation for his account of the heart bone,

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This Caesar is probably Marcus Aurelius, although Garofalo (1991a: 665 n. 60) identifies him as Commodus. Since Anatomical Procedures was revised over time and parts were rewritten after the fire at the Temple of Peace burned Galen’s library in 192ce, the identification is difficult. Marcus Aurelius is a more plausible identification if, as he seems to be doing, Galen sets the passage in the period of his life when he reports having conducted most of his public dissections. Galen’s use of νῦν in this context argues against reading ἐστί as an historical present. Cf. Galen’s account of the intercostal nerve demonstration in On Prognosis, which ends with the same conceit (Praen. 5, CMG v 8,1 100.2–3 = xiv.630 K.): “And to this day, Epigenes, no one has dared to contradict them, even though there have been fifty years between then and now”. (καὶ μέχρι γε νῦν, ὦ Ἐπίγενες, οὐδεὶς ἐτόλμησέν ἀντειπεῖν αὐτοῖς ἐτῶν ἐν τῷ μεταξὺ γεγονότων πεντεκαίδεκα …). As in Anatomical Procedures, νῦν and the present tense foster a sense of intimacy with the reader—in this case through the reader’s surrogate, Epigenes. Cf. AA 7.10 (664–668 Garofalo = ii.621–622 K.). The relevant point is that Galen generalizes from single or relatively small numbers of observations to all animals on the grounds that nature is an ideally organizing principle. On Galen’s thoroughgoing teleology, see Hankinson (1989: 206–227).

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deployed to demonstrate the importance of empirical observation in medical theory.26 According to Galen, his rivals believed that a bone did not exist in the hearts of large animals on the grounds that they did not observe it in smaller ones, an oversight arising from faulty training.27 Afterwards, a theoretical commitment to structural analogy drove their empirical claims.28 At the end of his narrative Galen describes an empirical investigation that he undertook earlier in his career, which first convinced him that a support structure for the cardiac skeleton was theoretically necessary: For example, I swear by all the gods that I have later seen many things not at all visible to me earlier. And so it is in the case of the heart bone, which I tried to find on my own by cutting the organ into little pieces, since I had not heard from my teachers where [the heart bone] lay or even if it was present in all animals. This way seemed to me to be the most certain for undertaking my investigation. But when I found the roots of the valves attached to it and the sources of the arterial vessels, I was first persuaded that out of necessity nature strove toward that end in all animals as a craftsperson. Afterwards, I was also persuaded through empirical examination itself, once I tracked down the sources of the aforementioned parts.29

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See AA 7.10 (660–662 Garofalo = ii.618 K.). Cf. Opt.Med. 1 (284 B-M = i.53 K.), a flamboyant general denunciation of medical ignorance: “Many athletes are afflicted with a sort of thing, although they desire to become Olympic victors, they do not make an effort to act so as to achieve this. This sort of thing also happens to many doctors. For although they praise Hippocrates and consider him first among all [doctors], to make themselves like him as much as possible they do everything but this” (Οἷόν τι πεπόνθασιν οἱ πολλοὶ τῶν ἀθλητῶν ἐπιθυμοῦντες μὲν ὀλυμπιονῖκαι γενέσθαι, μηδὲν δὲ πράττειν ὡς τούτου τυχεῖν ἐπιτηδεύοντες, τοιοῦτόν τι καὶ τοῖς πολλοῖς τῶν ἰατρῶν συμβέβηκεν· ἐπαινοῦσι μὲν γὰρ Ἱπποκράτην καὶ πρῶτον ἁπάντων ἡγοῦνται, γενέσθαι δ’ αὑτοὺς ἐν ὁμοίοις ἐκείνῳ πάντα μᾶλλον ἢ τοῦτο πράττουσιν). Also cf. Protr.; Lib.Prop. prol. (134–136 B-M = xix.9–10 K.) and Ord.Lib.Prop. (88–92 B-M = xix.49–54 K.). See AA 7.10 (664 Garofalo = ii.620 K.). Galen criticizes the views of palaioi, such as Aristotle, who discussed a heart bone in some large animals primarily on teleological grounds. Otherwise, he explains their inaccuracies as the natural result of more primitive anatomical knowledge and practice (AA 7.10, 660– 662 Garofalo = ii.618 K.). AA 7.10 (666 Garofalo = ii.621–622 K.): ἐγὼ γοῦν ἐπόμνυμι τοὺς θεοὺς πάντας, ὡς πολλὰ τῶν ἔμπροσθεν οὐδ’ ὅλως ἑωραμένων μοι κατεῖδόν ποθ’ ὕστερον. καὶ τοιοῦτ’ ἔστι τὸ κατὰ τὴν καρδίαν ὀστοῦν, ὃ μήθ’ ὅπου ὑπόκειται, μήτ’ εἰ πᾶσι τοῖς ζῴοις ἐστί, παρὰ τῶν διδασκάλων ἀκούσας, ἐπεχείρησα μὲν αὐτὸς ἐξευρεῖν, εἰς μικρὰ μόρια κατατέμνων τὸ σπλάγχνον· ἀσφαλέστατος γὰρ οὗτος ὁ τρόπος ἐδόκει μοι τῆς ζητήσεως ὑπάρχειν. ἐπεὶ δ’ ἅπαξ εὗρον ἀνηρτημένας εἰς αὐτὸ τῶν θ’ ὑμένων τὰς ῥίζας καὶ τῶν ἀρτηριωδῶν ἀγγείων τὰς ἐκφύσεις, πρῶτον μὲν ἐπείσθην, ὡς ἀναγκαῖόν

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This quotation complicates Galen’s claim that observation should drive and check theoretical claims. Discovering the bone in the heart of one animal, Galen concludes it must be present in animals generally. The discovery convinced him that nature was necessarily (ἀναγκαῖον) directed toward something like a heart bone as an end in all animals. Only later did he confirm its existence by empirical examination (δι’ αὐτῆς τῆς πείρας). Galen’s reasoning follows straightforwardly only if organs are so structured that similar or identical structures are predictable across kinds. Here and in his longer narrative of his debate on the structure of the elephant’s heart quoted earlier, Galen treats hearts as structurally and functionally analogous across air-breathing creatures, which are themselves coextensive with the class of creatures Galen and Aristotle call “blooded” (ta enaima).30 The viscera that are identical across species are structurally identical although they need not be materially so. Galen remarks: “by however much the kind of animal is unusual in its size, by that degree does the cartilage acquire a bony structure”.31 While it may differ compositionally, Galen believes that some sort of anchor or scaffolding is necessary for the valves and vessels leading out from them: “the valves, which I said are called tricuspid, and the base of the arterial vessels (aorta) are attached to a structure, in every case a hard [structure] but not hard to the same degree in all animals”.32 To this sort of structure he gives the name, “the bone in the heart” (τὸ κατὰ τὴν καρδίαν ὀστοῦν), which is descriptive only in some cases, a point on which I will elaborate presently. The graduated density of the os cordis cannot be separated from his commitment to the presence of a structural support at the base of the valves. Since larger structures require larger supports, nature “as a craftsperson” (τὴν τεχνικὴν φύσιν) strives to supply a support whose hardness is adequate to the structural demands of the creature’s heart. This teleological commitment—along

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ἐστιν ἐν ἅπασι τοῖς ζῴοις τὴν τεχνικὴν φύσιν ἐστοχάσθαι τούτου τοῦ σκοποῦ· μετὰ δὲ τοῦτο καὶ δι’ αὐτῆς τῆς πείρας ἐπείσθην, ἀκολουθῶν ταῖς πρώταις ἐκφύσεσι τῶν εἰρημένων μορίων. For Galen, the heart was an organ of respiration, a process dependent on the movement of the thorax. When Galen discusses the class of air breathing creatures, those creatures will have a heart, which is involved in the elaboration of blood. The apparent criteria by which Galen determines which organs will exist across what kinds are similar to Aristotle’s. In particular, both differentiate between kinds on the basis of articulation. See Manuli, P. and M. Vegetti (1977: 177–182) and foldout. Galen follows Rufus of Ephesus even more closely (cf. Onom. 127). For Aristotle’s methods of classification, see my discussion in chapter three, especially pp. 112–114. I am aware of no modern discussion of Rufus’ system of classification. AA 7.10 (662 Garofalo = ii.619 K.): ὅσῳ γ’ ἂν ᾖ τὸ τοῦ ζῴου γένος ἀξιολογώτερον τῷ μεγέθει, τοσούτῳ πλέον ὀστώδους οὐσίας ὁ χόνδρος ἐπικέκτηται. AA 7.10 (662 Garofalo = ii.619 K.). Cf. UP 6.19 (i.365.14–366.13 Helmreich = iii.501–503 K.).

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with his observation of the bone in some smaller ruminants—likely prompted Galen to suppose that the elephant possesses an os cordis. For the most part, the episode tracks Aristotle’s account of the heart in so-called blooded animals in book three of Parts of Animals.33 There, Aristotle acknowledges the presence of a bone in the hearts of some oxen and horses, while denying it in the hearts of other animals he reports having observed.34

3

Galen’s Engagement with Aristotle

Aristotle figures prominently in Galen’s account of the heart both in Anatomical Procedures and in The Function of the Parts. The physicians against whom Galen argues in the narrative of Anatomical Procedures are gathered in the street to examine the number of apices and chambers of the heart. These are questions that Galen explicitly associates with Aristotle, whose views he repudiates.35 Here Galen introduces his account of the heart bone, whose existence in certain animals is denied by Aristotle and his Roman rivals. Aristotle believed that the chambers (κοιλίαι) of the heart differ in number from one to three, relative to body size.36 Aristotle’s claim is difficult to explain observationally. The term “κοιλίαι”, commonly translated as “ventricles”, is better rendered “chambers”. Translating them as “ventricles” reflects the modern identification of κοιλίαι with two of the four chambers of the heart. It obscures a common ancient Greek notion that the heart possessed only two chambers. If Aristotle meant “κοιλίαι” to describe what later anatomists took to be the right and left ventricles, it is unclear how he might have envisioned a third ventricle. It is difficult to untangle the knot by supposing a taxonomical difference involving the atria, which in antiquity were generally not seen as distinct chambers of the heart, but as the expanded terminal points of the venae cavae and the pulmonary vein.37 Aristotle’s view on the three κοιλίαι of the heart in large animals

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Aristotle PA 3.4, 665b9–667b14. See Aristotle PA 3.4, 666b17–19. Cf. Aristotle HA 2.15, 506a9–10. See, e.g., AA 7.10 (660–662 and 664–666 Garofalo = ii.618 and 621 K.). Aristotle’s claims about the apices and chambers of the heart can be found in PA 3.4, 666b1–666b35; HA 1.17, 496a4–27 and 3.3, 513a27–b1. See Aristotle PA 3.4, 666b21–666b35. On the chambers of the heart in Aristotle, see Harris’ overview (1973: 121–133). There is no consensus on a solution to this puzzle. Suggestions range from supposing that Aristotle was simply mistaken or was motivated by a need for a single source (ἀρχή) of blood and volition, to attempts to locate what his third chamber may have been. See, e.g., Harris (1973: 98). The account is out of date but comprehensive.

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is a springboard for Galen to criticize him and contemporary physicians for their observational and methodological failures. It introduces Galen’s discussion of the heart bone and then his anecdote on the slaughtered elephant.38 Galen’s discussion of the number of the heart’s ventricles then closes his general discussion of cardiac anatomy, of the elephant episode, and finally of his criticism of the physicians who share Aristotle’s views. Galen is sympathetic to Aristotle’s functional explanation of the heart bone, even if he criticizes Aristotle for his willingness to deny its existence in some larger animals. Aristotle argues that some structure will serve as a cardiac support. He is only committed to this structure being a bone in some cases, however: [the heart] of all [animals], even the ones that we have examined, is boneless, except for horses and a certain kind of ox. And, on account of their size, these [animals] possess a bone [in their heart] for support (ἐρείσματος χάριν), just as also whole bodies do.39 Galen takes issue with Aristotle on the explanatory force of animal size. He reads Aristotle as saying that animal or perhaps organ size determines the density of the support structure. On this reading, Aristotle’s observations are at odds with his theoretical claims. The text admits of another reading, however. Size may explain the presence of a heart bone while not demanding it. In other words, for all animals, if an animal’s heart exhibits a denser supportive structure, the animal or its organ must be larger. Aristotle need not hold the converse view, that the hearts of all larger animals must possess denser supportive structures. However, this interpretation merely defers questions about the inconsistent presence of the heart bone among animals, especially of the same kind. Galen’s retrojection of his terminology onto Aristotle muddies the water further. As we have seen, in some cases Galen uses “bone” (ὀστοῦν) as a name. It just picks out the cardiac support, whatever its composition: “[l]ikewise, the 38

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Singer (1956: 251 n. 155) believes that Galen’s reference is to the number of vessels in the heart. I agree, contra Singer, with Garofalo (1991a: 663 n. 53 and references), who takes the dispute to be over the number of chambers in the heart rather than coronary vessels: “Galeno allude al numero di ventricoli non ai vasi come pensa Singer, nota 155”. The context both before and after this passage involves Aristotle’s claim about the three cardiac chambers. Aristotle PA 3.4, 666b17–21: ἔστι δ’ ἀνόστεος πάντων ὅσα καὶ ἡμεῖς τεθεάμεθα, πλὴν τῶν ἵππων καὶ γένους τινὸς βοῶν· τούτοις δὲ διὰ τὸ μέγεθος οἷον ἐρείσματος χάριν ὀστοῦν ὕπεστι, καθάπερ καὶ τοῖς ὅλοις σώμασιν. Cf. HA 2.15, 506a8–10.

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bone in the heart, which [some people] think exists in large animals and not even in all of those, does exist in all the rest although it is not precisely a bone in all of them but cartilage”.40 In the case of the elephant, however, he means it descriptively—as a bone. In the passage quoted from Parts of Animals, Galen takes Aristotle’s usage to be stipulative, referring to its structural scaffolding. It is more straightforward to take Aristotle’s “bone” (ὀστοῦν) as descriptive, referring to an actual bone in the heart. Aristotle probably would not deny that some functionally identical supportive structure should be found in the hearts of all blooded animals. For example, Aristotle describes what must be the chordae tendineae, which aid in the operation of the tricuspid valves.41 He treats these νεῦρα as structural supports, analogous to the body’s skeleton: The heart has a number of tendons (νεύρων), and this is reasonable as the motive impulses (κινήσεις) proceed through [its] contracting and relaxing. Consequently, it needs this sort of service (τοιαύτης ὑπηρεσία) and strength. And the heart, just as I said also earlier, is a sort of animal in those who have it.42 The word ὑπηρεσία generally refers to the groups of rowers, who power a trireme. The image is lost in translation, but it is informative here. The bank of rowers strains to aid the heart in contraction and then relaxation. They require some sort of brace to aid them in their efforts. Aristotle does not explicitly conclude that all hearts, in virtue of possessing νεῦρα, require an underlying structural support. But his argument on the function of the νεῦρα in the heart makes a support functionally necessary. On this interpretation, Aristotle’s view is consistent with Galen’s. Both believe that all the hearts of blooded animals possess a structural support, but not all possess one made of bone. Galen has merely committed Aristotle to a problematic view by reading his own usage into Aristotle’s text.

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AA 7.10 (662 Garofalo = ii.618 K.): καὶ γὰρ οὖν καὶ τὸ κατ’ αὐτὴν ὀστοῦν, ὃ τοῖς μεγάλοις ζῴοις ὑπάρχειν νομίζουσι, καὶ τούτοις οὐ πᾶσιν, ἐν πᾶσι μέν ἐστι καὶ τοῖς ἄλλοις, οὐ μὴν ὀστοῦν πᾶσί γε ἀκριβῶς, ἀλλὰ χόνδρος. Although it is unlikely that Aristotle had this function in mind. The tricuspids had not yet been identified as such. Depending on how one reads Galen’s comments at PHP 6.6 (CMG v 4,1,2, 396 = v.548–550 K.), this discovery is credited to Erasistratus in the third century bce or later Erasistrateans. See Harris (1973: 197–198), and von Staden (1975: 183–184). Aristotle PA 3.4, 666b13–17: ἔχει δὲ καὶ νεύρων πλῆθος ἡ καρδία, καὶ τοῦτ’ εὐλόγως· ἀπὸ ταύτης γὰρ αἱ κινήσεις, περαίνονται δὲ διὰ τοῦ ἕλκειν καὶ ἀνιέναι· δεῖ οὖν τοιαύτης ὑπηρεσίας καὶ ἰσχύος. ἡ δὲ καρδία, καθάπερ εἴπομεν καὶ πρότερον, οἷον ζῷόν τι πέφυκεν ἐν τοῖς ἔχουσιν.

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Galen’s description of these views as topics proposed for public intellectual debate (problēmata), evokes the language of second-century intellectual demonstrations and sets the episode in a formal agonistic context: “… many doctors gathered together for its dissection to determine whether the [elephant’s] heart possesses one or two apices and two or three ventricles”.43 Given the questions posed for debate and the positions implicitly taken by the gathered rivals, they should be identified as including Peripatetics and probably Stoics. Galen often links the two groups in his anatomical demonstrations on the heart.44 On Prognosis contains a particularly striking example of this guilt by association. As we have seen, Galen demonstrates the function of the recurrent laryngeal nerve and intercostal muscles in voice production as part of his suite of demonstrations against cardiocentrists.45 He refers to this encounter as his agōn against Stoics and Peripatetics.46 To the extent that Galen can undercut Aristotle’s views on these problēmata, he undercuts Aristotle’s views on the heart generally, including the heart’s role in volition. While Galen explicitly mentions Aristotle in his discussion of cardiac ventricles, to claim that he targets Aristotle and his cardiocentrism specifically in his arguments for the heart bone requires further argument. In the digression on the elephant, Galen intimates that Aristotle is the source of his rivals’ mistaken views, including those on the heart’s bone and its ventricles: “[s]o even the biggest structures in animals [sc. the heart bone] elude the untrained and it is not at all unbelievable that Aristotle both was mistaken about many other anatomical matters and thought that the heart had three ventricles in large animals”.47 Aristotle’s texts bear this connection out. Throughout book three of Parts of Animals, Aristotle discusses the elephant’s heart bone, the ventricles, and the apices of the heart.48 He also mentions the heart bone in passing both in book two of Historia Animalium and book five of Generation of Animals.49 43 44 45 46 47

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AA 7.10 (664 Garofalo = ii.619–620 K.): ἠθροίσθησαν μὲν ἐπὶ τὴν ἀνατομὴν αὐτοῦ πολλοὶ τῶν ἰατρῶν ἕνεκα τοῦ γνῶναι, πότερον ἔχει δύο κορυφὰς ἢ μίαν ἡ καρδία, καὶ δύο κοιλίας ἢ τρεῖς. Cf. PHP 2.8 (CMG v 4,1,2, 160 and 162 = v.276 and 278 K.), 7.1 (CMG v 4,1,2, 428–430 = v. 587– 588 K.), et passim. Praen. 5 (CMG v 8,1, 94–100 = xiv.624–630 K.). Praen. 5 (CMG v 8,1, 94.25–26 = xiv.626 K.): κατὰ τὸν πρὸς τοὺς Στωϊκούς τε καὶ Περιπατητικοὺς ἀγῶνα. AA 7.10 (664 Garofalo = ii.621 K.): οὕτως ἄρα καὶ τὰ μέγιστα τῶν ἐν τοῖς ζῴοις μορίων λανθάνει τοὺς ἀγυμνάστους. καὶ θαυμαστὸν οὐδὲν, ἄλλα τε πολλὰ κατὰ τὰς ἀνατομὰς Ἀριστοτέλη διαμαρτεῖν, καὶ ἡγεῖσθαι, τρεῖς ἔχειν κοιλίας ἐπὶ τῶν μεγάλων ζῴων τὴν καρδίαν. See Aristotle PA 3.4, and especially PA 3.4, 666b14–35. Aristotle HA 2.15, 506a8–10: “[e]xcept that in the case of oxen there is something peculiar in the heart, although not [in] all of them, as there is a kind of ox which has a bone in the heart. And the heart of horses also contains a bone” (πλὴν ἐν τῇ καρδίᾳ ἴδιόν τι ἐστὶν ἐπὶ

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The passages in Historia Animalium and Generation of Animals do little more than locate a heart bone in oxen, horses, and bulls. Setting them aside, let us focus on Aristotle’s fuller account in Parts of Animals. After discussing the material composition of the heart and one of its primary functions (as a source and central vessel for blood in the body), Aristotle engages critically with thinkers who believe the brain is the source of blood vessels, an etiolated encephalocentric position.50 For him, the primacy and centrality of the heart make an implicit case for cardiocentrism.51 But Aristotle claims that the human heart is off-center while it is centered in other animals.52 The human heart is indeed off-center, complicating Aristotle’s argument from position. This account is interesting in its own right but,53 for present purposes, it suffices to note an emerging pattern in which Aristotle’s reports of cardiac anatomy are consistent with empirical observation and problematic for his general theoretical claims. Galen’s discussion of the double apex and chambers of the heart,54 the problēmata he establishes as context for the elephant episode, and his references to Aristotle’s views on the heart bone in Anatomical Procedures as well as The Function of the Parts are evidence that he had this section of Parts of Animals in mind while constructing his own accounts of the heart bone. Galen’s repeated references to material in Parts of Animals 3.4 elsewhere also suggest that the section was a point of contention and engagement with Aristotle.55 Galen’s

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τῶν βοῶν· ἔστι γάρ τι γένος βοῶν, ἀλλ’ οὐ πάντες, ὃ ἔχει ἐν τῇ καρδίᾳ ὀστοῦν. ἔχει δὲ καὶ ἡ τῶν ἵππων καρδία ὀστοῦν). In GA 5.7, 787b17–19, Aristotle explains “that the heart of oxen is so by nature is clear since there is a bone in some of them; and bones seek out the nature of sinews” (δηλοῖ δὲ τοιαύτη τὴν φύσιν οὗσα ἡ καρδία τῶν βοῶν τῷ καὶ ὀστοῦν ἐγγίνεσθαι ἐν ἐνίαις αὐτῶν· τὰ δ’ ὀστᾶ ζητεῖ τὴν τοῦ νεύρου φύσιν). Aristotle PA 3.4, 665b9–21 and 665b28–33. Galen focuses on Aristotle’s arguments from position in PHP 2.4 (CMG v 4,1,2 116.34–118.21 = v.228–229 K.). Cf. Tieleman (1996: 39–42). Furthermore, Galen’s digression at AA 7.11 (670 Garofalo = ii.624 K.) echoes Aristotle’s account in HA 2.17, 507a2 ff. Both discuss the apex of the fish heart in the immediate context of their broader discussions of the heart. Cf. Aristotle Resp. 478b3; HA 2.17, 506b32–507a10. By comparison, Galen’s accounts of the position of the heart differ in The Function of the Parts and Anatomical Procedures. In The Function of the Parts he claims that the human heart lies in the center of the chest and in Anatomical Procedures that the right ventricle is off-center. Galen’s changing views on the subject or the unusual editorial process both texts underwent may explain the discrepancy. Briefly, Aristotle argues that in human beings the left side of the body is colder than the right. The heart is positioned slightly left-of-center in order that its heat may compensate for the coldness of the left side of the human body. See Aristotle PA 3.4, 666b6–11. AA 7.101 (668–670 Garofalo = ii.624–625 K.). See, e.g., At.Bil. 8 (CMG v 4,1,1 93 = v.147 K.).

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engagement with Aristotle on the heart is hardly surprising; he spends a great deal of time inveighing against cardiocentrists, and Aristotle was strongly identified as a source for the view. These connections, however, make the case that the os cordis episode is not merely a corrective of Aristotle’s views on cardiac structure and function—it also collaterally undermines his cardiocentrism and the views of later cardiocentrists, whose beliefs derive from him.

4

Galen’s Teleology and Cardiac Structure

Aristotle describes the heart as structurally analogous to a living body.56 One might therefore expect there to be a supportive structure in the heart that performs the same function as the skeleton does for a body: Flesh surrounds the bones, fastened by thin and fibrous sinews. The skeleton is for the sake of [the flesh]. For just in the way that sculptors who are sculpting an animal out of clay or some other wet substance set up some sort of solid body as a support or mold around [a support], in the same way nature builds an animal out of flesh.57 Like Galen, Aristotle believes that every heart will be reinforced by some functionally analogous structure and that when a bone is present, it is so in virtue of animal size. This functional account explains the presence of a heart bone in large animals. It does not, however, address the bone’s presence in only some members of the same species, as in the case of the ox, and its complete absence in some larger animals like the elephant. One might expect that functionally useful structures would exist in every member of a kind, if they exist in any member of it. Aristotle offers no explanation; his silence leaves the door open for Galen to question whether he had seen the consequences of his theoretical commitments. One avenue for response involves the degree to which teleological structure pervades the natural world. Although Aristotle’s teleological commitments incline him to the view that organs should be usefully structured, his teleol-

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Cf. Aristotle PA 3.4, 666a18–24. Aristotle PA 2.9, 654b27–32: περὶ δὲ τὰ ὀστᾶ αἱ σάρκες περιπεφύκασι, προσειλημμέναι λεπτοῖς καὶ ἰνώδεσι δεσμοῖς, ὧν ἕνεκεν τὸ τῶν ὀστῶν ἐστι γένος. ὥσπερ γὰρ οἱ πλάττοντες ἐκ πηλοῦ ζῷον ἤ τινος ἄλλης ὑγρᾶς συστάσεως ὑφιστᾶσι τῶν στερεῶν τι σωμάτων, εἶθ’ οὕτω περιπλάττουσι, τὸν αὐτὸν τρόπον ἡ φύσις δεδημιούργηκεν ἐκ τῶν σαρκῶν τὸ ζῷον. Cf. AA 1.2 (82–84 Garofalo = ii.218–219 K.), which repeats the metaphor.

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ogy admits of occasional structures that exist for no proximate reason but are the consequence of goal-directed processes (τὰ περιττώματα), such as the gallbladder. In some rare cases, his teleology even allows structures to exist to the detriment of their possessor, as in the much-discussed case of deer antlers or bile.58 These phenomena are partly explained by two Aristotelian views: nature is goal-directed but materially constrained, and nature in the sub-lunar realm may operate ‘for the most part’ (ὡς ἐπὶ τὸ πολύ). These two features of Aristotle’s teleology potentially account for his silence on the os cordis. While Aristotle explained that the heart bone exists in some animals for support, in virtue of their size, this explanation only commits him to the weaker claim that an animal possessing a heart bone will be large; it does not follow that being large is a sufficient condition for the presence of a heart bone. Hence, its absence in some oxen. This weaker claim is consistent with Aristotle’s view that functional structures exist for a benefit but not all of them are necessary (e.g., kidneys, which filter urine but are not necessary on the grounds that the bladder can do their work). Galen reads Aristotle as asserting an equivalence: if a creature has a heart bone, it will be large and if a creature is large, it will have a heart bone. This reading is reasonable, but may be distorted by the lens of Galen’s more robust teleology. For Galen, the teleological organization of the world is more thoroughgoing. As much as possible, every structure in the world exists for some purpose and there is a strict economy of structures to accomplish that purpose, what Hankinson refers to as Galen’s Principle of Creative Economy.59 In The Function of the Parts, Galen writes: But it would be better said as follows: Nature attached the ends of ligaments to cartilage or to cartilaginous bone [in the body]. She was not about to overlook the ligaments in the heart, seeing as the membranes at the openings of the vessels are of this type, nor the tunic of the arteries, which is similar to a ligament in the nature of its material. Rather, she also attached the ends of all these to this cartilaginous bone, as I have shown in my Anatomical Procedures. In large animals the bone is cartilaginous, in very small animals it is a neurocartaliginous structure. And so every heart has some hard structure in the same place, which is present in all animals for the same purpose. And the fact that larger [hearts] require this sort of structure is not at all strange, for a large heart possesses a harder

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The antlers of deer are discussed in Aristotle PA 2.16, 659a19, 3.2, 663a8–14. On account of their weight, they can be more of a hindrance than a help. See Hankinson (1988b: 151–155).

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structure, suitable as an attachment for the ends of ligaments and as a foundation for the whole heart.60 Galen’s more thoroughgoing teleological views commit him to the stronger equivalence claim mentioned earlier: if a creature has a heart bone, it will be large and if a creature is large, it will have a heart bone. Aristotle’s account is consistent with the former claim but his teleology does not commit him to the latter. Aristotle only claims that not every large heart contains a bone. He remains silent on whether they must possess some other foundational support materially analogous to it, since he primarily discusses functional analogy. Aristotle’s silence is relevant because Galen appears not just to fault him for believing that the elephant has no heart bone but also for a failure to cleave to his own teleological commitments—as Galen interprets them.61 Explicitly, Galen faults Aristotle for his claims about cardiac anatomy. Implicitly, he takes Aristotle to task for a lapse in his adherence to robust teleology. While Aristotle shares Galen’s commitment to functional and, therefore to a certain degree, structural analogy across animal kinds, this shared commitment does not move him to commit to the stronger claims resulting from Galen’s teleological commitments. Rather, empirical evidence seems to drive Aristotle’s account of the elephant’s heart. Had it been theoretically driven, his anatomy of the heart bone would have more closely resembled Galen’s. Galen can infer a heart bone in the elephant on teleological grounds alone. Since the bones in oxen and horses, which Aristotle observed, establish a baseline for the density of the support structure in animals of this size, larger animals should also have a heart bone in Galen’s descriptive sense. Galen’s com60

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UP 6.19 (i.365.22–366.13 Helmreich = iii.502–503 K.): κάλλιον δ’ ἂν ἥδε λέγοιτο. πανταχοῦ τῶν συνδέσμων τὰς ἀρχὰς ἡ φύσις ἢ εἰς χόνδρον ἢ εἰς ὀστοῦν ἀνάπτει χονδρῶδες. οὔκουν οὐδὲ τῶν κατὰ τὴν καρδίαν συνδέσμων, ἐκ τούτου γὰρ τοῦ γένους εἰσὶν οἱ ἐπὶ τοῖς στόμασι τῶν ἀγγείων ὑμένες, ἀλλ’ οὐδὲ τοῦ χιτῶνος τῶν ἀρτηριῶν, ὁμοίου συνδέσμῳ τὴν τοῦ σώματος οὐσίαν ὄντος, ἤμελλεν ἀμελήσειν, ἀλλὰ καὶ τούτων ἁπάντων εἰς τουτὶ τὸ χονδρῶδες ὀστοῦν ἀνῆψε τὰς ἀρχάς, ὡς ἐν ταῖς Ἀνατομικαῖς ἐγχειρήσεσιν ἐδείκνυμεν. ἐν μὲν οὖν τοῖς μεγάλοις ζῴοις ὀστοῦν ἐστι χονδρῶδες, ἐν δὲ τοῖς πάνυ μικροῖς νευροχονδρῶδές τι σῶμα. πᾶσα δ’ οὖν ἔχει καρδία κατὰ τὸν αὐτὸν τόπον οὐσίαν τινὰ σκληρὰν ἕνεκα τῶν αὐτῶν χρειῶν ἐν ἅπασι τοῖς ζῴοις γεγενημένην. τὸ δὲ τὰς μείζονας σκληροτέρας δεηθῆναι τῆς τοιαύτης οὐσίας οὐδὲν θαυμαστόν· εἴς τε γὰρ τὸ τὰς ἀρχὰς τῶν συνδέσμων ἀσφαλέστερον ἀνῆφθαι καὶ εἰς τὴν ἕδραν ὅλης τῆς καρδίας ἐπιτηδειότερόν ἐστι τῇ μεγάλῃ τὸ σκληρότερον. On Galen’s exploitation of other authors’ silences as tacit denials, see von Staden (1997b: 183–208): “This [referring to Erasistratus] is similar to other instances in which Galen infers an elaborate negation or negative theory—here ‘in vain the spleen, in vain the omentum, in vain the renal arteries, in vain numberless other things’–from an author’s silence or putative silence on a given point” (196).

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ments in the heart bone episode, quoted earlier, suggest that he made just his inference.62 His teachers of anatomy were unsure of the bone’s existence and he himself was unable to find it at first. He expected it, however, and on finding an instance of it, extrapolated it to other animals. The argument is fleshed out in The Function of the Parts: And since there is also found a certain bone at the top of the heart in large animals, it would also be reasonable not to overlook its function. And perhaps the function mentioned by Aristotle is right. He said that it was a sort of support and a foundation for the heart and for that reason is found in the large animals. For clearly it would be reasonable that a large heart hanging in a large chest would also require this sort of part.63 It is not enough for Galen that animal size explains the presence of a heart bone. In order to be explanatory, it requires the presence of the heart bone. Aristotle’s account was right insofar as it proceeded from the notion that the heart’s structure entails certain functional supports but for Galen the heart’s function also entails that particular structure. This discussion has centered on theoretical reasons for Galen’s account of the heart, which diverges in slight but significant ways from Aristotle’s account by describing a non-existent structure, whose absence Aristotle noted. Not only does the elephantine heart lack a heart bone, but also there is also no obvious fibrous structure in a normal heart that could be mistaken for one. It is just possible, however, that Galen saw a pathological structure that he mistook for an os cordis. Sylvia Sikes, a veterinary scientist, conjectured that Galen was describing a case of advanced coronary sclerosis.64 But this seems unlikely.

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AA 7.10 (664 and 666 Garofalo = ii.620 and 622 K.). UP 6.19 (i.365.14–365.22 Helmreich = iii.501–502 K.): Ἐπεὶ δὲ καὶ ὀστοῦν εὑρίσκεταί τι κατὰ τὴν κεφαλὴν τῆς καρδίας ἐν τοῖς μεγάλοις ζῴοις, εὔλογον ἂν εἴη καὶ τὴν ἐκείνου χρείαν μὴ παρελθεῖν. ἔστι μὲν οὖν ἴσως καὶ ἡ ὑπ’ Ἀριστοτέλους εἰρημένη λόγον ἔχουσα. στήριγμα γάρ τι καὶ οἷον ἕδραν εἶναί φησι τῆς καρδίας αὐτὸ καὶ διὰ τοῦτ’ ἐν τοῖς μεγάλοις ζῴοις εὑρίσκεσθαι. δῆλον γάρ, ὡς ἐν μεγάλῳ θώρακι μεγάλην καρδίαν αἰωρουμένην εὔλογον ἦν δήπου καὶ τοιούτου τινὸς δεηθῆναι μορίου. Sikes (1971: 218): “Galen (ad 130–200) described an os cordis, or ‘bone of the heart’, in an elephant heart he examined at autopsy. As is usual (even today) in such circumstances, he was so crowded during his dissection by spectators and fellow ‘scientists’ that he decided to curtail the autopsy. As was customary the heart was taken to the palace kitchen to be served up for the royal dinner that evening. By a judicious alliance with the palace cooks, he managed to re-examine the heart in less disturbed circumstances and reported finding this ‘bone’. It seems most probable, however, that what he really found, making

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Sikes overlooks his claim that the bone is described as massive.65 Its size belies identifying it with arterial plaque, which is limited by the size of the arteries in which it is found.66 Its material composition is also a stumbling block for this identification. Moreover, it is worth mentioning some of the methodological dangers of retrospective identifications and diagnoses such as Sikes’. In his groundbreaking Diseases in the Ancient Greek World, Mirko Grmek strikes an apt and cautionary note about the historical contingency of pathological systems and how they necessarily inform our conception of disease(s).67 Grmek’s discussion is about the retrospective diagnosis of pathological conditions, but his point can—and should—be extended to the application of contemporary anatomical knowledge and writing to ancient accounts of the body. This is not to say that contemporary knowledge has no heuristic place in the history of medicine of course, only that it should be used advisedly. While it is not clear what—if anything—Galen is describing in this episode, it is clear that Galen did not see an os cordis. Indeed, Galen’s account of the elephant’s necropsy suggests that perhaps he also never went looking for it. Galen has powerful theoretical and polemical motives for describing an os cordis, made out of bone, in the elephant’s heart. There are stylistic, textual, and anatomical reasons to

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allowances for his harassment during the autopsy, was pathological and was actually a case of advanced coronary sclerosis”. AA 7.10 (664 Garofalo = ii.620 K.): οὐ σμικρὸν μὲν ὑπάρχον τῷ μεγέθει, θαυμαστὴν δὲ παρέχον ἀπιστίαν τοῖς ὁρῶσιν, εἰ τηλικοῦτον ὀστοῦν ἐλάνθανε τοὺς ἰατρούς. Sikes (1971: 218) suggests that Galen may have mistaken a case of advanced arteriosclerosis for the heart bone, also cited in Nutton (2013: 237–238 and n. 16). Against this view, Dr. Dennis Schmitt, professor emeritus of Agriculture and Director of Research and Conservation at Missouri State University, as well as Chair of Veterinary Care, Research, and Conservation with the Ringling Brothers Center for Elephant Conservation, has written to me in personal correspondence that there is no likelihood of mistaking any fibrous structure in the elephant’s cardiac skeleton for a genuine os cordis. Gourevitch (2001: 159) cites French veterinary scientists who also were not able to find a structure that could be mistaken for an os cordis. Grmek (1989: 1). The reference is worth quoting in full: “It is impossible to apprehend correctly the significance of an ancient text concerning a pathological event unless we rid ourselves as completely as possible of the ontological notion of disease embedded in our everyday language. Notions of disease and even of particular diseases do not flow directly from our experience. They are explanatory models of reality, not its constitutive elements. To put it simply, diseases exist only in the realm of ideas. They interpret a complex empirical reality and presuppose a certain medical philosophy or pathological system of reference”. For further discussion of the methodological issues associated with retrospective diagnosis in particular, see Karenberg and Moog (2004) and Leven (2004). On the history of retrospective diagnosis, see Graumann and Horstmanshoff (2016).

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suppose that this is not simply a case of Verformungstendenzen, seeing what one wants to see, but that Galen is actually describing the heart of an ox. There are parallels for Galen postulating structures in human beings without having seen them. In order to explain neural physiology, he mistakenly posits a retiform plexus (rete mirabile) in human beings by analogy from the ox, which does possess this structure. Galen’s comments regarding the subjects of his dissections and Rocca’s work on the brain show that Galen made analogical claims about humans specifically from the anatomy of oxen, sheep, and goats, all of which possess an os cordis. Moreover, the ox was easily available in Rome: “[o]x brains suitably stripped of most of the parts of the cranium are commonly sold in big cities”.68 As the largest anatomical subject widely available it was also a useful tool for the magnification of analogous structures in smaller animals. In addition, it was a common subject of his anatomical investigations, common in ritual sacrifices, cooking, and one of the only animals dissected by him also known to contain an os cordis. From a strictly anatomical point of view, Rudolph Siegel has concluded that Galen dissected only the hearts of oxen, on the grounds that his description of the atria matches the auricles of oxen but not the atria of humans or apes.69 Of course, Galen’s use of the ox as an exemplar does not preclude his knowledge of the internal anatomy of other animals. Siegel’s observation that Galen’s account of the auricles describes an ox heart rather than the heart of a primate, however, furthers the view that Galen modeled the elephantine heart on that of the ox, whose heart was the largest familiar to him. C.R.S. Harris has argued against Siegel, in his discussion of Galen’s changing views on the position of the human heart.70 Harris dismissed Siegel’s claim that Galen worked exclusively on oxen. Nevertheless, he concluded that Galen’s cardiac anatomy was comparative not autoptic.71 The anecdotal structure and language of the necropsy episode also mark it differently from Galen’s general anatomical narrative, which prompts one to question what role that narrative plays in a treatise often considered to 68 69

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AA 9.1 (794 Garofalo = ii.708 K.): ἕτοιμοι δὲ τοὐπίπαν ἐν ταῖς μεγάλαις πόλεσιν ἐγκέφαλοι βόειοι πιπράσκονται τῶν πλείστων τοῦ κρανίου μερῶν γυμνοί. Siegel (1968: 34): “Only in the ox heart, which Galen exclusively studied, both venae cavae appear to terminate in the right atrioventricular valve without forming an atrium. Since Galen never stated that he dissected a human heart, we should not consider his description of the relation between auricle, venae cavae, and right ventricle as erroneous, as we so often read”. See Harris (1973: 270 n. 1). See Harris (1973: 269–270), referencing Daremberg’s extensive note to his translation of The Function of the Parts: Daremberg (1854–1856: 383 ff.).

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be merely technical.72 Furthermore, there are textual reasons to suspect that Galen based his elephantine anatomy in Anatomical Procedures on the ox. In Anatomical Procedures as well as The Function of the Parts, Galen claims that the structure of the heart across kinds of air-breathing animals is identical. His argument takes the same form in both texts: for any air-breathing animal a, where a is larger than the largest animal or smaller than the smallest, the structure of their hearts will be the same. However, Galen’s sample candidates for the largest and smallest animals in each text differ. In Anatomical Procedures, he introduces the elephantine heart to present structures so minute as to be hidden (ἄδηλα) in smaller animals, for direct observation in an enlarged context. In book seven, he gestures toward the elephant and lark as extreme ends of size: [f]or it is necessary that you know well that even if there were some airbreathing animal bigger than an elephant or smaller than the crested lark, the structure of its heart would be similar to theirs; and it is not better to say similar but rather the same in form.73 Galen illustrates the same point about the structure of the heart in book six of The Function of the Parts: The largest horse has precisely the same cardiac structure as the smallest sparrow, even if you should dissect a mouse or an ox and even if, of animals, there were yet some other either smaller than a mouse or larger than an ox, the number of its ventricles would be equal and the rest of the structure of the heart would be the same.74 Galen’s account of cardiac structure in The Function of the Parts mirrors his account in Anatomical Procedures at most points. The heart bone and ventricles are both mentioned, as is, as is the issue of their scaling size. Galen’s exemplars for massive and minute animal size, however, differ illustratively. He 72 73

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This notion of technical writing is anachronistic of course. Greco-Roman work on technical subjects did not adhere to the generic norms typical of contemporary technical work. AA 7.11 (668–670 Garofalo = ii.624 K.): εὖ γὰρ εἰδέναι χρή σε, κᾂν ἐλέφαντος ᾖ τι μεῖζον, ἢ κορυδοῦ μικρότερον, ἐξ ἀέρος ἀναπνέον, ὁμοίαν αὐτοῖς εἶναι τὴν κατασκευὴν τῆς καρδίας· ἄμεινον δ’ οὐχ ὁμοίαν, ἀλλὰ τὴν αὐτὴν κατ’ εἶδος εἰπεῖν. UP 6.9 (i.323.3–9 Helmreich = iii.442–443 K.): τὴν αὐτὴν γὰρ ἀκριβῶς ἔχει κατασκευὴν καρδίας ἵππος ὁ μέγιστος ἐλαχίστῳ στρουθῷ, κἂν εἰ μῦν ἀνατέμοις κἂν εἰ βοῦν κἂν εἴ τι τῶν ἄλλων ζῴων ἢ μικρότερον ἔτι μυὸς ἢ μεῖζον βοός, ἅπασιν αὐτοῖς ὅ τ’ ἀριθμὸς ἴσος ὁ τῶν κοιλιῶν ἥ τ’ ἄλλη κατασκευὴ τῆς καρδίας ἡ αὐτή.

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contrasts the elephant with the lark in Anatomical Procedures, while his points of comparison are the ox and mouse in The Function of the Parts. Although Galen does not mention the elephant in conjunction with the heart in The Function of the Parts, parallels between the two texts argue either that the two cardiac accounts are the same—one merely more compressed than the other—or that they influenced one another during the complicated editing process of their treatises.75 Galen’s general account of the heart better describes the auricles of an ox than those of human beings or elephants. When taken along with his well-documented use of oxen as subjects for anatomical study and demonstration, the details of his description strongly suggest that his account is simply based on the cardiac structure of the ox. His use of the ox in the same vein as the elephant, as examples of the largest animal imaginable in two intimately linked texts, further argues that the elephantine heart in Anatomical Procedures is an extrapolation from the anatomy of oxen, made for polemical purposes, rather than an account of actual autopsy. Galen has simply substituted elephant for ox as more spectacular evidence: first, for the specific claim that viscera across animal kinds will be similarly structured and that they will scale proportionately in size with the body that contains them and, second, for his more general commitments to the thoroughgoing teleological structure of the natural world. Galen’s general description of the heart began with a reference to Aristotle’s belief that the hearts of larger animals possess more chambers than those of smaller animals. This critique is flanked by language that emphasizes the importance of direct observation and its results: It is better to examine (ἐπισκέπτεσθαι) these things, as I said earlier, once the heart has been removed from the animal, even more so in the case of a large animal. For [things] obtain similarly for all animals and there is no

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Galen rewrote parts of each treatise. Both texts refer to one another and it is not always clear to which version of a text Galen is referring. For present purposes, this complication just means that arguments about relative chronology between episodes in each treatise and, therefore, about the influence of one text on the other are not straightforward. It is clear, though, that the two texts are closely related. They follow one another in the order of anatomical exposition and in many episodes, such as the heart bone, compress or expand the same account. E.g., at UP 6.18–19 (i.364.5–366.13 Helmreich = iii.500–503 K.), Galen mentions AA 7.10 (660–668 Garofalo = ii.618–622 K.). In AA 7.1 (620–622 Garofalo = ii.590–591 K.) he says that he has detailed the theoretical (i.e., teleological) background of the structure of the respiratory organs in books 6–7 of UP. In UP 6.8 (i.320.17–22 Helmreich = iii.439 K.) he alludes to the method of dissection he recommends in AA 7.12 (672–680 Garofalo = ii.626–632 K.).

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difference among them on account of size as Aristotle supposes (οἴεται). But, the sight (ἡ θέα) is more fully visible (σαφεστέρα) in large hearts.76 Galen contrasts what Aristotle erroneously supposes (οἴεται) with visual experience, which is clearer (ἡ θέα … σαφεστέρα) for purposes of direct examination (ἐπισκέπτεσθαι). This sort of language is common in Galen, who frequently tells the reader that his claims are not only manifest to reason but also often manifest visually to those who possess the right sort of training and disposition.77 Galen’s emphasis on visual language is hardly surprising given the role that perception, along with reason, plays in his epistemology as a guarantor of truth and a control on truth claims.78 Galen requires that premises be manifest (ἐναργής) either to sensation or to reason. This demand is reflected in his pervasive use of verbs of perception. Unlike his opponents, he claims that his own observations are clearly perceptible. Galen’s language presents a picture to the reader of how vision and sensation underwrite epistemic medical claims. While Aristotle’s and his rivals’ theoretical claims are a consequence of misperception or even of a failure to investigate empirically at all, Galen’s claims follow from facts that can be clearly presented to an eyewitness, facts manifest to reason and sensation. This contrast underscores the overall trajectory of Galen’s digression on the os cordis. Galen presents the case of the heart bone as an example of how epistemic anatomical claims should take their warrant from careful empirical observation, observations which by Galen’s lights Aristotle had failed to make, at least properly. By holding up Aristotle’s account of the cardiac chambers, the number of apices, and structures such as the os cordis to observational criticism, Galen undercuts one of his bêtes noires, Peripatetic and Stoic cardiocentrism.79 How can one be confident, after all, in Peripatetic claims about the 76

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AA 7.10 (662 Garofalo = ii.618 K.): ἅπερ, ὡς ἔφην, ἄμεινον ἐξῃρημένης τοῦ ζῴου τῆς καρδίας ἐπισκέπτεσθαι, καὶ μᾶλλον ἐπὶ μεγάλου ζῴου· πᾶσι μὲν γὰρ ὡσαύτως ὑπάρχει, μηδεμιᾶς διὰ μέγεθος ἐν αὐτοῖς γιγνομένης διαφορᾶς, ὡς Ἀριστοτέλης οἴεται. σαφεστέρα δ’ ἡ θέα κατὰ τὰς μεγάλας ἐστὶ καρδίας. It is not always clear what structures should be identical across kinds for Galen. Gross structural features (e.g., the number of cardiac chambers, the number of organs, the types of organs) must remain the same among animals analogous to human beings. See, e.g., Opt.Med.; Protr.; Lib.Prop. prol. (134–136 B-M = xix.9–10 K.); and Ord.Lib.Prop. 1–2 (88–92 B-M = xix.49–54 K.). See, e.g., Opt.Doc. 3–4 (CMG v 1,1 102–104 = i.48–49 K.); Temp. 2.2 (51–52 Helmreich = i.590– 591 K.); PHP 9.1 (CMG v 4,1,2, 540–542 = v.722–723 K.); MM 1.4 (x.36–37 K.); and HNH 2.10 (CMG v 9,1 78 = xv.152 K.). This debate occupies Galen’s attention throughout his corpus. He devotes most of The Doctrines of Hippocrates and Plato to a defense of encephalocentrism, as he retrojects it onto Plato and Hippocrates, against the cardiocentrism of the Stoics and Peripatetics. For his recurrent laryngeal nerve experiment, which is intended to show that the brain rather

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sovereign role of the heart if their observations about its basic anatomy are demonstrably false? Throughout Anatomical Procedures Galen engages the reader conversationally, reporting detailed procedural instructions in the second person. Time, place, and context are mostly absent, however. The heart bone anecdote breaks sharply with this pattern, situating the reader in time (ἔναγχος, νῦν) and place (ἐν Ρώμῃ). A performative context takes shape as interlocutors are introduced. Galen pits himself against these rivals in an exotic agonistic medical display. He figures himself as character as well as narrator, taking pains to reiterate a frequent criticism of rival physicians. These armchair physicians (λογίατροι) generalize recklessly about medical and anatomical matters, since their claims are not founded in and checked by empirical examination (πεῖρα).80 For Galen, the structure of the elephant’s heart proves this criticism true and proves that nature is thoroughly organized, a fact which passes his rivals by. The anecdote’s unfolding events demonstrate Galen’s complaints to the reader. Lack of training results in avoidable observational failure. Galen and his associates easily find the heart bone with their fingers; his rivals gape blindly. Galen’s belief that the elephant would possess a heart bone before it was examined predicts this failure and underscores the training that made it avoidable. Atypically, Galen’s hetairoi cannot persuade him to compete publicly with his rivals. His demonstration of the heart’s structure and his victory are for the reader alone. After the heart is taken away by Caesar’s cooks, the heart bone is laid out on a table, now available for all to see, found both through Galen’s philosophical training and his observational skill. As a coda to the anecdote, Galen exclaims that passersby looking on the bone as he writes his account, “even now” are mystified that anyone could have been so blind as to have missed this immense but, as it turns out, non-existent structure. If taken merely as a case study in dissection, Galen’s account of the heart bone is difficult to explain. The heart bone does not exist in elephants. Galen had every reason to be familiar with the structure, so as not to have mistaken

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than the heart is the source of volition, see Praen. 5 (CMG v 8,1 94–100 = xiv.625–630 K.).; UP 7.14 (i.414–425 Helmreich = iii.570–585 K.); 16.4 (ii.386–389 Helmreich = iv.278–281 K.); AA xi.4 (81–87 Duckworth), xi.11 (104–107 Duckworth) and xiv.6–7 (203–214 Duckworth). Cf. AA 8.3–8 (724–766 Garofalo = ii.661–690 K.) for the related experiment involving the destruction or ligation of the intercostal nerves. Walsh (1926: 176–184), on the recurrent laryngeal nerve, is in this limited respect useful. The word πεῖρα has a wider semantic scope than “experiment”. Although the word is often translated as “test”, “trial”, or “experiment”, all three of these translations can suggest a misleading degree of rigor and standardization. For its breadth, see LSJ i.1–2. On πεῖρα, see von Staden (1975).

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another structure for it easily. There are compelling theoretical reasons, however, for Galen to have expected the bone in larger mammals. These theoretical reasons and most probably his experience with oxen, which do possess a heart bone, motivate Galen to extrapolate the structure to elephants. Galen does not just extrapolate though; he claims to have seen, recovered, and still possess the bone long after its recovery. Rather, I think that Galen has invented or at least distorted events, justified by analogical and teleological beliefs. I read this episode as a powerful example of Galen’s use of invention to develop his philosophical and medical arguments in the context of his anatomical narrative. This is not to claim, however, that Galen’s account is fraudulent rather than being merely mistaken. One can resist this dichotomy. The modern technical treatise has no exact generic ancient equivalent. Typical features of contemporary technical literature (e.g., economy of speech, standardness of style, and avoidance of anecdotal evidence or personal commentary) are not typical of ancient medical treatises. Certainly they are not features of the Galenic corpus, even in procedural descriptions.81 These differences caution one against summarily evaluating Galen’s anatomical narrative through contemporary frames of reference, especially regarding strict fidelity to historical events throughout the treatise. Galen may well have considered his account to be true, in that it was faithful to its aim: describing the structure and function of major organs in teleological terms, of whose truth he was unassailably convinced. But Galen’s inaccurate anatomical conclusions and their explanations illuminate the role his teleological beliefs can play in empirical claims and the central role of the heart in his engagement with other theorists. 81

See von Staden (1994); Hine (2009: 13–30); and Nutton (2009a).

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It Is Difficult Not to Write Anatomy: Galen on Erasistratus and the Arteries This chapter explores the place of polemical anecdote in Galen’s anatomical narrative from a different perspective. It examines Galen’s use of tropes from other—more traditionally “literary”—genres of Greek writing, such as Classical Oratory and New Comedy, in an effort to illustrate important points of discontinuity between Galen’s writing on technical subjects and contemporary expectations of technical writing, broadly construed. Shortly after the heart bone episode in book seven of Anatomical Procedures, Galen turns to the question of arterial content and function. The book culminates in an experiment on the femoral artery of a living animal.1 The account is a longer version of a demonstration that Galen reports in Whether Blood is Naturally Contained in the Arteries, from which it differs in a few significant respects.2 In Anatomical Procedures the experiment aims to demonstrate a feature of arterial function fundamental to Galen’s system of physiology. But Galen situates it in the broader context of his dispute with Erasistratus and Erasistrateans over their view that the arteries are passageways for a substance called “pneuma” and normally contain no blood. This question was highly contested by Galen, his Erasistratean contemporaries, and Erasistratus’ accounts from which they drew authority. Galen offers the demonstration and four brief but vivid anecdotes to illustrate the theoretical and technical failings of contemporary Erasistrateans. The anecdotes are highly stylized and erudite. They also serve as a justification for Galen’s digression on the question of arterial content. While he takes the issue as settled, he laments that he is forced into further discussion on account of his rivals’ intransigence. The pattern of criticism that Galen lays out for the reader in the four vignettes is consistent: Contemporary Erasistrateans make claims that contradict observational results because they are anatomically ignorant; they do not perform the experiments whose results they claim to know; and, finally, they attempt to deceive lay people with their fraudulent claims in order to conceal 1 See, e.g., AA 7.1 (620–622 Garofalo = ii.589–590 K.). Galen’s narrative bookends his account of the respiratory system, whose organs include the heart, lungs, thorax, and arteries. 2 AA 7.16 (698–704 Garofalo = ii.645–648 K.) and Art.Sang. 8 (178–180 F-W = iv.733–734 K.), respectively.

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their ignorance. Galen’s charge of deception against rival theorists, especially contemporaries at Rome, is a recurring theme in his work. The accusation binds his opponents’ theoretical positions to their alleged ethical failures. The added moral overtones of his criticisms thereby allow Galen to position his targets as exempla for the reader to avoid. A spirited example of this phenomenon is found in On the Natural Faculties, where Galen accuses Asclepiades of confecting a series of lies in order that he may reject the view that natural faculties are responsible for filtering urine from blood in the kidneys. The one target shades into a second, when he accuses Erasistratus of a similar deception, by omission: So since Erasistratus understood all of these beliefs were full of problems and he found that belief in a faculty of attraction was the only solution to all of them, but neither wanted to face these difficulties nor was willing to say that Hippocrates’ belief was better, he figured that he had to keep quiet about the way in which the separation [of urine happened]. But even if he stayed quiet, I will not! For I know that it is impossible to ignore the Hippocratic view and claim something else about kidney function without being utterly ridiculous. And it is for this reason that Erasistratus kept quiet and Asclepiades lied, like slaves who earlier in life talked non-stop and often dodged many accusations through their excessive fraudulence but when caught in the act find no alibi. Then while the more modest one keeps quiet, as though he has been gripped by paralysis, the more shameless one still hides what one is looking for in his armpit, swearing and saying over and over that he has never even seen it … And so, these two panic like slaves caught in the act, the one keeps quiet and the other lies shamelessly.3

3 Nat.Fac. 1.16 (SM 3, 149–150 = ii.66–67 K.): ταῦτ’ οὖν ἅπαντα συνιδὼν ὁ Ἐρασίστρατος ἀποριῶν μεστὰ καὶ μίαν μόνην δόξαν εὔπορον εὑρὼν ἐν ἅπασι τὴν τῆς ὁλκῆς, οὔτ’ ἀπορεῖσθαι βουλόμενος οὔτε τὴν [πρὸς] Ἱπποκράτους ἐθέλων λέγειν ἄμεινον ὑπέλαβε σιωπητέον εἶναι περὶ τοῦ τρόπου τῆς διακρίσεως. ἀλλ’ εἰ κἀκεῖνος ἐσίγησεν, ἡμεῖς οὐ σιωπήσομεν· ἴσμεν γάρ, ὡς οὐκ ἐνδέχεται παρελθόντα τὴν Ἱπποκράτειον δόξαν, εἶθ’ ἕτερόν τι περὶ νεφρῶν ἐνεργείας εἰπόντα μὴ οὐ καταγέλαστον εἶναι παντάπασι. διὰ τοῦτ’ Ἐρασίστρατος μὲν ἐσιώπησεν, Ἀσκληπιάδης δ’ ἐψεύσατο παραπλησίως οἰκέταις λάλοις μὲν τὰ πρόσθεν τοῦ βίου καὶ πολλὰ πολλάκις ἐγκλήματα διαλυσαμένοις ὑπὸ περιττῆς πανουργίας, ἐπ’ αὐτοφώρῳ δέ ποτε κατειλημμένοις, εἶτ’ οὐδὲν ἐξευρίσκουσι σόφισμα κἄπειτ’ ἐνταῦθα τοῦ μὲν αἰδημονεστέρου σιωπῶντος, οἷον ἀποπληξίᾳ τινὶ κατειλημμένου, τοῦ δ’ ἀναισχυντοτέρου κρύπτοντος μὲν ἔθ’ ὑπὸ μάλης τὸ ζητούμενον, ἐξομνυμένου δὲ καὶ μηδ’ ἑωρακέναι πώποτε φάσκοντος … οὗτοι μὲν οὖν τοῖς ἐπ’ αὐτοφώρῳ κατειλημμένοις οἰκέταις ὁμοίως ἐκπλαγέντες ὁ μὲν ἐσιώπησεν, ὁ δ’ ἀναισχύντως ψεύδεται.

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It is a cornerstone of Galen’s physiological theory that organs possess basic capacities that are responsible for their self-maintenance (e.g., the capacity selectively to attract materials suitable for their sustenance, to retain this material, and then expel other materials). There is no evidence for such a view in the Hippocratic Corpus, although features of Galen’s systematic theory of natural capacities have Aristotelian antecedents. Galen’s attribution of his own view to Hippocrates allows him to assume the mantle of Hippocratic authority, which has the ancillary benefit of undermining his rivals’ views with its ancient pedigree. To the extent that Galen can retroject his view on to Hippocrates, he is able to demand that Erasistratus respond to a theory that post-dated him by over four centuries and to find ethical fault in him for not doing so. The terms in which Galen frames his accusations against Erasistratus (and Asclepiades) position them not only as moral inferiors to Hippocrates and, by extension, Galen, but also social ones. Galen extends the comparison to Erasistrateans of his own day, who not only inherit the moral failure and social subordination of their intellectual forbearer but also add to it: And the moderns, however many puff themselves up with the names of these men, calling themselves “Erasistrateans” and “Asclepiadeans”, are like the Daoi and the Getae, the slaves introduced by the most excellent Menander into his comedies, who thought that they had done nothing good unless they had swindled their master three times. So also these [moderns] at great leisure cobble together shameless frauds, some [the Asclepiadeans] in order that Asclepiades may never be refuted when he lies and the others [the Erasistrateans] in order that they may do badly in asserting what Erasistratus did well in keeping quiet.4 Daoi and Getae were stock slave characters in Menandrean comedy. In what remains of Menander’s work, these characters are frequently incompetent and inveterate schemers.5 And, while Galen may be making a more specific association between the two characters and his rivals, it appears more likely that he 4 Nat.Fac. 1.17 (SM 3, 150.10–20 = ii.67–68 K.): Τῶν δὲ νεωτέρων ὅσοι τοῖς τούτων ὀνόμασιν ἑαυτοὺς ἐσέμνυναν Ἐρασιστρατείους τε καὶ Ἀσκληπιαδείους ἐπονομάσαντες, ὁμοίως τοῖς ὑπὸ τοῦ βελτίστου Μενάνδρου κατὰ τὰς κωμῳδίας εἰσαγομένοις οἰκέταις, Δάοις τέ τισι καὶ Γέταις, οὐδὲν ἡγουμένοις σφίσι πεπρᾶχθαι γενναῖον, εἰ μὴ τρὶς ἐξαπατήσειαν τὸν δεσπότην, οὕτω καὶ αὐτοὶ κατὰ πολλὴν σχολὴν ἀναίσχυντα σοφίσματα συνέθεσαν, οἱ μέν, ἵνα μηδ’ ὅλως ἐξελεγχθείη ποτ’ Ἀσκληπιάδης ψευδόμενος, οἱ δ’, ἵνα κακῶς εἴπωσιν, ἃ καλῶς ἐσιώπησεν Ἐρασίστρατος. 5 According to MacCary (1969: 285–286) unsuccessful or pointless scheming is characteristic of Daoi in Menander’s extant work. The association is not so clear-cut, however. For some examples of this behavior, see, e.g., Menander Epit. 218–375; Per. 1–16; and Pk. 267–396.

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is gesturing toward slaves in comedy as a generic social type. In either case, Galen’s comparison does double duty. It reinforces the identification of his rivals with a socially subaltern group, marked by a lack of paideia as much as of moral character. Simultaneously, it puts Galen’s status as a pepaideumenos on display in a learned reference to the Greek literary past, a rhetorical maneuver that has the added benefit of drawing the reader who understands his allusion into Galen’s circle of pepaideumenoi,6 framed as both culturally elite and morally upright.7 It is of course also difficult to tell how closely Galen intended to draw the analogy between these rivals and Menander’s stock characters. However, it is worth observing that amidst accusations of Erasistratean and Asclepiadean bluster, ignorance, and stupidity, Galen implies that their attempts at fraud will prove unsuccessful much in the way that is of a piece with a comic plot progression in Menander’s work. Galen frequently argues that he is compelled to condemn his rivals in order to right their intellectual and moral wrongs. For the frauds of Erasistrateans and Asclepiadeans to fail, someone, perhaps Galen, has to catch them out. Galen thus places himself squarely in a satirical tradition, in which a lone figure is forced to stand against a degenerate present as a champion of an earlier age.8 He invokes this rhetoric of didactic compulsion to great effect in the close of book seven of Anatomical Procedures. Already in his digression on the heart bone, Galen is moved to edify the crowd of inexpert cardiocentrists gathered together to debate a series of Peripatetic views about the structure of the 6 See Rosen (2013: 188) on Galen’s use of poetry as an invocation of cultural authority in the context of his technical writing. For the similarities between Galen’s patterns of reference to Greek comedy and that of self-identified sophistical authors of the second century ce, see Coker (2019), especially her concluding remarks concerning Galen’s engagement with the scholastic tradition on Attic Old Comedy (84–85). Galen refers to Menander and other New Comic poets less frequently than their fifth-century counterparts and, while he privileges Attic Old Comedy, there is no reason to suppose that his reference to Menander here is marked. 7 Cf. Rosen’s discussion of the function of this Galenic trope as a captatio benevolentiae in Rosen (2010: 329). 8 See Rosen (2010: 326–327): “authors working in such genres [sc. Greco-Roman satirical poetry] commonly position themselves as men of superior knowledge, driven by the ignorance of the people around them to try to rectify a world that they regard as perennially corrupt or fast degenerating, especially when compared to a morally idealized past”. While he sees Galen as potentially drawing from a wide range of ancient genres, Rosen (331) argues that Galen’s stance in these passages, especially his rhetoric of compulsion, should be understood against the backdrop of Roman and Greek satirical authors—from Juvenal, through Hellenistic authors, Old Comedy, Hipponax, ultimately stretching back to Archilochus. While he is cautious not to assert that Juvenal and the Roman satirical tradition were direct influences on Galen’s writing, Rosen (339–340) raises the possibility as a plausible one.

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heart. There are four elements in this narrative on which I would like to focus:9 First, anatomical training and blind adherence to theoretical commitments. Galen and his colleagues were able to discover the heart bone easily; his opponents could not do so because they were inexperienced in anatomical matters and overly committed to their theoretical position. Second, ridicule. Galen’s companions laugh at the incompetence of his opponents. Third, a dichotomy between antiquity and modernity. Galen places Aristotle and his opponents at the poles of a binary. Both Aristotle and his contemporary analogues are mistaken, in part due to their anatomical ignorance. However, Aristotle may be forgiven in light of the state of anatomical knowledge in his time. There is no such excuse for his second-century analogues. Finally, training and the character to pursue it. What hope is there for these moderns who approach anatomical matters without experience and without the discipline to acquire it?

1

Maryllus the Mime-Writer and the Value of Anatomical Experience

The heart bone episode, which includes Galen’s discussion of the coronary arteries, trails into a brief overview of heart’s chambers before segueing to his discussion of how to perform demonstrations on the respiratory organs of living animals. One need not be overly anxious about keeping alive an animal whose heart has been exposed, Galen writes. He offers a case history as an explanation of his claim: The slave of a mime-writer named Maryllus suffered an injury while wrestling at the palaestra.10 About four months later his chest began to suppurate. A physician was called to treat the injury but ultimately failed to do so successfully. Consequently, Maryllus summoned a crowd of physicians that included Galen for a group consultation. While all of the gathered physicians agreed that the suppurating bone should be removed, Galen writes that none of the others could bring themselves to do so from fear of accidentally perforating the thoracic cavity and killing the patient: None of them dared to excise the affected bone; for they supposed that a perforation of the thorax at the spot of the bone would be inevitable. But I said that I would excise it, without causing a perforation, as it is technically called by physicians (τὴν καλουμένην ἰδίως ὑπὸ τῶν ἰατρῶν σύντρησιν).

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AA 7.10 (664–668 Garofalo = ii.620–621 K.). The case history runs through AA 7.13 (680–684 Garofalo = ii.632–634 K.).

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However, I promised nothing regarding his complete recovery, since it was unclear if anything situated underneath the sternum was affected and, if so, how much it was affected.11 It is important to note Galen’s language of promise and prognosis. The other physicians mistakenly believe that it is impossible to excise the bone safely; it is simply impossible for them. It is indeed possible to excise the bone safely, as Galen goes on to show; the excision merely requires a high degree of technical skill. In part, the episode is an advertisement of Galen’s surgical acumen. While his colleagues fail to understand the limits of the profession, Galen is educated enough to know that the procedure is medically possible, skilled enough to perform it, and sufficiently experienced to realize what he cannot promise or predict. The limits Galen places on the powers of therapy and prognosis reaffirm the status of medicine as a proper technē that is well-defined by disciplinary boundaries. They also allow Galen to assert his authority over the construction and interpretation of that technē.12 In the remainder of the episode, Galen reports details that affect both his prognosis and his confidence in it. At first, he finds that the affected area had not spread beyond the sternum. Consequently, he grows more sanguine over the possibility of the patient’s recovery. After he safely excises the bone and exposes the heart, he finds that the pericardium in that area had decayed or putrefied (ἐσέσηπτο).13 In the end, Galen has very little hope that the patient will survive. The patient does survive of course, which Galen writes, “would not have happened if no one had dared to excise the affected bone. And no one would have dared without previous training in anatomical procedures”.14 Had they dared, the consequences would have been 11

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AA 7.13 (682 Garofalo = ii.632–633 K.): οὐδεὶς ἐκκόπτειν ἐτόλμα τὸ πεπονθὸς ὀστοῦν· ᾤοντο γὰρ, ἐξ ἀνάγκης ἐπ’ αὐτῷ σύντρησιν ἔσεσθαι τοῦ θώρακος. ἐγὼ δ’ ἐκκόψειν μὲν ἔφην αὐτὸ χωρὶς τοῦ τὴν καλουμένην ἰδίως ὑπὸ τῶν ἰατρῶν σύντρησιν ἐργάσασθαι· περὶ μέντοι τῆς παντελοῦς ἰάσεως οὐδὲν ἐπηγγελλόμην, ἀδήλου ὄντος, εἰ πέπονθε καὶ μέχρι πόσου πέπονθε τῶν ὑποκειμένων τι τῷ στέρνῳ. On the circumscription of a discipline as a mechanism for its construction, as well as for its legitimization and that of its practitioners, see Edelstein (1967c) and von Staden (1990). See also, e.g., Prognostic and Celsus De Medicina 5.26.1. For a modern analogue, see Shapin (1992). AA 7.13 (682 Garofalo = ii.633 K.). AA 7.13 (682–684 Garofalo = ii.633 K.): ὅπερ οὐκ ἂν ἐγένετο, μηδενὸς τολμήσαντος ἐκκόψαι τὸ πεπονθὸς ὀστοῦν· ἐτόλμησε δ’ ἂν οὐδεὶς ἄνευ τοῦ προγεγυμνάσθαι κατὰ τὰς ἀνατομικὰς ἐγχειρήσεις. Cf. Celsus’ anecdote (De Medicina 1.pr.49–50) about the emergence of a new disease that the most elite physicians (nobilissimi medici) were unable to treat. He writes that none attempted diagnosis and treatment because they were afraid to be accused of killing the patient if she died. Something may have saved the patient, writes Celsus, if only one of

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equally dire, as Galen illustrates in the short case history that follows. Another physician recognizes the need for surgical intervention in a septic arm, but he lacks the proper anatomical training. This one severs an artery. Then he panics when the artery hemorrhages. Finally, he manages to get the bleeding under control, only to kill the patient during recovery. The moral of these two histories, according to Galen, is that proper anatomical training, as exemplified in Anatomical Procedures, is necessary for the practicing physician and useful even to the educated reader.15

2

Claims of Knowledge and Refutations of Ignorance

Galen’s digression on his successful treatment of Maryllus’ slave sets the stage for a series of cardio-arterial experiments, in which he serially refutes his rivals and reveals them as charlatans. Galen gives four reasons for exposing the heart in vivisectory demonstrations: (1) to observe how the heart beats and determine whether it strikes against the chest in its systolic or diastolic phase; (2) to examine if the aorta contracts and expands in time with the movements of the heart or if arterial contraction occurs during cardiac diastole and arterial expansion occurs during cardiac systole, an experiment that Galen also conducts on the femoral artery; (3) to study what the effects on the subject are of grasping and manipulating the living heart with fingers or forceps; (4) to expose the mistakes of those who speculate on the effects of ligating the aorta or pulmonary vein. Most of the experiments he describes aim at rival theoretical positions. I discuss Galen’s experiment on the femoral artery, to which (2) refers, at length in chapters six and seven.16 The experiment to which Galen alludes in (3) is intended to demonstrate—against cardiocentrists—that the seat of the hēgemonikon is not the heart by showing that manipulation of the heart does not affect sensory-motor function, especially voice production, while pressure

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the physicians had been more courageous. In Anatomical Procedures, Galen reframes an ethical question about the point at which a physician must intervene into a question of professional competence: do the physicians have the requisite training to intervene? “Let these few things I have mentioned as a digression (apart from many others) serve as a demonstration of the usefulness of my present treatise to any who are intelligent”. (AA 7.13, 684 Garofalo = ii.634 K.: ταυτὶ μὲν οὖν ἀπὸ πολλῶν ὀλίγα κατὰ πάρεργον εἰρήσθω, [αὐ]τοῖς νοῦν ἔχουσιν ἐνδεικνύμενα τῆς προκειμένης πραγματείας τὴν χρείαν). This experimental question is distinct from the main line of inquiry which the femoral artery experiment pursues. However, it is a point of some importance to Galen, who mentions the question of the relationship between cardiac movements and the arterial pulse again at AA 7.15 (692 Garofalo = ii.640 K.).

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applied to the ventricles of the brain and the nerves that ramify from it does. Galen says quite explicitly the final aim of his vivisectory experiments on the heart aim of (4) is to expose rival theorists as liars (ὡς ἂν ψευδομένους δείξωμεν); and, as we will see, this aim comes to dominate the remainder of Galen’s narrative in book seven.17

3

Compulsion of the Truth and the Anatomy of Deception

In the case of Maryllus’ slave, the physicians around Galen did not dare to treat the patient because they lacked the experience to excise the bone from his chest and the training to recognize that it could be done. Galen’s opponents in (4) suffer from a distinct but related professional malady. They too lack the anatomical expertise to expose the heart without perforating the pericardium. However, his rivals offer inexperience as an excuse for their failure to demonstrate their broader theoretical claims in public. Galen writes: I have made trial of those who are always saying these things; they cannot expose the heart without perforation and even if someone compels (βιάσαιτο) them, they immediately perforate the thorax. They say that it was difficult to get it right and postpone the practical demonstration to another time for this reason. [They say] that if they had managed to expose it, they would have clearly demonstrated what they promised after tying the ligature [around the pulmonary vein].18 Galen’s opponents make a series of claims about the putative results of ligating the pulmonary artery or vein in a living animal subject. Some, who can be identified as Erasistrateans, argue that when the pulmonary vein is ligated the arterial system becomes motionless and the lungs no longer contract. The identification can be made on two theoretical grounds: 1) the first claim Galen reports—that the ligation of the pulmonary vein will result in the motionlessness of the arterial system—is best explained by the belief that the arteries pulsate because of the movement of pneuma passing through them from the

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AA 7.14 (686 Garofalo = ii.636 K.). AA 7.14 (686–688 Garofalo = ii.636 K.): λεγόντων δ’ ἐπειράθην ἀεὶ ταῦτα τῶν μηδὲ γυμνῶσαι καρδίαν δυναμένων ἄνευ συντρήσεως, ἀλλ’ εἰ καὶ βιάσαιτό τις αὐτοὺς, εὐθέως συντρησάντων τὸν θώρακα, φασκόντων χαλεπὸν εἶναι τυχεῖν τούτου, καὶ διὰ τοῦτ’ ἀναβαλλομένων τὴν χειρουργίαν εἰς αὖθις, ὡς, εἴ γ’ εὐτυχηθείη γυμνωθῆναι, περιβάλλοντες ἂν τὸν βρόχον ἐπιδεῖξαι σαφῶς, ἅπερ ἐπηγγείλαντο.

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lungs by way of the heart; 2) the second claim—that the lungs will no longer contract—only follows if there is a causal connection between pulmonary contraction and cardiac diastole, which is here interrupted by the ligature. This second claim appeals to a mechanical model for physiological processes that is clearly Erasistratean, in which the heart draws pneuma from the lungs through the pulmonary vein (φλεβώδης ἀρτηρία) in diastole.19 This identification is only strengthened by the surrounding context, since Galen positions Erasistratus and Erasistrateans as his main opponents throughout these closing sections of book seven of Anatomical Procedures.20 The passage is striking for a number of reasons. First, it is worth observing that Galen once again introduces a moral dimension to his critique of rival physicians. Not only do they lack the technical skill to perform the demonstrations about whose results they make false promises, they exploit their anatomical incompetence in an attempt to escape being caught out. Second, the language of compulsion (βιάσαιτο) becomes prominent. Since Galen’s opponents are unwilling to perform the demonstrations on which their claims depend, allegedly because doing so is overly difficult, it is only possible to disprove their claims by forcing them to perform: Contrary to these people, I promise and I deliver (ἐπαγγελλόμεθά τε καὶ πράττομεν). For after exposing the heart easily [for them] without damaging any of the membranes dividing the thoracic cavity, I ask them to tie the ligature around the vessels growing out of the heart. Although they are compelled (βιάζονται) to such a degree, they manage to accomplish nothing up until they tear apart some of the membranes and cause a perforation. Then they say that they should try their hands at it no further. But I quickly expose the heart again in another animal. I present it to them. And, I force them to try again until they disgrace themselves (ἀσχημονήσωσιν) because of the boasts they have made (ἐφ’ οἷς ἠλαζονεύσαντο).21

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See, e.g., Ut.Resp. 2 (82.5–84.20 F-W = iv.473–474 K.) and 2 (92.19–94.3 F-W = iv.481 K.). For Erasistratus, the relaxation of the diaphragm was necessary for cardiac diastole to draw pneuma from the lungs into the heart. While the chest remains expanded, pneuma cannot be removed from the lungs without creating a void in them. Unlike the heart, which is muscle-like and therefore actively propelled pneuma into the arteries, the exhalation of the lungs is a passive process. At AA 7.14 (688–690 Garofalo = ii.638 K.). Galen mentions a second group, who make claims about the behavior of the lungs after the windpipe is ligated. One should recall that the windpipe is, along with arteries in a more familiar sense, among the artēriai involved in respiration. It is unclear to what group of theorists this claim may refer. AA 7.14 (688 Garofalo = ii.636–637 K.): τούτοις οὖν ἡμεῖς ἔμπαλιν ἐπαγγελλόμεθά τε καὶ πράτ-

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In order to compel his opponents to conduct the experiment, Galen removes all of the practical obstacles standing in their way. In doing so, he draws attention to the gulf between his anatomical training and his opponents’ limitations. Galen’s assertion that whatever anatomical claims he makes he demonstrates is a straightforward and pithy self-promotion of his technical acumen. The contrast Galen draws between his behavior and the Erasistrateans’ also positions him and his practice opposite to their alleged intellectual dishonesty. There are elenchic features of Galen’s engagement with his opponents. They, or at least we as readers, must come to recognize openly that their claims to knowledge are false. Galen’s narrative of this public demonstration and others like it presents the reader with an anatomical auto-da-fé. First, his rivals demur from performance on the grounds that exposing the heart in public is too difficult for them. He exposes the heart for them easily, without incident (γυμνώσαντες γὰρ τὴν καρδίαν ῥᾳδίως ἄνευ τοῦ τρῶσαί …). Then they hesitate further, until they are pressured to attempt to ligate the pulmonary vessels, which Galen has claimed cannot be done without perforating the membranes surrounding them. After the procedure is botched, they throw up their hands in an attempt to withdraw from the public debate. Galen produces another animal and then another. The production of animal subjects in quick succession and in seemingly endless supply, in order to prevent his opponents from escaping refutation, is a stock feature of these experimental narratives. He easily prepares the animal for the Erasistrateans to resume where they had left off in the demonstration. Galen continues the process until his rivals are compelled at last to face their false claims (ἐφ’ οἷς ἠλαζονεύσαντο) and, in doing so, disgrace themselves before a public audience (ἀσχημονήσωσιν). The language of coercion plays multiple roles in these episodes. Galen’s opponents will not reveal themselves as frauds unless they are compelled to do so. The need for this external compulsion to engage sincerely marks them as morally subordinate to Galen, a subordination that is at least partly a natural result of their lack of cultural and intellectual education (paideia). The servile analogies that he deploys against them are evidence of the added social dimension of Galen’s polemic. Galen’s claim that Erasistrateans can only be truthful under compulsion also perhaps plays on a trope of classical Greek

τομεν. γυμνώσαντες γὰρ τὴν καρδίαν ῥᾳδίως ἄνευ τοῦ τρῶσαί τινα τῶν διαφραττόντων ὑμένων τὸ κύτος τοῦ θώρακος, ἀξιοῦμεν αὐτοὺς περιβαλεῖν τὸν βρόχον τοῖς τῆς καρδίας ἐκφυομένοις ἀγγείοις. οἱ δ’ ἄχρι τοσούτου βιάζονται μὲν, ἀνύουσι δ’ οὐδὲν, ἄχρι τοῦ διασπάσαι τινὰ τῶν ὑμένων σύντρησίν τε ἐργάσασθαι· τηνικαῦτα γὰρ οὐδ’ ἐπιχειρεῖν ἔτι χρῆναί φασιν. ἀλλ’ ἡμεῖς τε ἐν τάχει πάλιν ἐφ’ ἑτέρου ζῴου γυμνώσαντες αὐτοῖς τὴν καρδίαν παρέχομεν, ἀναγκάζομέν τε πάλιν ἐγχειρεῖν, ἄχρι περ ἂν ἀσχημονήσωσιν ἐφ’ οἷς ἠλαζονεύσαντο.

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oratory, in which the testimony of slaves was said to be reliable only if they had been interrogated under torture—the so-called basanos (βάσανος). The servile terms in which Galen casts Erasistrateans elsewhere strengthens the association. Maud Gleason has made a similar observation about the echoes of criminal trials in Galen’s language of compulsion, although for her the juridical setting that Galen’s language evokes is a distinctly Roman one.22 On her view, “[f]or Galen’s spectators public vivisection may have resonated with their memories of another sort of agonistic performance, violent but banal, familiar to all who frequented the assize cities of the Roman Empire: the criminal interrogation”.23 Gleason focuses on the forced testimony of animal bodies as a form of lurid display that perhaps will have been familiar to a Roman audience for whom “[t]he excitement of these performances was visceral as well as cerebral. However controlled or stylised the violence, killing and maiming were part of the show”.24 Anatomical demonstrations and criminal interrogations share in both gore and spectacle. Moreover, Gleason is right to draw attention to the visceral register of their persuasive force. I think that more can be said about this point of resemblance, however. There is certainly a sense in which Galen compels his animal subjects to produce a form of testimony, a metaphor most apt in the case of his experiments on the voice. He does so not only to reveal the goal-oriented structure of body, but also to testify against his opponents’ views. In these passages, however, Galen’s language of compulsion does not center around his animal subjects; rather, it is his Erasistratean rivals whom he forces to testify—against themselves. To the extent that Galen associates Erasistrateans with the sorts of people who can be coerced to testify and, indeed, can only testify truthfully under coercion, he reinforces the image of the Erasistratean as a subaltern figure. Whether, as Gagarin has argued, the practice of testimony by interrogation under torture (βάσανος) was a legal fiction or not, its close cultural association with slaves rather than free Athenian citizens meant that βάσανος had a powerful social function as a tool of marginalization.25

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Gleason 2009: 105–108. Gleason 2009: 106. Gleason 2009: 106. Cf. Petit (2018: 153–161). Petit distinguishes between the violence and gore of Galen’s anatomical procedures and Galen’s dispassionate and detached written accounts of them. Galen’s procedural writing aids in establishing his intellectual authority. It allows him to present himself as a disinterested observer of the body and participant in dissection. To the degree that an audience’s interest was piqued by the blood and spectacle of the procedures themselves, all the better. Galen’s instructions to the reader suggest he was sensitive to both concerns. Gagarin 1996: 17. Cf. Finley 1980: 94–95 and duBois 1991: 35–62. In this vein, it is also worth considering the ways in which the staged and competitive aspects of Athenian trials align

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However, Galen also uses the language of compulsion to describe his own behavior in these debates. While only coercion can motivate the Erasistrateans in Anatomical Procedures (and On the Natural Faculties) to be truthful, Galen reports that only the great weight of moral compulsion can motivate him to engage in these public debates at all. The enormity of his opponents’ fraudulence compels him to enter the fray.26 Galen goes so far as to claim that refuting the fraudulent claims of his opponents is a necessary public service: I have said nearly everything that is necessary and useful for those who conduct procedures on the heart of a live animal. And, it would be better to transition to the phenomena in the thorax and lungs. But, since some people prattle on shamelessly (ἀναισχύντως φλυαροῦσιν) while vividly promising to show that the arteries are devoid of blood, one and another falsifying (καταψευδόμενοι) the observational results of anatomy, because of those people, I will have to go on further about the matter.27

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with Galen’s public experiments. Indeed, both were explicitly called ἀγῶνες whose outcomes were determined by the acclaim of a public audience who adjudicated between their competing λόγοι. See Gagarin 1996: 2. See, e.g., AA 7.14 (688 Garofalo = ii.637–638 K.): “So great is the fraud and audacity about things of which they have no knowledge that some people use against people who are ignorant” (τοσαύτῃ τινὲς ἀλαζονείᾳ τε ἅμα καὶ τόλμῃ περὶ ὧν οὐκ ἴσασι πρὸς τοὺς οὐκ εἰδότας χρῶνται …). The close collocation of ἀλαζονεία and τόλμη is relatively infrequent in Greek before Galen, twice fittingly in Isocrates Orat. 13, Against the Sophists; once in Polemo Ep. 2, once in a fragment of Menander, and finally in Philo of Judea. Verbal forms of each word occur close to one another twice in Isocrates Orat. 13, which contains a number of close thematic parallels with the end of book 7 of Anatomical Procedures. In section 1, where Isocrates accuses sophists of promising more than they can hope to deliver, failing to respect serious study, and being disputatious, he describes them in these terms: οἱ τολμῶντες λίαν ἀπερισκέπτως ἀλαζονεύεσθαι. Sections 3–8 are an extended invective against accepting payment for education. In section 10, Isocrates decries sophists on the grounds that they have no regard for experience, training, or native ability yet insist that they can teach their subject as though they would teach students their letters: κακῶς εἰδότες ὅτι μεγάλας ποιοῦσι τᾶς τέχνας οὐχ οἱ τολμῶντες ἀλαζονεύεσθαι περὶ αὐτῶν, ἀλλ’ οἵτινες ἄν, ὅσον ἔνεστιν ἐν ἑκάστῃ, τοῦτ’ ἐξευρεῖν δυνηθῶσιν. I am not arguing that Galen has Isocrates’ speech specifically in mind when writing the end of book 7, although it is tempting to think so. My point, rather, is that Galen frames these episodes in terms that are recognizably oratorical and performative. AA 7.16 (694 Garofalo = ii.641–642 K.): Ὅσα μὲν οὖν ἀναγκαῖα καὶ χρήσιμα τῶν περὶ τὴν καρδίαν ἐστίν, ἔτι τοῦ ζῴου ζῶντος ἐγχειρούντων, εἴρηται σχεδὸν ἅπαντα, καὶ βέλτιον ἦν ἐπὶ τὰ κατὰ τὸν θώρακά τε καὶ τὸν πνεύμονα φαινόμενα μεταβαίνειν. ἐπεὶ δ’ ἔνιοι τῶν ἐναργῶς ἐπαγγελλομένων δείξειν ἀρτηρίαν αἵματος κενὴν ἀναισχύντως φλυαροῦσιν, ἄλλος ἄλλου τῶν φαινομένων ἐξ ἀνατομῆς καταψευδόμενοι, δι’ ἐκείνους δεήσει καὶ ἡμᾶς ἔτι διατρίψαι περὶ τὸν τόπον.

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This passage introduces a somewhat digressive epilogue to book seven of Anatomical Procedures. While Galen discusses theoretical disputes—and occasionally engages in them—earlier in the book, his presentation of the respiratory organs is not overtly polemical until he comes to describe the internal structure of the heart in chapter ten. The transition from procedural narrative to polemical engagement is unsurprising, since the episode bears directly on Galen’s dispute with cardiocentrists over the location of the control center (hēgemonikon) in animals. Galen’s discussion of vivisectory demonstrations becomes increasingly trenchant in proportion to the public and agonistic context in which these experiments were performed.

4

A Polemic in Four Parts

Book seven ends with a sustained polemic against the Erasistratean view that the arteries are devoid of blood under non-pathological circumstances.28 Discussion of this point, Galen says, is superfluous to the primary aims of Anatomical Procedures. And while the subject matter does not merit continued discussion, the effrontery and deceit of his opponents compel him to write further (δι’ ἐκείνους δεήσει καὶ ἡμᾶς ἔτι διατρίψαι περὶ τὸν τόπον). His Erasistratean rivals falsify (καταψευδόμενοι) the results of their demonstrations, then brazenly insist that the falsified results are true (ἀναισχύντως φλυαροῦσιν). Since he is compelled to argue against his rivals for the public good, Galen’s justification allows him to engage in debates that he decries as manifestly absurd, while he remains unsullied by the engagement. The four vignettes all exhibit the same cluster of criticisms: Erasistrateans argue in bad faith, making false claims that are intentionally difficult or impossible to test. Their fraudulent claims are motivated by the need to conceal their medical ignorance and their lack of intellectual rigor. Each of the vignettes underscores the high professional stakes of live public medical debates familiar to us already. As Galen progresses from one episode to the next, however, the context in which the public debates he describes are conducted shifts from a live arena to a literary one. In the first episode, an Erasistratean continually promises to show that the aorta is empty of blood, but never does so. The claim is about a point of long-standing debate, in this case Erasistratus’ belief that the arteries contain pneuma rather than blood. A band of young people associated with Galen

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I discuss the theoretical debate between Galen and the Erasistrateans on this point in greater detail in chapters six and seven.

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challenges the Erasistratean to deliver, at last, on his promises. They arrive on the scene with subjects for vivisection in tow: “… when some young people, hungry for distinction, brought him some animals and challenged him to a demonstration, he began to say that he would not perform a demonstration without payment”.29 We have seen the powerful effect of this agonistic strategy in Galen’s confrontation with Pergamene doctors for the post of gladiatorial physician, which launched his early career.30 The number of animal subjects is sufficient to forestall opponents’ potential evasion of Galen’s challenges on the grounds that meeting them would be pragmatically difficult or impossible. The tactic adds to the spectacular nature of these anatomical contests. And, while Galen offers us few specifics about just how many animal subjects he (or his surrogates) bring to ambush their adversaries, the practice reminds the reader of the wealth and status required of such a display.31 After the man refuses to perform publicly without a suitable fee, the challenge takes dramatic shape: Right away, they laid down a thousand drachmae on the spot for him to carry off should he perform the demonstration. He turned every which way, finding no way out. Forced by everyone present, he picked up a lancet and dared to cut along the right side of the thorax at the point where he most believed that the aorta would be plainly visible to him. He was found out to be so practiced in anatomy that he cut all the way to the bone! And another member of this troupe cut between the ribs; but with the very first cut he immediately severed the artery along with the vein.32 This vignette recalls some elements of Galen’s account of the heart bone earlier in book seven; but it maps more closely on to the case of the Erasistratean in our earlier discussion, who insisted on the results of ligating the pulmonary vessels but would not—then could not—do so. In each instance, Galen’s opponent

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AA 7.16 (696 Garofalo = ii.642 K.): κομισάντων αὐτῷ τῶν φιλοτιμοτέρων νεανίσκων ζῷα καὶ προκαλεσαμένων ἐπὶ τὴν δεῖξιν, οὐκ ἄνευ μισθοῦ δείξειν ἔφασκεν. Cf. AA 7.14 (688 Garofalo = ii.636–637 K.). See Opt.Med.Cogn. 9.4–7 (CMG Suppl.Or.iv 103.10–105.19 Iskandar). See, e.g., Praen. 5 (CMG v 8,1 96–100 = xiv.627–630 K.). AA 7.16 (696 Garofalo = ii.642–643 K.): αὐτίκα δ’ ὑπ’ ἐκείνων εἰς μέσον κατατεθεισῶν δραχμῶν χιλίων, ἵν’, εἰ δείξειε, κομίσαιτο, πολλὰς μὲν ἀπορῶν ἐστρέφετο στροφάς· ἀναγκαζόμενος δ’ ὑπὸ πάντων τῶν παρόντων, ἐτόλμησε λαβὼν σμίλην τέμνειν κατὰ τὸ ἀριστερὸν μέρος τοῦ θώρακος, ἔνθα μάλιστ’ ᾤετο, τῆς συντρήσεως γενομένης, ἐναργῶς αὐτῷ φαίνεσθαι τὴν μεγάλην ἀρτηρίαν. εὑρέθη δ’ οὕτως γεγυμνασμένος ἐν ταῖς ἀνατομαῖς, ὥστε κατ’ ὀστοῦ ποιήσασθαι τὴν τομήν. ἄλλος δ’ ἐκ τούτου χοροῦ κατὰ μὲν τὸ μεσοπλεύριον ἔτεμεν, ἀλλ’ εὐθὺς ἅμα τῇ πρώτῃ τομῇ τήν τ’ ἀρτηρίαν διέκοψε καὶ τὴν φλέβα.

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lays claim to anatomical expertise in a public context but refuses to perform the procedure(s) that the claim requires. Ultimately, the opponent is compelled to perform, shows himself to be incompetent, and is publicly shamed. Galen’s charge of technical incompetence against this Erasistratean, and as we will see, against a series of Erasistrateans in these vignettes is a common critique in his writing. In these instances, however, Galen’s critique cuts especially deep. Erasistratus himself had condemned practitioners who did not engage in rigorous training: Those who are altogether unaccustomed to research are made blind in the initial movements of their minds and become baffled. And becoming mentally exhausted, they immediately shrink away from doing research—quite incapable, no less than those people who enter races unaccustomed to them. But the person practiced at doing research slips through any opening, does research, and turns to many places with his mind. He does not shrink away from doing research, not resting at it in any part of a day, nor in the whole of his life. And turning his mind to other thoughts, relevant to what is under investigation, he advances to meet what lies before him.33 Galen does not merely criticize second-century Erasistrateans for their lack of training and their incompetence. In depicting them as the sorts of thinkers whom Erasistratus would scorn, Galen turns Erasistratus’ ethical and intellectual advice against his epigones. Although this dispute is the kind in which Galen might himself engage, here the debate arises between an Erasistratean and some young associates who stand in for him, another recurring feature of his polemical digressions.34 This relationship allows Galen to use surrogates for his position in the debate while placing him above the fray. Their effective surrogacy adds to the Erasistratean’s public humiliation; after all, Galen describes them merely as young people hungry for distinction (τῶν φιλοτιμοτέρων νεανίσκων) and, later, as engaged 33

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Fr. 247.22–30 Garofalo (Cons. 1, CMG Suppl. iii 12.28–14.7): οἱ μὲν γὰρ ἀσυνήθεις τὸ παράπαν τοῦ ζητῆσαι ἐν ταῖς πρώταις κινήσεσι τὴν διάνοιαν τυφλοῦνται καὶ ἀποσκοτοῦνται καὶ εὐθέως ἀφίστανται τοῦ ζητεῖν κοπιῶντες τῇ διανοίᾳ καὶ ἐξαδυνατοῦντες οὐκ ἧττον ἢ ὅσοι πρὸς δρόμους ἀσυνήθεις ὄντες προσέρχονται· ὁ δὲ συνήθης τοῦ ζητεῖν πάντη διαδυόμενός τε καὶ ζητῶν τῇ διανοίᾳ καὶ μεταφερόμενος ἐπὶ πολλοὺς τόπους οὐκ ἀφίσταται τῆς ζητήσεως, οὐχ ὅτι ἐν μέρει ἡμέρας ἀλλ’ οὐδὲ ἐν παντὶ βίῳ ἀναπαύων τὴν ζήτησιν· καὶ μεταφέρων ἐπ’ ἄλλας ἐννοίας τὴν διάνοιαν, οὐκ ἀλλοτρίας μὴν τοῦ ζητουμένου, προβαίνει ἐπὶ τὸ προκείμενον ἐλθεῖν. Cf., e.g., AA 7.10 (664 Garofalo = ii.620 K.), 7.14 (688 Garofalo = ii.637 K.), 7.16 (696–698 Garofalo = ii.642–643 K.); and Sem. 2.1 (CMG v 3,1 146.11–13 = iv.595 K.).

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members of the audience to Galen’s previous anatomical performances.35 The authority of the Erasistratean is undercut by the youth of Galen’s surrogates, and by the implication that their training comes primarily from observing Galen at work, rather than from professional experience. The fee that the Erasistratean demands and that the young men offer is also noteworthy.36 Galen

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The philotimia of Galen’s associates here does not appear to bear a negative connotation. On some of its more positive uses in Greek science writing, see Berrey (2017: 94, 99). Galen often, however, uses philotimia pejoratively, to criticize the character of his rivals. It is a use shared with other similar terms, such as philoneikia. Lloyd (1991b: 400, n. 8) contains a range of instructive examples. While the primary significance of Galen’s reference to the drachmae on deposit in this episode has to do with the substantial value of the sum and the rarity of such a reference to money in Galen’s work, his choice of the drachma is puzzling. The drachma would have been a highly unusual currency for an episode set in the city of Rome at any point in Galen’s lifetime, whether this episode is historical or fictive; of course, it may plausibly be either or somewhere in between. On the prevalence of currencies in different areas of the Roman empire in the second century, see Harl (1996: 97–124). The majority of Galen’s public anatomical experiments took place in Rome during the period of his first stay there in the early to mid 160s. However, Galen did conduct such experiments at other times in his life and in other places in Asia Minor where the drachma would not have been so unusual a currency; the competitive demonstration that he performs ca. 157 as an audition for the post of gladiatorial physician in Pergamum is one such example. On these and other relevant dates in Galen’s life, see Nutton (1973). Since we know that an earlier draft of Anatomical Procedures was composed shortly after Galen’s arrival in Rome in 162 (AA 1.1, 78 Garofalo = ii.215 K.), it is conceivable that this episode might belong to that earlier compositional layer and refer to events that took place in Asia Minor before 162. Drachmae continued to be struck and used in the second half of the second century throughout the area, which might suggest Pergamum or Syria Palestina as plausible dramatic settings for the confrontation. Perhaps the localized currency is a nod to Flavius Boethus, an influential patron of Galen to whom Anatomical Procedures is dedicated. Boethus was appointed governor of Syria Palestina and Galen tells us that he gave an early version of the treatise to him on his departure (AA 1.1, 78–80 Garofalo = ii.215–216 K.). However, a setting in the city of Rome seems far more likely. Galen markedly comments that the young people had occasion to learn at his side, suggesting to me that the episode is set in or after his period of active public demonstration at Rome. Galen often waxes nostalgic about his homeland, Pergamum. It is possible for this reason that the reference merely marks the young men who outdo the Erasistratean as Greeks from Asia Minor, perhaps even from Pergamum, to evoke an association between their Hellenism and their competence. It is also possible that Galen’s reference is merely a Hellenizing manner of discussing money or a substitution for “denarius”. In my view, either of these views or a combination of them—they are not mutually exclusive—is the most plausible interpretation of Galen’s choice of drachmae in this passage. It must be said that Galen uses “δραχμή” as a stand-in for “denarius” explicitly when discussing measurements of volume in Comp.Med.Loc. 8.3 (xiii.160 K.): “It is abundantly clear that I use the term ‘drachma’ to denote what all the Romans call the ‘denarius’, along with such people as are my contemporaries” (πρόδηλον δ’ ὅτι δραχμὴν

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shares a common elite Greek and Roman disdain toward accepting money as a fee, an attitude that he further embraces as a Platonic inheritance.37 The Erasistratean’s demand of payment for intellectual production associates him with historical sophists, a further Platonic echo; it also associates him with the vice of Roman luxuria that Galen so frequently bemoans.38 The money that the young people lay down as a deposit on his performance, one thousand drachmae, is a substantial sum.39 Their display of wealth, like the ready supply of animal subjects they bear with them, draws attention to their status as elite members of Roman society. It is worth lingering on this point. The status of the young people challenging the Erasistratean—and their success in doing so—is a powerful advertisement to Galen’s readership, which encourages his contemporary elite readers to consider that they too could learn to perform publicly in anatomical contests like these with Galen’s instruction. Galen’s opponent finds himself cornered and coerced to demonstrate his claims, a demonstration that reveals his inexperience with dissection and undercuts his claims to anatomical knowledge:

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λέγομεν νῦν ἐν τοῖς τοιούτοις ἅπαντες ὅπερ Ῥωμαῖοι δηνάριον ὀνομάζουσιν). This instance is the single occurrence of δηνάριον in the Galenic corpus. Perhaps Galen simply extends this usage beyond measurements of volume. However, this suggestion is complicated by the fact that the two currencies would have had different values at the time, while the unit of volume would have been fixed. The infrequency of δηνάριον may just be explained by Galen’s general predisposition not to discuss money at all. For example, I can find only three occasions on which Galen uses δραχμαί to pick out a sum of money (rather than a measurement of volume or an idiom, such as ἀδόκιμος δραχμή), including AA 7.16 (696 Garofalo = ii.642 K.). The other two instances are generically large numbers found at Protr. 6 (91 B-M = i.9 K.) and Ind. 47 (15.13–18 BJP). Famously, Galen also reports that 400 aurei were given to him by Boethus as a gift for the successful cure of his wife at Praen. 8 (CMG v 8,1 116.16–19 = xiv.647 K.). On Galen’s professed disdain for the acquisition of money and its corrupting influence, see, e.g., Opt.Med. 2–3 (287.7–291.21 B–M = i.56–61 K.); PHP 9.5 (CMG v 4,1,2 564.19–30 = v.751–752 K.); Cris. 2.2 (129.10–15 Alex. = ix.645 K.); HVA 1.16 (CMG v 9,1 132.20–23 = xv.450 K.); Praen. 4 (CMG v 8,1 92.11–20 = xiv.623 K.); and CP 1.2 (70.7–10 Hankinson). Although Ecca (2016b) focuses on the late Hippocratic text Precepts, its discussion of the sometimes fraught relationship between the physician and payment in the Roman period offers helpful context for this attitude. For an especially striking instance, see Praen. 1 (CMG v 8,1 72.13–74.11 = xiv.603–605 K.). Cf. Seneca Ep. 76.1–7; Juvenal Sat. 3; 11.1–55; Lucian Nig.; and Maximus of Tyre Or. 4. For the many evils of urban life, especially in the city of Rome, as a spur to authorship see, e.g., Juv. Sat. 3; Pliny Ep. 1.9; Martial Ep. 3.38; Tacitus Dial. 11 ff.; Dio Chrysostom Or. 7; and Lucian Nig. There is some inscriptional evidence for payments of this size to medical practitioners. See, e.g., Samama (2003: no. 341).

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Laughing at them, the young people who had given the thousand drachmae to the crowd gathered there for safekeeping, they fulfilled the Erasistrateans’ promise. They cut between the ribs without damaging any of the vessels, as they had seen [done] at my side, and they applied two ligatures quickly, one right past the point where the aorta grows out of the heart and the other where it meets the spine, so that after the death of the animal the section of the artery that is between the ligatures might be shown to be devoid of blood, as these blowhards claimed.40 In the compass of one sentence, Galen evokes the Erasistrateans’ humiliation and its public context (καταγελάσαντες οὖν αὐτὸν … τοῖς ἠθροισμένοις ἐπὶ τὴν θέαν …); he reminds the reader of the hefty stakes involved in the demonstration (οἱ θέντες τὰς χιλίας νεανίσκοι); and he shows that, where his opponents fail, his surrogates succeed (αὐτοὶ τὴν ἐκείνων ἐπαγγελίαν ἐποιήσαντο …). Naturally, they owe their success to Galen’s expertise and the time they have spent by his side watching him at work (ὡς ἑωράκεισαν παρ’ ἐμοί). After the young men partition a section of the artery from the arterial system, they dissect it. They then reveal that, contrary to the Erasistratean’s claims, it contains blood. Galen’s Erasistratean cannot recognize that he has been beaten. He alleges that the young men have merely demonstrated that there is blood in the artery because of the damage caused to it by the initial ligatures. Their placement caused an irruption of blood into the arteries drawn through invisible pathways connecting the arterial system to the venous system, which Erasistratus called anastomōseis (ἀναστομώσεις).41 Like

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AA 7.16 (696 Garofalo = ii.642–643 K.): καταγελάσαντες οὖν αὐτῶν οἱ θέντες τὰς χιλίας νεανίσκοι τοῖς ἠθροισμένοις ἐπὶ τὴν θέαν, αὐτοὶ τὴν ἐκείνου ἐπαγγελίαν ἐποιήσαντο, τεμόντες μὲν, ὡς ἑωράκεισαν παρ’ ἐμοί, τὸ μεσοπλεύριον ἄνευ τοῦ τρῶσαί τι τῶν ἀγγείων, περιβαλόντες δὲ διὰ ταχέων δύο βρόχους, ἕνα μὲν μετὰ τὴν ἔκφυσιν εὐθέως ἐκ τῆς καρδίας, ἕτερον δ’ ἐπιβαίνειν μελλούσης τῇ ῥάχει τῆς ἀρτηρίας, ἵν’, ὡς οἱ θρασεῖς ἐπηγγείλαντο, μετὰ τὸν τοῦ ζῴου θάνατον, ὅσον ἐν τῷ μεταξὺ τῶν βρόχων ἐστὶ τῆς ἀρτηρίας, ἐπιδειχθῇ κενὸν αἵματος. See, e.g., Art.Sang. 2 (150 F-W = iv.709 K.) and Ven.Sec.Er. 3 (xi.153–154 K.) See also Furley and Wilkie (1984: 36–37) and Garofalo (1988: 33–35). The term “anastomosis” continues to be used in contemporary medical discourse; its current usage, however, should be distinguished from its ancient one. In a modern context, “anastomoses” usually refer to alternative routes for blood flow that bypass capillary beds or collateral connections between parts of the body. Some are species-typical like the Circle of Willis, the coronary arteries, and plantar arches. Others are surgical or pathological (e.g., fistulas, etc.). In ancient Greek medical writing, anastomōseis are junctures between the arterial and venous systems that are a typical feature of vascular anatomy. They share limited functional similarities with modern capillary beds. Galen uses the term to refer to connections at the terminal points of vessels. These include connections between some arteries and the pores of the skin. See,

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his counterpart in Whether Blood is Naturally Contained in the Arteries, who could not recognize the proper falls in an argument, the Erasistratean’s appeal to irruption is a final and amateurish attempt to avoid refutation, a characterization that Galen explicitly compares to the behavior of untrained wrestlers, a long-standing metaphor of Greek argumentation. Even though they have been soundly beaten and are lying on their backs, they continue to grasp at the necks of their opponents in a vain attempt to avoid a loss.42 The narrative of the public debate shifts abruptly to a more private context, although one disseminated to a broader public through Galen’s written account. Galen reports that another Erasistratean designed a special ax, whose blade was square-shaped, to prove that the arteries were devoid of blood:43 And a man of this sort even thought up a four-bladed ax, although he never made it nor even tried to! Nevertheless, he was not ashamed (οὐκ ᾐδεῖτο) to promise that he would show an artery devoid of blood with it. His dream went something like this …44

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e.g., SMT 1.12 (xi.402 K.). In chapter nine of his De Motu Cordis, Harvey was still using the term “anastomosis” in its more ancient sense, to refer to the unobservable but theoretically necessary links between the arterio-venous systems. While da Vinci described the vessels now known as capillaries, he did not treat them as such. Vascular junctures between the arterio-venous systems were theoretical for all intents and purposes until 1661, when Marcello Malpighi was able to observe capillary activity directly under a microscope in the lungs of a frog. For a very brief historical overview of these 17th century observations, see Pearce (2007). See Art.Sang. 5 (160.3–10 F-W = iv.717 K.): “… just as in wrestling rank amateurs cling to the neck[s] of those who have thrown them and do not permit them to stand upright, since sometimes they do not realize that their back[s] are lying on the ground, in the same way these [Erasistrateans], as they are ignorant of the falls in arguments, do not permit [me] to be free while they turn out some trick or another, always new, ducking and dodging until anyone would leave, disgusted and exasperated at their shamelessness compounded with their ignorance” (ὥσπερ οἱ παντελῶς ἰδιῶται παλαισμάτων οὐ γνωρίζοντες κείμενον ἐπὶ γῆς ἐνίοτε τὸν νῶτον αὐτῶν ἔχονται τραχήλου τῶν καταβαλόντων οὐδ’ ἐπιτρέποντες ἀναστῆναι, τὸν αὐτὸν τρόπον καὶ οὗτοι ἀμαθεῖς ὄντες τῶν ἐν τοῖς λόγοις πτωμάτων οὐκ ἐπιτρέπουσιν ἀπαλλάττεσθαι καινάς τινας ἀεὶ στροφὰς στρεφόμενοι καὶ παντοίως λυγιζόμενοι μέχρι τοῦ μισήσαντά τινα τήν τ’ ἀναισχυντίαν ἅμα καὶ τὴν ἀμαθίαν αὐτῶν ἀποδυσπετήσαντα χωρισθῆναι.). Cf. Galen’s allegation of their evasion and his colorful contempt for it in Art.Sang. 7 (172.1–4 F-W = iv.727 K.), where he accuses Erasistrateans of running off to an altar of Podunk Pyrrhonism for sanctuary (ἐπί τινα βωμὸν ἐλέου καταφεύγουσι τὴν Πυρρωνείαν ἀγροικίαν …). The episode runs from AA 7.16 (698 Garofalo = ii.643–644 K.). It is worth noting that there is not, so far as I know, any surviving evidence for a tool of this sort and there is no reference to a πέλεκυς in Bliquez (2015). Indeed, the satirical force of this episode depends partly on the fantastical nature of the device and its construction. AA 7.16 (698 Garofalo = ii.643–644 K.): τοιοῦτος δὲ καὶ ὁ τὸν τετράστομον πέλεκυν ἐπινοήσας,

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Like the other Erasistrateans in these episodes, the inventor of the improbable ax remains unnamed. It is not possible to say who the anonymous Erasistratean may have been or whether indeed Galen is referring to a historical figure at all. It is not uncommon for ancient medical authors to omit the names of their contemporaries when referring to them. The anonymity of his Erasistratean targets, however, also permits Galen to paint his rivals with a broad critical brush more easily and encourages the reader to envision them as a comic type. The four blades of the ax would form a square. On striking a pronated animal on the back, the inventor hoped the blade would make a cut that included a section of the aorta. The shape of the blade would allow the experimenter to remove a section of the artery so quickly that it could control for the possible irruption of blood into the artery. It was structured, … in order that it would cut out a square section of its back with one blow in the shape of its peculiar outline, in which he kept on saying the part of the aorta enclosed [in the ax head] would be found to be devoid of blood. But let this thing be left to people who write mimes of absurd subjects for laughs.45 Galen’s account of the Erasistratean’s ax is interesting in part because his opponent explicitly did not perform the experiment, despite making strong claims about its experimental results. Indeed, far from just failing to construct the ax, the Erasistratean never even attempted to have it made. Consequently, the public context for the Erasistratean’s humiliation is a wholly written one. In the earlier cases I have discussed, Galen presents his opponent as making theoretical claims without the technical skills to support them, strongly implying that these claims are not founded or tested against empirical observations. Galen’s critique of his adversaries is thematic: they are charlatans who are prone to assertion, although they lack either the ability to provide adequate proofs for what they claim or the scruple to engage in debate honestly. In this instance, Galen’s criticism is more pointed. Like the others he has mentioned, this Erasistratean makes medical claims that he does not, and indeed cannot, support

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εἶτα μήτε κατασκευάσας ποτ’ αὐτὸν, μήτε πειραθείς, ὅμως οὐκ ᾐδεῖτο δι’ αὐτοῦ τούτου δείξειν ἐπαγγελλόμενος ἀρτηρίαν κενὴν αἵματος. ἦν δ’ οὖν αὐτοῦ τοιόνδε τι τὸ ἐνύπνιον. AA 7.16 (698 Garofalo = ii.644 K.): … ἵνα μιᾷ πληγῇ τετράγωνόν τι σχῆμα τῆς ῥάχεως ἐκκοπῇ κατὰ περιγραφὴν ἰδίαν, ἐν ᾧ τὸ περιλαμβανόμενον τῆς μεγάλης ἀρτηρίας εὑρεθήσεσθαι κενὸν αἵματος ἔφασκε. τοῦτο μὲν οὖν εἰς γελωτοποιΐαν τοῖς γράφουσι τοὺς μίμους τῶν γελοίων ἀφείσθω.

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with anatomical demonstrations. He cannot even make a pretense of a performance at a later time, however. The device is so far removed from reality that it belongs in a dream, a comic prop. The third vignette tells the story of an older Erasistratean, who had devised a demonstration of arterial content. The experiment that Galen describes is elaborate; its description alone constitutes most of the episode. The experiment is so elaborate because it aims to control for the possible irruption of blood into the arteries from their anastomōseis, a consequence that was the basis for the Erasistratean’s final objection to this sort of demonstration in the first episode Galen describes. If one recalls, one challenge to the Erasistratean view that the arteries contain only pneuma under normal circumstances is that whenever their contents can be observed directly the arteries can be seen to contain blood. One response to the challenge is to argue that the contents of the arteries can never be observed directly without injury to the vessels. Since injury to the vessel allows their pneumatic contents to escape very quickly and with tremendous force, the potential vacuum left in the wake of their departure pulls blood into the arteries from the veins through minute connections (anastomōseis) between the arterial and venous systems. The Erasistratean’s experiment attempts to circumvent the observational challenges posed by injury to the vessel: Let me recall another procedure, in which some senescent septuagenarian used to say that he would demonstrate an artery devoid of blood. He required that the animal be one of those called “skinnable”, such as sheep, oxen, or goats. Then [he required] that a cut be made in some place where there is a large artery right under the skin, then that the artery be must be stripped of skin and that it must be laid bare from the material all around it, so as to be attached to nothing. Then after six or seven days in which the incision is kept safe, having separated the edges of the wound, apply two ligatures around the artery separate from one another as much as possible. Then excise the section between the ligatures, for it would be found to be empty. So, while that seventy-year old man never dared to test this procedure in action, I tested it right after I first heard about it. And when I tested it, I prepared a goat and a sheep in advance. Then I took them to the old man, calling to him to wake up and see me refute, once and for all, the things that appeared to him in a dream.46

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AA 7.16 (698–700 Garofalo = ii.644–645 K.): μνημονεύσωμεν δ’ ἡμεῖς ἑτέρας ἐγχειρήσεως, ἐφ’ ἧς δείξειν ἔφασκε γέρων τις ἑβδομηκοντούτης πάνυ σεμνὸς ἀρτηρίαν κενὴν αἵματος. ἠξίου γὰρ

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After the artery is stripped of its surrounding material, the wound is allowed time to heal. During the healing process, the artery will have cleared itself of any blood that may have entered it due to the initial incisions made around it. Only then are ligatures applied to a segment of the artery. Consequently, the experimenter can be more certain that the experiment itself has not introduced blood into the artery under observation when an incision is finally made into the isolated section of the vessel. The structure of the demonstration is clear and the attempt at controlling for irruption is clever. Galen underscores the complexity of the procedure to satirical effect, however. As we have seen in the first episode, the Erasistratean notion of irruption was a source of some ridicule for Galen, since the mechanism under which it operates could neither be seen nor tested. Although the Erasistratean’s underlying concern to control for arterial irruption explains the complexity of the experiment, the force of Galen’s closing remark draws a sharp contrast between mere assertion of empirical outcomes and the actual observation of them: the old man’s experiment is all plan and no action. Galen’s depiction of him is of a piece with the other Erasistrateans in these narratives. The older man has had a lifetime to perform the demonstration but has never dared to do so (τὴν ἐγχείρησιν ταύτην οὐδέποτ’ ἐτόλμησεν ἔργῳ βασανίσαι). Galen, on the other hand, tests the procedure immediately upon learning of it: What he promises, he delivers. In one sense, this test takes emphatically public form. Galen arrives at what one imagines is the Erasistratean’s home with experimental subjects in train. Once there he summons the old man out into the open and into the waking world, where he is to be a witness to his own refutation. As in the case of the Erasistratean who devised the four-bladed ax, Galen here uses the language of dreams and dreaming to emphasize how little the Erasistrateans ground their views in empirical observations. It is not merely the case that their arterial theory lacks an observational basis; its basis in dreams stands at one further

εἶναι μὲν τὸ ζῷον ἕν τι τῶν δαρτῶν ὀνομαζομένων, οἷον ἢ πρόβατον, ἢ βοῦν, ἢ αἶγα, διαιρεθῆναι δὲ κατά τι μόριον, ἔνθα μεγάλη μετὰ τὸ δέρμα εὐθύς ἐστιν ἀρτηρία, περιδαρῆναι δ’ ἐκείνην καὶ γυμνωθῆναι τῶν πέριξ σωμάτων, ὡς προσηρτῆσθαι μηδενὶ, κᾄπειτα φυλαττομένης τῆς κατὰ τὸ δέρμα τομῆς μεθ’ ἡμέρας ἓξ ἢ ἑπτὰ, διαστήσαντας τὰ χείλη τοῦ ἕλκους, περιβάλλειν βρόχους δύο περὶ τὴν ἀρτηρίαν, καθόσον οἷόν τε πλεῖστον, ἀλλήλων διεστῶτας, εἶτ’ ἐκκόπτειν τὸ μέσον αὐτῶν, εὑρεθήσεσθαι γὰρ κενόν. ἐκεῖνος μὲν οὖν, ἑβδομήκοντα γεγονὼς ἐτῶν, τὴν ἐγχείρησιν ταύτην οὐδέποτ’ ἐτόλμησεν ἔργῳ βασανίσαι. πρὸς ἡμῶν δ’ εὐθέως ἐβασανίσθη μετὰ τὸ πρῶτον ἀκοῦσαι, καὶ ὡς ἐπειράθημεν αὐτῆς, αἶγα καὶ πρόβατον οὕτω προπαρασκευάσαντες, ἐκομίσαμεν τῷ γέροντι παρακαλοῦντες αὐτὸν ἐξεγερθέντα θεάσασθαί ποτε κᾂν ἅπαξ παρελεγχόμενος τὰ κατὰ τὸν ὕπνον αὐτῷ φαντασθέντα.

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remove from reality.47 The demonstration implicitly occurs in some local space, the house out of which the man is called. Likewise, Galen only implies the audience that bears witness to the Erasistratean’s refutation, effectively creating a place in which the reader can be incorporated into the written performance of his experiment. Like the young men who challenged the earlier Erasistratean to prove that the arteries were devoid of blood—before an audience and under its compulsion—Galen’s experimental narrative coopts his reading audience to participate in a reenactment of his refutation. The episodes grow progressively less moored to a time and place. In the first episode, Galen describes a richly detailed scene that includes an audience of onlookers. By adding that they acted as guarantors for the hefty sum at stake in the dispute, he reinforces their role as referees of the debate. Not one but two Erasistrateans fail to carry out the demonstrations that they profess will bear out their theoretical claims. Their failure is exacerbated by the many opportunities Galen affords them to perform on a series of animal subjects that he provides. Galen reminds the reader that his rivals fail because they lack the requisite training, which the young people who shame them possess, in virtue of their association with Galen himself. The second and the third episodes lack much of the performative detail of the first. Neither episode contains an internal audience to adjudicate Galen’s performance or to shame the two Erasistrateans for their failure to perform, although experimental incompetence continues as a theme. The Erasistratean of the second episode is unwilling or unable even to commission the device that he offers as evidence for his theoretical claim, a figment of his dreaming life that Galen dismisses as prop comedy. The septuagenarian of Galen’s third anecdote is a comic figure, whose engagement in these abstract debates also takes place in a dream-world. The length of his long life, a point on which Galen fixates, underscores the many opportunities he has had to undertake his own experiment and the enormity of his failure to do so. In the fourth and final episode of the series, Galen introduces writing explicitly into the narrative of his debates with Erasistrateans. In this instance, an Erasistratean has publicly contradicted the results of an experiment on the femoral artery about which Galen had written in an earlier work:48 “Then, not long ago, someone else gave an account of the experiment written by me in my book titled, Whether Blood is Naturally Contained in the Arteries, contrary

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Galen’s references to the dreaming life of his opponents to signal their disconnection from reality are a recurring theme in his work. Cf. Art.Sang. 7 (174.5–8 F-W = iv.729 K.). The experiment is found in Art.Sang. 8 (178.12–180.2 F-W = iv.733–734 K.).

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to the truth of the matter”.49 While it is not uncommon for Galen to refer to his other treatises, this reference foregrounds textual engagement. The experiment is a written procedure (γεγραμμένην ἐγχείρησιν), contained in one of his books (ὑπ’ ἐμοῦ κατὰ τὸ βιβλίον), whose title he is careful to identify as a booktitle (οὗ τοὐπίγραμμά ἐστιν). As in the first of these episodes, a group of people who had observed Galen conduct the experiment previously are present at the occasion: Then, marveling at his audacity (τόλμαν), those who had witnessed the experiment at my elbow began to ask him if he had conducted the experiment himself or if he held this belief because he had heard someone explain it to him. He said that he had conducted it very often. So, after bringing out a goat for him they attempted to force (ἠνάγκαζον) him to demonstrate. And when he was unwilling (because he did not know how to do it), they demonstrated to those present that the facts of the matter contradicted [him], putting an end to his charlatanry (ἀλαζονείας) once and for all.50 The Erasistratean responds to Galen by explaining (διηγεῖτο) this written procedure in the context of a live performance. The narrative setting appears to be a public epideixis of the sort Galen describes in My Own Books, where Galen and Martialius (also, it turns out, an Erasistratean) interpret and argue over a passage of Erasistratus’, as a problēma or proposed topic of intellectual debate.51 In this case, however, the text under public discussion is Galen’s own, a feature of this narrative that positions Galen’s work alongside more ancient authorities, as an object for analysis and discussion. It is a matter of pointed irony that Galen’s Erasistratean engages with this Galenic account of the experiment, since the procedure was originally devised by Erasistratus, as I discuss further in chapter seven. This passage shares a number of features with earlier sections of Anatomical Procedures that I have already discussed. Galen’s references to his opponent’s 49

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AA 7.16 (700 Garofalo = ii.645 K.): καὶ τοίνυν καὶ ἄλλος τις οὐ πρὸ πολλοῦ γεγραμμένην ἐγχείρησιν ὑπ’ ἐμοῦ κατὰ τὸ βιβλίον, οὗ τοὐπίγραμμά ἐστιν, εἰ κατὰ φύσιν ἐν ἀρτηρίαις αἷμα, διηγεῖτο πρὸς τοὐναντίον, ἢ κατὰ ἀλήθειαν ἔχει. AA 7.16 (700 Garofalo = ii.645–646 K.): θαυμάζοντες οὖν αὐτοῦ τὴν τόλμαν οἱ τεθεαμένοι παρ’ ἐμοὶ τὴν ἐγχείρησιν ἠρώτων, εἴποτ’ αὐτὸς ἐποίησεν αὐτήν, ἢ διηγουμένου τινὸς ἀκούσας ἐπίστευσεν. ὁ δὲ καὶ πάνυ πολλάκις ἔφη πεποιηκέναι. κομίσαντες οὖν αἶγα αὐτῷ δεικνύειν ἠνάγκαζον. ὡς δ’ οὐκ ἐβούλετο, διότι μηδ’ ἠπίστατο, δείξαντες τοῖς παροῦσιν ἐναντίως ἔχον τὸ φαινόμενον, ἔπαυσαν οὕτως τῆς εἰς τὸ λοιπὸν ἀλαζονείας. Lib.Prop.1 (138–139 B-M = xix.14 K.).

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audacity (τόλμα) and charlatanry (ἀλαζονεία) echo his justification for engaging with Erasistrateans on the question of arterial content in the first place, a question which he dismisses as absurd. He is drawn into debate with them, he says, to prevent the truth from being distorted and laypeople from being defrauded: “So great is the fraud (ἀλαζονείᾳ) and audacity (τόλμῃ) about things of which they have no knowledge that some people use against people who are ignorant”.52 His opponents must be compelled (ἠνάγκαζον) to demonstrate the truth of their claims—in this case the Erasistratean does not perform, even under compulsion. The language is wrought. It has oratorical associations and closes a ring composition with Galen’s introduction of Erasistrateans as opponents who, in contrast with him, cannot perform what they promise.53 This theme, which Galen has maintained throughout the first three episodes, also dominates the last. The audience-members had previously witnessed Galen conduct the procedure, here an experiment on the femoral artery. They stand in as surrogates for him, like the young men in the first episode who had learned from Galen how to isolate an arterial segment in order to demonstrate that the arteries contain blood even under healthy conditions. The Erasistratean here refuses to perform the experiment for the same reasons as his counterparts have: he lacks technical know-how (διότι μηδ’ ἠπίστατο), a pretense of which he must maintain as far as he is able. Galen’s surrogates again produce an animal subject, with which they attempt to compel the Erasistratean to reveal his ignorance. His refusal to perform the demonstration incriminates him, and it affords Galen’s surrogates an opportunity to demonstrate both the truth of Galen’s experiment and the efficacy of his instruction. Furthermore, one recalls that Galen’s surrogates ask the Erasistratean if he held his belief about the emptiness of the arteries on the basis of first-hand experience conducting the experiment or through having learned about it second-hand. In isolation, Galen’s language suggests that the distinction here is between practical experience (εἴποτ’ αὐτὸς ἐποίησεν αὐτήν) and some kind of verbal instruction, a belief acquired after having “heard someone articulating it” (διηγουμένου τινὸς ἀκούσας). The Greek accommodates a more expansive reading of this passage, however. As a consequence of the historic aural dimensions of Greco-Roman reading, one can “hear” written accounts.54 The textual dimension to this last episode is worth exploring further, especially in light of Galen’s careful introduction of himself as an author and his writing as an 52 53 54

AA 7.14 (688 Garofalo = ii.637–638 K.): τοσαύτῃ τινὲς ἀλαζονείᾳ τε ἅμα καὶ τόλμῃ περὶ ὧν οὐκ ἴσασι πρὸς τοὺς οὐκ εἰδότας χρῶνται … See AA 7.14 (686–688 Garofalo = ii.636–637 K.). Cf. Polybius Hist. 1.13.6 and 2.59.5.

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object for public interpretation and debate. It is possible that Galen’s criticism of his Erasistratean opponent is not limited to his lack of first-hand knowledge but extends to his uncritical reading of texts. On this more expansive reading, Galen’s critique of the Erasistratean includes the theme he has maintained throughout these four episodes. This opponent, like his counterparts, certainly lacks the anatomical and philosophical training, in short the education, to support his claims. Indeed, his lack of education is in part explanatory of his uncritical reliance on Erasistratus’ written account of the experiment. As Galen hastens to observe, this report is not only contrary to the facts of the matter, it is of course contrary to Galen’s actual observations: The real observational result is so [i.e., in agreement with Galen’s view]. And yet, on this point Erasistratus reports the opposite result, saying that the segment distal to the reed clearly moves. This is how great the audacity (τόλμα) is of some people who make reckless claims about things which they have never seen for themselves!55 While Erasistratus may have been mistaken about the results of the experiment, Galen clearly believes that he performed it.56 The great vice of Galen’s contemporary opponents is to possess the audacity to make public assertions merely on the basis of written authorities without recourse to first-hand observations or the skill to conduct them. Throughout the close of book seven, Galen offers the reader very little in the way of an argument against the theoretical positions held by his Erasistratean opponents. As we will see in the following chapters, Galen is perfectly capable of engaging with their arguments directly. The persuasive force of Galen’s digression on the question of arterial content in Anatomical Procedures, however, depends entirely on the satirical portrait he draws of contemporary Erasistrateans. They are, as a group, bad intellectual actors. They lack the requisite training—anatomical and intellectual—to make informed medical claims or to test them empirically. What is worse, their educational failures align closely with moral ones. Galen’s Erasistrateans are desperate to hide their ignorance,

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AA 7.16 (704 Garofalo = ii.648 K.): τὸ μὲν οὖν ἀληθῶς φαινόμενον οὕτως ἔχει. διηγεῖτό γε μὴν ἐναντίως ὁ Ἐρασίστρατος ὑπὲρ αὐτοῦ, φαίνεσθαι λέγων κινούμενον τὸ κάτω τοῦ καλάμου. τοσαύτη τίς ἐστιν ἐνίων τόλμα, προπετεῖς ἀποφάσεις ποιουμένων ὑπὲρ ὧν οὐδέποτ’ ἐθεάσαντο. Cf. Art.Sang. 8 (180.28–182.4 F-W = iv.735 K.) and Art.Sang. 8 (182.9–10 F-W = iv.736 K.): “But Erasistratus was not so shameless as to try to write what he could see was impossible”. (ἀλλ’ οὐκ ἦν εἰς τοσοῦτον Ἐρασίστρατος ἀναίσχυντος, ὡς γράφειν ἐπιχειρεῖν, ὃ δὴ ἰδεῖν ἦν ἀδύνατον ⟨ὄν⟩).

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and so they habitually deceive a lesser-informed public with misdirection. His rivals’ moral shortcomings contribute to their intellectual ones, and vice versa. The pattern of Galen’s criticisms is highly socially coded. The servile terms in which he frequently describes Erasistrateans reinforce the image of them as morally and intellectually subaltern. The same pithy and engaging indictments of his rivals, imitative of tropes drawn from literature of the Classical Greek past and steeped in references to it, advertise Galen’s culturally elite status. To the extent that his rhetoric encourages the reader to align moral and intellectual virtue with social status, the sophistication of Galen’s invective against Erasistrateans of his day affirms the quality of his mind and character as it undercuts the quality of theirs. These anecdotes, highly wrought as they are, sit comfortably among procedural discussions of the other respiratory organs. Textuality and texts traditionally understood as literary play an integral role in Galen’s four-part polemic against Erasistrateans of his day. There is no hint that the technical subject matter or generic constraints of Anatomical Procedures preclude Galen from including learned echoes of fifth-century Athenian forensic oratory, making pointed use of tropes drawn from pages of New Comedy—in short, from signaling his status as a second-century Greek pepaideumenos at Rome to the reader through displays of his paideia.

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Galen and the Experiment on the Femoral Artery In the previous chapter, I focused on Galen’s use of text, culture, and paideia in Anatomical Procedures as a means of polemical engagement with secondcentury Erasistrateans and their beliefs about arterial content. In this chapter, I turn to the theoretical claims over which Galen and his Erasistratean rivals argued, and the experiment that both sides believed would settle the point at issue. On two occasions in his work, Galen describes an experiment on the femoral artery. The structure of the demonstration is elegant and its performance requires a high level of surgical expertise. It would, of course, have been conducted without the aid of sedatives to calm the animal subject. In Galen’s account of such procedures, the animal would be secured to a wooden board (σανίς) with ropes. An assistant, probably a slave, would pass the ropes through holes drilled into the boards for this purpose. Galen reports that he maintained a number of differently sized boards to fit the widest range of animal bodies.1 First the practitioner must expose, ligate, and dissect the artery of a living subject. Then a cannula or tube is inserted into the open artery, which is sutured with the cannula fixed in place by a new set of ligatures. The legacy of the experiment has been enduring; its identification with Galen is deep and abiding. This identification is also the source of a great historical irony. As with many of his other experiments, Galen deploys this arterial procedure against contemporary medical rivals. In this instance the demonstration targets Erasistrateans whose views on the function and contents of the arteries Galen rejects. Despite its association with Galen in the history of medicine, however, the experiment does not originate with him; it derives from Erasistratus himself, against whose ideas Galen turned it to devastating effect. Erasistratus’ femoral artery experiment survived recast in the theoretical framework of Galen’s physiology. Its earlier place in Erasistratus’ thought has largely been ignored or remembered in the occasional scholarly footnote. But the story of the two femoral artery experiments is as sophisticated as the experiment itself. Galen’s account offers a fitting opportunity to recover at least part of the Erasistratean story, which it has nearly consumed. Furthermore, the erasure of Erasistratus under Galen’s

1 See, e.g., AA 7.12 (674 Garofalo = ii.627 K.). While the basic manner of restraint is the same, a few more details about Galen’s methods can be found at AA 8.8 (766–768 Garofalo = ii.691 K.).

© Luis Alejandro Salas, 2020 | doi:10.1163/9789004443860_008

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influence invites scrutiny of Galen’s argumentative method, which so powerfully turned the demonstration on its inventor and second-century Erasistrateans along with him.2 For these reasons it is worth examining Galen’s writing about the procedure on the femoral artery as an experimental narrative, focusing on three broadly related questions. First, what was the probative force of the experiment for Galen, both in the context of a live performance and of his written account? Proposing answers to this question requires a discussion not only of what Galen aimed to prove by his demonstration, but also what precise set of views he believed it would refute and in what sort of performative context such a refutation would take place. Second, what can Galen’s explanation of the experiment tell us about those theoretical commitments that are load-bearing for the structure of his own physiological views? What were the stakes in the debate? Third and finally, what can Galen’s narrative tell us about the role of experimental accounts like these in his polemics against rival theorists? By carefully considering the layers of this account that do substantive work for Galen’s physiological arguments and isolating them, I believe that it is possible to recover the place of the experiment in Erasistratus’ work, specifically the theoretical framework in which it was originally devised and the debate in which Erasistratus would have deployed it. This line of inquiry is historically interesting in its own right. Distinguishing the Erasistratean experiment in its theoretical context from its Galenic iteration, however, allows us to illuminate an important and typical feature of Galen’s writing that I have referred to as a doxographical polemic. First Galen invokes erudite knowledge of the work of an ancient figure whom his opponents consider an authority in order to discredit their paideia. After arguing that his contemporaries misread or misunderstand this authoritative intellectual ancestor due to their ignorance, Galen purports to show that the ancient source, now properly understood through the interpretative lens of his own education, is mistaken. Circumstantial factors are likely to have contributed to the historical influence of Galen’s written narrative. The technical demands of the femoral artery experiment on the experimenter are exigent, in part because the workspace it offers is exceedingly small. The only animal subject to which Galen explicitly alludes in the context of this demonstration is the goat, which along with 2 Galen’s reformulation of other thinkers’ views in his own theoretical terms is well-documented. Galen’s definition of disease, for example, is a synthesis of an existing tradition of disease definition into his own nosological system. As in the case of Erasistratus’ femoral artery experiment, the earlier definition of disease has been all but erased from the historical record in the process of Galen’s appropriation. On this example, see Salas (2020).

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pigs and small apes is a typical animal subject for many of his demonstrations.3 The average diameter of the femoral artery in a typical adult goat is roughly 3 millimeters or about the width of a cocktail straw. Although Galen makes no mention of pigs in regard to the experiment, the dimensions of the porcine femoral artery are much the same.4 The diminutive size of the arteries in available subjects and the minute movements of the artery under observation place strict demands on the experimenter’s anatomical technique. The narrow gauge of the goat’s femoral artery gives a sense of how difficult it would be, first to dissect the artery without severing it and then to insert a cannula into its lumen. For the same reasons, the procedure presents significant observational challenges; so much so that disagreement about its actual and probable results has been a central and enduring theme in discussions of the demonstration from Galen’s own account, through the Renaissance, and to the present. As an important corollary to this point: the practical and performative limitations of the procedure have special bearing on its accessibility to a wider audience. These limitations would have made the demonstration on the femoral artery a much more intimate affair, in contrast to the occasion of Galen’s experiments on phonation, the bladder, and, in principle, his dissection of the elephant’s heart. His experiment on the interruption of the recurrent laryngeal nerve, whose results could be heard by a relatively large number of people, was accessible as both an erudite demonstration and as a spectacular display. Galen’s sophisticated arguments about the relation of voice production to volition and the bearing of his experimental results on questions of the nature and location of the body’s control center, the hēgemonikon, might only reach the pepaideu3 The reference comes immediately before his longer account of the demonstration (AA 7.16, 700 Garofalo = ii.645–646 K.), as part of the occasion for the account. Galen writes that people who had observed him perform this demonstration were taken aback at the audacity of an Erasistratean who had contradicted Galen’s account of the results of the experiment or, as he says, how things really are (διηγεῖτο πρὸς τοὐναντίον, ἢ κατὰ ἀλήθειαν ἔχει). The onlookers questioned whether the man had performed the experiment or had mere secondhand experience with it. After he claims to have performed it, they produce a goat on the spot and demonstrate that the results conform to Galen’s claims. One might wonder whether the context of the reference discourages too strict a reading of the passage, although it is consistent with indirect evidence for the limited range of animals on which Galen might have performed the procedure. 4 The mean diameter of the femoral artery in goats is about 2.98 mm (Vaishi et al., 2003: 498); in pigs it is about 2.79mm (Solanes et al. 2005: 110). There is no reason to think that Galen conducted this procedure on human beings. However, it is worth noting that the diameter of the femoral artery in humans at its largest point, including only the lumen, is still only about 6.6mm or roughly the diameter of a wooden pencil (Spector and Lawson 2001: 210).

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menoi in the audience; but the spectacle of Galen’s control over the cries of the animal on the stage was a source of public awe and amazement. The experiment on the femoral artery requires close attention to relatively small structures and, as its later reception in the 20th century shows, its results are difficult to observe even among trained specialists. While its live performance would have been accessible only to a very limited audience, its written performance suffers no such restrictions. It is an experiment that would have been more effective in the telling than in the doing, a point to which Galen’s careful narrative suggests he was keenly sensitive. The experiment precludes the sorts of solutions that Galen deploys to meet the observational demands placed on him by other demonstrations of minute structures. Here it bears reminding that it was impossible for Galen simply to magnify the image of the structure(s) he was examining; magnificatory technologies were not available throughout the span of Greco-Roman antiquity. In these cases, Galen enlarged the actual structure by performing demonstrations on larger animals with proportionately larger internal anatomies.5 In purely anatomical experiments, Galen had recourse to larger animals whose internal structures were correspondingly more visible to onlookers as well as to the experimenter. But these kinds of experiments are perforce anatomical rather than physiological. For the most part, experiments aimed at physiological questions required Galen to work on living subjects. In these instances, the larger animal subjects on which the morphological descriptions of Anatomical Procedures are typically based, in particular oxen, are likely to have presented significant if not insurmountable logistical problems for the performance of the demonstration. One need only consider, for example, the relatively modest wooden boards in which Galen bored holes for restraining ropes.6 These could hardly have accommodated animals of any considerable size, preventing Galen from performing the demonstration on the sorts of animals that might have offered clearer and more spectacular experimental results. On account of the observational limitations it placed on an audience, the performance of the femoral artery experiment lacks the kind of agonistic context in which a live audience adjudicated the intellectual and professional

5 I discuss this point in greater detail in chapter 3. Galen believed that anatomical structures and physiological processes were analogous across animal kinds that exhibited them, for reasons having to do with his commitments to the deep teleological structure of the natural world. Consequently, air-breathing creatures should be expected to have hearts. Hearts should be expected to be suited ideally to their activity. And, all the hearts of air-breathing creatures should be similar, morphologically and functionally. 6 See AA 7.12 (674 Garofalo = ii.627 K.).

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authority of elite practitioners such as Galen. A written account, however, obviates the restrictions placed on him by live performance, for which it acts as a surrogate. Written demonstration allows Galen to detail the movement of the artery, otherwise too small to be apparent to the naked eye. It provides a venue, unmoored to time and place, in which he contends with his rivals; and conjures an audience, in which the reader participates and is called upon to adjudicate Galen’s expertise. Its reception in the history of medicine also bears out the importance of a written surrogate for its live performance. In the 16th century, the demonstration made its way onto the pages of Andreas Vesalius’ Fabrica, where its association with Erasistratus had already been elided. Vesalius approves of Galen’s observational results and agrees with his interpretation of them. However, he relegates it to an appendix of the seventh book of the Fabrica, where it was to be collated in the fourth book but never was.7 Vesalius ultimately acknowledges the importance of the experiment but discounts the utility of its live performance for the purpose of learning arterial function. In the 17th century, it fared worse. William Harvey, in his second letter to Jean Riolan, denies out of hand that Vesalius or Galen performed the experiment at all. He believed it was too technically challenging for them, as it was for him. Nonetheless, he writes that had they performed the experiment they would have observed results quite contradictory to those they reported.8 As late as the middle of the 20th century, the probable results of the experiment and the feasibility of its performance in Greco-Roman antiquity have continued to be subjects of scholarly interest.9 These historical questions about whether Galen performed the experiment are interesting, especially for how they might illuminate the degree to which Galen privileged fidelity to historical detail in the context of his writing. I would like to put such questions aside. I see no reason to suppose that Galen would not have performed the experiment; but I also see no way to answer such a question satisfactorily with the present state of our knowledge. However, the historical challenges of conducting the experiment underscore the importance of written narratives to its identity. Regardless of whether Galen or Erasistratus conducted the demonstration, there is strong reason to think that the results they describe reflect their theoretical considerations far more than what is likely to have been observable to them. So, I am interested in the telling: What do Galen’s accounts reveal 7 Vesalius (1543: 659) = (1555: 819). I cite Vesalius’Fabrica first by book then chapter, followed by reference to the pagination in his edition of 1543. In cases where the Latin of the 1555 edition of the Fabrica differs meaningfully, a reference to it will follow. 8 Harvey Ad Riolanum 2 (1649: 47–49). 9 Forrester (1954); Amacher (1964); and Malato and Scarano (1966).

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about its place in his physiological theory and in his rejection of competing physiological systems?

1

The Femoral Artery Experiment

The demonstration on the femoral artery itself is straightforward, although the background for the theoretical positions it was deployed to rebut and support require more careful explanation. Its primary aim is to examine the causal mechanism responsible for arterial pulsation, as witnessed by Galen’s accounts and their Renaissance reception. The experiment involves exposing and dissecting a large artery in a living animal. First, the artery is ligated at a suitable point upstream of arterial flow (a second ligature may be applied downstream from the first but it is useful mainly for another experiment sometimes mentioned in conjunction with this one). Then a cannula is placed lengthwise in the dissected section of the artery. The artery is sutured to prevent blood loss and the section of arterial tissue surrounding the cylinder is ligated around it. Although these ligatures remain in place, those interrupting blood flow are removed. Finally, the experimenter observes whether a pulse can be detected downstream of the cylinder. Galen’s fuller account is found in his anatomical handbook, Anatomical Procedures. While lengthy, it is worth including in full: The procedure is as follows: one must lay bare one of the large arteries near the skin (e.g. the artery by the groin, on which I usually perform this operation), then apply a ligature at a point above it. Next compress the artery itself with the fingers of the right hand, as far as possible from the ligature until the artery comes to a major branch. Cut the artery longitudinally with a wide incision, such that a hollow body can be inserted between the ligature and the fingers. Prepare yourself a slender reed (κάλαμος), the sort with which we write, or a suitably constructed piece of bronze: one that is the length of a finger will do. It is therefore clear that there will be no hemorrhage of the dissected artery in keeping with its activity, since 1) the point above [the incision], from where the blood flows is cut off by the ligature and 2) the point distal to [the incision] does not pulsate any longer on account of the ligature and because it is compressed manually. And so you can calmly insert the hollow body into the artery, placing it under the dissected segment of its tunic. Then cinch the artery as well as the reed in a loop of fine linen, being mindful that none of the reed extends past the incision along the artery. See to it that the reed, as I said, is of such a gauge so as not to sit loose in the coat of the artery, for

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we want it to remain in place and neither move further above nor below the incision in the artery. After this is done, first undo the ligature and for good measure, if you will, move the fingers with which you were compressing the artery to the section of it surrounding the reed. If indeed the reed is snugly inserted and carefully bound, as I instructed, there will no longer be any need for you to control it; it will remain in place. In this way you will be able to see that the section above the reed is still pulsing as it did before and that the section distal to it has become completely pulseless. This is the way that the result truly appears. But Erasistratus made the opposite claim about it, saying that the section distal to the reed clearly continued to move.10 Galen’s focus is on practical instruction in this passage, as it is throughout much of Anatomical Procedures. One can, however, reconstruct a rough account of the argumentative structure that Galen envisioned for the experiment, including the range of relevant results and the arguments that these sorts of results would support.11 The cannula and ligature pinch the arterial walls internally

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AA 7.16 (700–704 Garofalo = ii.646–648 K.): ἡ δ’ ἐγχείρησίς ἐστι τοιάδε. τῶν ἐγγὺς τοῦ δέρματος ἀρτηριῶν τῶν μεγάλων χρὴ γυμνώσαντα μίαν, οἵα πέρ ἐστιν ἡ κατὰ τὸν βουβῶνα, μάλιστα γὰρ ἐπ’ ἐκείνης εἴωθα ποιεῖσθαι τὴν ἀνατομὴν τήνδε, βρόχον περιβάλλειν τοῖς ὑψηλοτέροις αὐτῆς μέρεσιν, εἶτα τοῖς δακτύλοις τῆς ἀριστερᾶς χειρὸς αὐτὴν σφίγγοντα τὴν ἀρτηρίαν, ὅσον οἷόν τε πορρωτάτω μὲν τοῦ βρόχου, πρὶν δ’ ἀποβλάστημα ποιήσασθαι μέγα, διατέμνειν αὐτὴν κατὰ τὸ μῆκος εὐθείᾳ τομῇ, τηλικοῦτον ὡς ἐνθεῖναι δύνασθαι κοῖλόν τι σῶμα μεταξὺ τοῦ βρόχου καὶ τῶν δακτύλων. παρεσκευάσθω δή σοι κάλαμος τῶν λεπτῶν, οἷς γράφομεν, ἢ χαλκοῦν τι τοιοῦτον ἐπίτηδες γεγονός· ἀρκεῖ δ’ εἶναι τοῦτο τῷ μήκει δακτυλιαῖον. εὔδηλον οὖν, ὡς κατὰ τὴν ἐνέργειαν ταύτην οὐδεμία γενήσεται τῆς διῃρημένης ἀρτηρίας αἱμορραγία, τοῦ μὲν ὑψηλοτέρου μέρους, ὅθεν ἐπιρρεῖ τὸ αἷμα, βρόχῳ διειλημμένου, τοῦ ταπεινοτέρου δὲ μήτε σφύζοντος ἔτι διὰ τὸν βρόχον, ὑπό τε τῶν δακτύλων σφιγγομένου. κατὰ πολλὴν οὖν σχολὴν ἔνεστί σοι τὸ καθιέμενον εἰς τὴν ἀρτηρίαν σῶμα κοῖλον ὑποκείμενον ποιῆσαι τῷ διῃρημένῳ μέρει τοῦ χιτῶνος αὐτῆς, εἶτα περιλαμβάνειν ἐν κύκλῳ λίνῳ λεπτῷ τὴν ἀρτηρίαν ἅμα τῷ καλάμῳ, προνοούμενον, ὅπως μηδὲν ὑπερεκπίπτῃ τῆς κατὰ τὴν ἀρτηρίαν τομῆς τοῦ καλάμου. τῷ πάχει δὲ ἔστω τηλικοῦτος ὁ κάλαμος, ὡς ἔφην, ὥστε [σε] τὸν χιτῶνα τῆς ἀρτηρίας μὴ χαλαρὸν ἐγκεῖσθαι, βουλόμεθα γὰρ αὐτὸν κατὰ χώραν μεῖναι, μήτ’ ἀνώτερον τῆς κατὰ τὴν ἀρτηρίαν διαιρέσεως ἐνεχθέντα, μήτε κατώτερον. γενομένου δὲ τούτου, λῦσον μὲν τὸν βρόχον, αὐτὸς δὲ ὑπὲρ ἀσφαλείας, εἰ βούλει, μετάθες τοὺς δακτύλους, οἷς ἔσφιγγες τὴν ἀρτηρίαν, ἐπὶ τὴν περὶ τῷ καλάμῳ μοῖραν αὐτῆς. εἴ γε μὴν, ὡς εἶπον, ἐσφηνωμένος τ’ εἴη καὶ δεδεμένος ἀκριβῶς ὁ κάλαμος, οὐδὲν ἔτι δεήσεταί σου κρατοῦντος, ἀλλ’ ἐπὶ χώρας μενεῖ. οὕτως ὑπάρξει σοι θεάσασθαι τὸ μὲν ἀνώτερον τοῦ καλάμου τῆς ἀρτηρίας ἔτι καὶ νῦν σφύζον, ὡς ἔμπροσθεν, ἄσφυκτον δ’ ἀκριβῶς γιγνόμενον αὐτοῦ τὸ κατώτερον. τὸ μὲν οὖν ἀληθῶς φαινόμενον οὕτως ἔχει. διηγεῖτό γε μὴν ἐναντίως ὁ Ἐρασίστρατος ὑπὲρ αὐτοῦ, φαίνεσθαι λέγων κινούμενον τὸ κάτω τοῦ καλάμου. There are reasons to suppose, as I will argue, that the argumentative structure of the experiment as Galen understood it reflects a later stratum of its history.

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and externally. They are meant to arrest the active movement of the arterial walls downstream of them, while still allowing the artery’s contents to flow freely. The experiment effectively isolates the arterial walls as a possible cause of pulsation downstream of the cannula. At this point the experimenter observes whether the artery continues to pulsate downstream of the cannula, distal to the heart. If a pulse can be felt, the experiment is intended to show that 1) the active movement of the arterial walls does not cause them to pulsate and 2) the only remaining explanation for the arterial pulse is mechanistic: The pressure exerted by the material moving through the artery causes it to pulsate. On the other hand, if a pulse cannot be felt, Galen argues that the experiment is powerful evidence for the view that the pulse is caused by the arterial walls, since it ceases when the experimenter interrupts their capacity for active movement. According to Galen, this is just how the results really (ἀληθῶς) appear; a careful observer will find that the pulse ceases beyond the ligated section of the artery and the experiment demonstrates that the arteries pulsate in virtue of their capacity for active movement. These two views on the physiology of the pulse stake out the main positions in a debate over pulsation that can be traced back to the third century bce. Galen further retrojects his belief that pulsation is a function of the active movement of the arterial walls to Hippocrates, ascribing it also to Herophilus and all other ancient philosophers and physicians—at least those worth their salt: As it has been demonstrated elsewhere in my own work and in the work of countless others before me, the heart regulates this compound and double motion of the arteries, which we call “pulse”. Not at all in the way that Erasistratus supposed but as Herophilus, Hippocrates, and nearly all of the most esteemed of the ancient doctors and philosophers did.12 One should be cautious in taking Galen’s attribution of any theoretical position on the pulse to the Hippocratic tradition, given how little attention is paid to the pulse in the Hippocratic Corpus. Galen’s reference to Hippocrates in this context is perhaps better understood in light of his penchant for grounding his

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Us.Puls. 4 (208.17–210.6 F-W = v.163–164 K.): ταύτης δὲ τῆς διπλῆς καὶ συνθέτου τῶν ἀρτηριῶν κινήσεως, ἣν δὴ καὶ σφυγμὸν ὀνομάζομεν, ἐξηγεῖται μὲν ἡ καρδία, καθάπερ καὶ ἡμῖν ἐν ἑτέροις καὶ μυρίοις ἄλλοις πρὸ ἡμῶν ἀποδέδεικται, οὐ μὴν καθ’ ὃν Ἐρασίστρατος ὑπελάμβανεν τρόπον, ἀλλ’ ὡς Ἡρόφιλός τε καὶ Ἱπποκράτης, καὶ σχεδὸν οἱ δοκιμώτατοι πάντες τῶν παλαιῶν ἰατρῶν τε καὶ φιλοσόφων. Cf. Herophilus fr. 144 vS = Diff.Puls. 4.6 (viii.733 K.).

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theoretical views in those of Hippocrates, whose intellectual authority added to Galen’s own and shielded him from criticism. As the closing lines of this passage suggest, Galen strongly associates the mechanistic view with Erasistratus and later Erasistrateans, who held that the contraction of the heart propels material through the arteries. As the material in the arteries is consumed by the body, the partial vacuum left behind in the vessels draws new material into them. The force of the material’s passage through the arteries causes the vessels to pulsate. Galen describes the mechanistic principle that Erasistratus invokes to explain such processes as “following in the direction of what is being emptied” (πρὸς τὸ κενούμενον ἀκολουθία), often abbreviated as PTKA in order to avoid the historical freight of the principle better known by its Latin name horror vacui.13 Galen offers the action of bellows and inflated wineskins as examples of the main distinction between the views.14 Like his own view of pulsation, bellows are filled and emptied when they are actively expanded and contracted. Wineskins or balloons, on the Erasistratean model of pulsation, are inflated and deflated by the force the air inside them exerts on their interior walls on the Erasistratean model of arterial pulsation. As Galen puts it, the bellows fill when they are expanded while the wineskin expands when it is filled.15 There is some tension, however, between Galen’s criticism of Erasistratus’ account of pulsation and his own. Through much of Natural Faculties Galen argues that Erasistratus’ use of PTKA is insufficient to explain physiological processes. The principle is too blunt an explanatory instrument to account for stimulus specific responses in the body, such as the extraction and distribution of nutriment in digestion or the separation of specific waste products from the blood in the cases of the kidneys and the bile ducts.16 One might suppose that Galen 13

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I discuss the role of PTKA in Erasistratus’ theory of the pulse in greater detail in chapter seven. On this and related points, see von Staden (2000: 92–94); Lehoux (1999); Berryman (1997), (1999: 191–215); Debru (1996: 53, n. 26); and Furley and Wilkie (1984: 32–37). See, e.g., Art.Sang. 7 (176 F-W = iv.731 K.); Diff.Puls. 3.6 (viii.673 K.), 4.2 (viii.703 K.); and Dig.Puls. 1.2 (viii.784 K.). Art.Sang. 7 (176.6–9 F-W = iv.731 K.): “You might understand the difference between a thing expanding when it is filled and being filled when it is expanded even better by examples. For wineskins and sacks expand when they are filled while bellows are filled when they expand”. (νοήσαις δ’ ἂν ἔτι μᾶλλον ἐπὶ παραδειγμάτων τὴν διαφορὰν τοῦ πληρούμενον διαστέλλεσθαι καὶ διαστελλόμενον πληροῦσθαι. οἱ μὲν γὰρ ἀσκοὶ καὶ οἱ θύλακοι πληρούμενοι διαστέλλονται, αἱ φῦσαι δὲ τῶν χαλκέων διαστελλόμεναι πληροῦνται). For Erasistratus’ denial that any other attractive faculty besides PTKA is at work in digestion, see Nat.Fac. 1.16 (SM 3, 145.7–16 = ii.60–61 K.). Galen extends this argument to Erasistratus about kidney function, although he tells us that Erasistratus did not himself make it explicitly (Nat.Fac. 1.16, SM 3, 146.27–147.6 = ii.62–63 K.). For Galen’s criticism of Erasi-

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rejects PTKA in physiological explanations tout court, especially on the basis of his arguments against it in the first two books of Natural Faculties. However, Galen appears to invoke a principle very similar to it in order to explain various biological processes—notably among them, pulmonary action as well as the pulsation of the heart and arteries.17 The inconsistency between Galen’s appeal to mechanical attraction to explain biological processes in some contexts and his repudiation of Erasistratus may be explained, as Adamson has argued, if Galen does not reject PTKA as an explanatory principle, so much as he rejects Erasistratus’ reductive use of it as the explanatory principle.18

2

Capacities and Their Explanatory Powers

The femoral artery experiment does not only bear on the proper explanation of the pulse and Erasistratus’ alleged shortcomings as an observer, although this criticism of Erasistratus’ technical skill is an important feature of Galen’s engagement with him and second-century Erasistrateans. It offers empirical evidence for the theoretical inadequacy of mechanistic accounts of physiology, such as those proposed by Erasistratus. At stake for Galen is the general proposition that capacities (δυνάμεις) internal to organisms and organs are properly explanatory of physiological processes (ἐνέργειαι), a proposition which he takes to be a fundamental feature of the biological world.19 Mechanical princi-

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stratus’ explanation of yellow bile production, see, e.g., Nat.Fac. 2.2 (SM 3, 157.15–158.24 = ii.78–79 K.). One of the arguments that Galen marshals against the Erasistratean account is that hollow organs can obviously become overfull (Nat.Fac. 1.16, SM 3, 147.19–148.2 = ii.64 K.). If PTKA were the only causal principle responsible for drawing material into these organs, they would no longer draw material into themselves when full, like an empty jar that has been submerged ceases to draw water into itself as soon as it has filled. See, e.g., Nat.Fac. 3.13–14 (SM 3, 249.6–250.4 = ii.204–205 K.); UP 6.15 (i.350.15–351.5 Helmreich = iii.480–481 K.), 7.4 (i.380.12–381.14 Helmreich = iii.523–525 K.), and 7.9 (i.397.11– 399.27 Helmreich = iii.546–549 K.). Adamson (2014: 202–204). Cf. Hankinson (2015: 953–954). It may also have been relevant to Galen that Erasistratus’ principle does not necessarily require the active participation of a goal-oriented structure to operate. Galen’s principle of attraction by space, as far as I am aware, is always or nearly always subordinated to a goal-directed process, such as the active movement of an organ. This difference too is reflected in Galen’s explanatory analogy of bellows—in which expansion is the active cause of suction—and wineskins, in which expansion is the passive effect of inflation. Galen’s concepts of δύναμις and ἐνέργεια differ from Aristotelian notions in crucial ways. For my purposes it is sufficient to note that Galen is primarily concerned with activities (ἐνέργειαι) as processes not states. Therefore the capacities (δυνάμεις) that correspond to them are capacities for doing things, such as generating blood or digesting food. Galen

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ples may contribute to physiological explanations, but physiological processes are not reducible to them. Consequently, the relevant underlying theoretical account of arterial function should be fundamentally dynamic. Galen elaborates on this theoretical position in On the Natural Faculties, whose account of the physiology of the kidneys also includes Erasistratus in its area of effect.20 The puzzle under examination is how urine is separated from blood in kidney function. Galen poses two alternative explanations: either kidneys draw urine out of the blood in the veins or urine is merely expelled from the veins into the kidneys.21 Galen poses the question: If the contraction of veins is responsible for the expulsion of fluids into the kidneys, what prevents them from expelling all of their contents in this way?22 Galen’s question cuts to the root of his objection. The organs involved in physiological processes such as digestion and the secretion of urine are sensitive to specific inputs. Bodies are disposed to digest and absorb substances that are useful to them, while they expel substances that are useless or reject those that are harmful. For Galen, the selectivity of these processes is an outgrowth of the goal-directed structure of organs and organisms in the natural world. Kidneys do not draw all or even most fluids into themselves; they specifically draw serous fluids from the blood, which they absorb, and expel urine into the bladder. Similarly, the stomach extracts those substances that are nourishing from food and expels what is not.23 These processes are best explained by inher-

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also does not appeal to δυνάμεις as explanatory of capacities for activities simpliciter. For him activities and their corresponding activities are functional features of living things at the level of type. See Hankinson (2014). See Nat.Fac. 1.13–16 (SM 3, 122–150 = ii.30–67 K.). It may be worthwhile briefly to orient the reader. From a contemporary perspective, blood passes through the renal arteries into the kidneys where it is filtered by microscopic structures (called “nephrons”). Blood pressure within this nephron, a smaller network of vessels, drives the filtration process. The fluid filtered out in this process is urine, which passes from the kidneys to the bladder through the ureters. It falls somewhat outside the scope of this book but this passage offers a sense of Galen’s occasional tendency to sprinkle comic asides into his abuse of rivals. He tells the reader that since he is proverbially forced to engage with lunatics (Nat.Fac. 1.15 SM 3, 142.15–16 = ii.56–57 K.: ὡς ἡ παροιμία φησί, μαινομένοις ἀναγκασθέντες συμμανῆναι) he may as well mention a third possibility, which he dismisses as absurd: the urine may travel from the bloodstream to the kidneys because it seems like a fine idea, quite like when Galen decides to go to the market (Nat.Fac. 1.15 SM 3, 142.22–23 = ii.57 K.: ὁπόταν εἰς τὴν ἀγορὰν ἀπίωμεν). One might counter that Galen has not offered two genuine horns of a dilemma. The veins may simply have a capacity for separating urine out from blood whose activity occurs through contraction. However, the separation of urine from blood does not occur throughout the venous system, arguing against associating the process with the veins as such. Galen also discusses magnets’ attraction of iron in this context (Nat.Fac. 1.14, SM 3, 133–138

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ent and specific features of the organs that dispose them to react to certain stimuli and not others. Mechanical principles are too blunt to be explanatorily adequate of many physiological processes, partly in virtue of their generality. They can account for certain aspects of physiological processes, such as the early stages of pulmonary respiration, in which the expansion of the chest inhales whatever can be suctioned into the windpipe.24 However, they fail to explain the disposition of organs to react discriminately to other, more particular, inputs in the way that magnets attract iron and organs absorb nutrients.25 The lungs do not merely take in ambient air; they also draw or elaborate pneuma—a substance of central importance to Galen’s physiology—from it. I will return to the topic of pneuma in due course. Briefly, in Galen’s physiological system it is the substance responsible for various life functions, especially those involving cognition, volition, sensation, and motor function.26 To account for the selective response of organs to specific stimuli, Galen introduces a hierarchy of capacities responsible for basic life functions, called “natural capacities”.27 At the most general level, all living things are generated (γένεσις), grow (αὔξησις), and then maintain themselves throughout the remainder of their lives (θρέψις).28 This power of living things to sustain themselves, which is often translated as “nourishment”, exists at the level of organ as well as the organism. It ramifies into three subordinate capacities:29 1) a capacity to attract or draw only specific materials (δύναμις ἑλκτική), which was central to my previous discussion of some of Galen’s arguments against mechanism. Key to this capacity in animals is its sensitivity only to the type of material, typ-

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= ii.44–51 K.). The example focuses on the inadequacies of Epicurean atomist explanations, which are interesting in themselves but beside the main point here. The gist of Galen’s criticism is that if, as Epicurus argued, magnetic attraction is a result of similarlyshaped atoms attaching to one another, it is difficult to explain how some atoms attach to the first object while others pass through and attach to the second and so on. If, Galen argues, magnets do not have some inherent capacity that is sensitive to iron why would they not attract objects indiscriminately? Galen appeals to mechanical explanations in the case of hollow organs or cavities, in particular. See Nat.Fac. 3.15 (SM 3, 251–252 = ii.206–208 K.). See Nat.Fac. 3.15 (SM 3, 251.4–12 = ii.206–207 K.). Cf. Galen’s discussion of other organs such as the gallbladder, which draws yellow bile into itself (Nat.Fac. 3.4–5, SM 3, 214–215 = ii.157–158 K.), and the spleen, which does the same with black bile (Nat.Fac. 3.9, SM 3, 229–230 = ii.177–178 K.). In this passage, he mentions that he holds the same view for the activity of the veins, arteries, heart, and all other organs. See Singer (2020) and Lloyd (2007). See, e.g., Nat.Fac., 1.5–9 (SM 3, 107.24–115.9 = ii.10–20 K.). Nat.Fac. 1.5 (SM 3, 108 = ii.10 K.). See Nat.Fac. 3.3 (SM 3, 207–208 = ii.147–149 K.).

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ically a liquid such as blood, that is appropriate (οἰκεῖον) to the maintenance of the organ. 2) Galen invokes an eponymous faculty (δύναμις καθεκτική) for the retention of nutrition while it is being absorbed by the organ(ism), since he supposes that the assimilation of these materials is a gradual process. Finally, 3) byproducts of this process of absorption are expelled by a faculty for their elimination (δύναμις ἀποκριτική).30 When referring to the capacity for a certain activity, Galen is not necessarily committing himself to a specific causal explanation for a given activity. In some instances, where the theorist did not understand the underlying cause of some effect, capacities could operate as explanatory placeholders: And while we are ignorant of the nature of the effective cause, we call it a ‘capacity’. So, we say that there is a ‘hematopoietic capacity’ in the veins and similarly we say that there is a ‘digestive capacity’ in the stomach, a ‘capacity for pulsation’ in the heart, and that there is some capacity in each of the other parts particular to its operation.31 These capacities may effect their correlate physiological activities with the aid of mechanical processes. For example, according to Galen organs draw material in through contraction of straight or longitudinal fibers in their tissues, expel it through the contraction of transverse fibers, and retain it through the action of both.32 But, physiological activities are not by and large reducible to these mechanical processes, which play at most an ancillary role. For Galen,

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Galen also refers to the attractive capacity as epispastic (ἐπισπαστική) and the eliminative as propulsive or expulsive (προωστική). For discussions of the capacities for attraction, retention, and elimination, see, e.g., Nat.Fac. 3.1 (SM 3, 204–205 = ii.143–145 K.), 3.9 (SM 3, 230 = ii.178 K.); and Symp.Diff. 4 (CMG v 5,1 228.19–230.2 = vii.63 K.). See, e.g., Nat.Fac. 1.4 (SM 3, 107.14–20 = ii.9–10 K.): καὶ μέχρι γ’ ἂν ἀγνοῶμεν τὴν οὐσίαν τῆς ἐνεργούσης αἰτίας, δύναμιν αὐτὴν ὀνομάζομεν, εἶναί τινα λέγοντες ἐν ταῖς φλεψὶν αἱματοποιητικήν, ὡσαύτως δὲ κἀν τῇ κοιλίᾳ πεπτικὴν κἀν τῇ καρδίᾳ σφυγμικὴν καὶ καθ’ ἕκαστον τῶν ἄλλων ἰδίαν τινὰ τῆς κατὰ τὸ μόριον ἐνεργείας. See UP 6.8 (i.320.10–17 Helmreich = iii.438–439 K.). For Galen’s description of these fibers throughout arterial walls, see AA 7.5 (636–638 Garofalo = ii.601–602 K.). Galen describes the arteries as having an outer and inner coat (perhaps corresponding to our tunica adventitia and media, respectively). He writes that the outer coat is distinguished by having longitudinal fibers, while the fibers of the inner coat are transverse. It is likely that the presence of these fibers both helps to motivate and confirm Galen’s belief in the pulse as a purely active arterial movement. Galen also describes an inner membrane that he says some regard as a third coat (which would correspond to our tunica intima), suggesting that he did not regard the inner membrane as a proper arterial coat, probably on functional grounds.

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the results of the femoral artery experiment are powerful proof that these three faculties are at work in pulsation and, therefore, in all the organs of the body: Once the capacity for attraction, also called the epispastic capacity, has been demonstrated clearly in any one organ, it is no longer difficult to extend it to the rest. For indeed it is not the case that nature gave this sort of capacity to the kidneys and not to the vessels that draw bile (from the blood). Nor is it the case (that it gave it) to these (vessels) and not to each of the other organs.33 If the arterial walls cease to pulsate downstream of the cannula, which as we recall is intended to arrest the transmission of these capacities from the heart through the arteries, the best explanation to which one can infer is that arterial function occurs in virtue of these capacities rather than in virtue of mechanistic principles. If, on the other hand, these arterial walls continue to pulsate, natural capacities cannot account for the movement of the arteries. It follows for Galen that, in light of such a result, the only remaining explanation for arterial movement would be mechanistic. However, the consequences of mechanism in this case are not only vicious for Galen’s account of arterial function; they pose a significant threat to his physiological theory: If the movement of urine does not occur due to the principle that what is evacuated will be replaced (PTKA), it is clear that neither does the movement of blood or bile. Alternatively, if the movement of these (sc. does occur in virtue of mechanical principles), then the movement of urine will also. For it is necessarily the case that all of these things (sc. processes) come about in the same way, even according to Erasistratus himself.34 Galen’s generalization from the physiology of one organ to all organs arises from his commitment to the thoroughgoing teleological structure of the natural world. This commitment does not only mean that the parts of organisms are goal-directed; these parts are maximally suited to their activities within the

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Nat.Fac. 2.1 (SM 3, 155.8–14 = ii.75 K.): δειχθείσης γὰρ ἐναργῶς ἐφ’ ἑνὸς οὑτινοσοῦν ὀργάνου τῆς ἑλκτικῆς τε καὶ ἐπισπαστικῆς ὀνομαζομένης δυνάμεως οὐδὲν ἔτι χαλεπὸν ἐπὶ τὰ λοιπὰ μεταφέρειν αὐτήν· οὐ γὰρ δὴ τοῖς μὲν νεφροῖς ἡ φύσις ἔδωκέ τινα τοιαύτην δύναμιν, οὐχὶ δέ γε καὶ τοῖς τὸ χολῶδες ὑγρὸν ἕλκουσιν ἀγγείοις οὐδὲ τούτοις μέν, οὐκέτι δὲ καὶ τῶν ἄλλων μορίων ἑκάστῳ. Nat.Fac. 1.17 (SM 3, 154.14–18 = ii.73 K.): ἀλλ’ εἰ μὴ τῶν οὔρων ἡ φορὰ τῇ πρὸς τὸ κενούμενον ἀκολουθίᾳ γίγνεται, δῆλον, ὡς οὐδ’ ἡ τοῦ αἵματος οὐδ’ ἡ τῆς χολῆς ἢ εἴπερ ἐκείνων καὶ τούτου· πάντα γὰρ ὡσαύτως ἀναγκαῖον ἐπιτελεῖσθαι καὶ κατ’ αὐτὸν τὸν Ἐρασίστρατον.

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constraints of materials out of which they are made.35 On the basis of this view, Galen’s identification of an organic structure with a specific function also identifies the function with a certain kind of structure: pulsation and, therefore, the physiology of all other organs is best explained in terms of powers or of mechanism. For this reason, the results of the femoral artery experiment, as he has constructed it, have far-reaching theoretical ramifications for Galen. In his second direct reference to the demonstration, Galen obliquely indicates some further consequences of the experiment to his physiological system: The following result is apparent: separate any of the large and clearly visible arteries, first from the skin, then also from the parts of the body in which it inheres and those around it so as to be able to place a ligature around it. Then, after making a longitudinal opening [sc. in the artery] insert a hollow reed (κάλαμος) or a bronze tube (αὐλίσκος) into the artery through the opening so as to plug the wound with it and prevent hemorrhage. You will see the whole artery pulsating, so long as you observe it under these circumstances. But, whenever placing the ligature you compress the tunic of the artery against the reed (κάλαμος) you will no longer see pulsation past the ligature, although the passage of blood and pneuma continues through the hollow of the reed to the end of the artery just as it had beforehand. And if indeed the arteries acted in this way with regard to pulsation [i.e., if pulsation were caused by the mechanical force of arterial flow rather than by the action of the arterial tunics], then even under these circumstances the length of the artery beyond the ligature would continue to pulsate near its points of termination. However, since this does not happen it is clear that the power that puts the arteries into motion is passed along from the heart to the arteries through their tunics.36 35

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This belief is an outgrowth of Galen’s highly directed teleology. On his view, structures in the natural world are ideally suited toward their ends, within material constraints. As a consequence of this view, Galen believes 1) that nature uses the fewest possible structures to perform activities and 2) that these structures will not exhibit features beyond those necessary for their activities. (1) and (2) are related to what Hankinson calls Galen’s Principle of Creative Economy and his No Redundancy Assumption (Hankinson 1988: 151– 154). Art.Sang. 8 (178.12–180.2 F-W = iv.733–734 K.): ἔστι δὲ τὸ φαινόμενον τόδε. τῶν προφανῶν τε ἅμα καὶ μεγάλων ἀρτηριῶν εἰ ἐθελήσεις ⟨ἡντιν⟩οῦν γυμνῶσαι πρῶτον μὲν τοῦ δέρματος, ἔπειτα δὲ καὶ τῶν ὑποκειμένων τε καὶ παρακειμένων σωμάτων, ὡς περ⟨ι⟩βάλλειν αὐτῇ δύνασθαι βρόχον καὶ μετὰ ταῦτα κατὰ μῆκος χαλάσας κοῖλον ἐνθεῖναι κάλαμον ἤ τινα χαλκοῦν αὐλίσκον εἴσω τῆς ἀρτηρίας διὰ τοῦ χαλάσματος ὡς ἐπιφράττεσθαι πρὸς αὐτοῦ τὸ τραῦμα καὶ κωλύεσθαι τὴν αἱμορραγίαν, ἄχρι μὲν ἂν οὕτως ἔχουσαν ἐπισκέπτῃ, θεάσῃ σφύζουσαν ὅλην, ἐπειδὰν δὲ βρόχον

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Although Galen’s account of the demonstration in Whether Blood is Naturally Contained in the Arteries is far more sparing of the logistical details involved in its execution, it offers important evidence for his interpretation of its results. It is worth discussing three points. First, Galen is explicit in this passage about the main conclusion he draws from the experiment: the pulse is caused by an active movement of the arteries, the capacity for which is transmitted by the heart through the arterial walls.37 This point underscores how puzzling it is that Galen’s accounts of the femoral artery experiment are found in the context of his polemics against Erasistratus regarding the contents of the arteries. Second, Galen’s refers to the manner in which a natural capacity is transmitted from one organ to other parts of the body, indicating the importance of this transmission model for the efficacy of his procedure. Galen appeals to the voluntary movement of extremities to explain the process. He writes that the capacity of the toes for movement is analogous to that of the arteries, although in the case of the toes this capacity is transmitted through the motor nerves and ultimately from the brain rather than through the arterial walls and from the heart:38 For just as when we choose to move a toe, we immediately move it not because we possess volition in the part itself but in virtue of some capacity [for movement] instantly transmitted to it, so it is also in the case of the heart and the arteries. For the speed of the movement corresponds to [the behavior of] capacities but is inconsistent with [the behavior] of material things.39 Galen claims that capacities are transmitted from certain source organs throughout the body. Importantly, he also draws a contrast between the move-

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περιβαλὼν σφίγξῃς τὸν χιτῶνα τῆς ἀρτηρίας πρὸς τὸν κάλαμον, οὐκ ἔτ’ ὄψει τὰ μετὰ τὸν βρόχον ἐπισφύζοντα, καίτοι ⟨γ’⟩ ἡ τοῦ αἵματός τε καὶ τοῦ πνεύματος φορὰ διὰ τῆς τοῦ καλάμου κοιλότητος ἐπὶ τὰ πέρατα τῆς ἀρτηρίας ὡσαύτως ἐπιγίγνεται. καὶ εἴπερ οὕτως εἶχον αἱ ἀρτηρίαι τὸ σφύζειν, ἔσφυζον ἂν καὶ νυνὶ τὰ πρὸς τοῖς πέρασιν αὐτοῖς μόρια τὰ μετὰ τὸν βρόχον. οὐ μὴν γιγνομένου ⟨τούτου⟩· δῆλον ὡς ἡ [μὲν] δύναμις ἡ τὰς ἀρτηρίας κινοῦσα παρὰ τῆς καρδίας αὐταῖς διὰ [δὲ] τῶν χιτώνων ἐπιπέμπεται. Galen makes this point repeatedly, see also Art.Sang. 8 (180.14–19 F-W = iv.734–735 K.). Galen discusses the heart as the source (ἀρχή) of the arterial pulse throughout book 6 of PHP and the whole of Us.Puls.. See especially PHP 6.6 (CMG v 4,1,2 396–398 = v.549–551 K.). Art.Sang. 8 (180.19–25 F-W = iv.735 K.): ὡς γὰρ καὶ τὸν τοῦ ποδὸς δάκτυλον κινῆσαι προελόμενοι παραχρῆμα κινοῦμεν αὐτὸν οὐ τὸν λογισμὸν ἔχοντες ἐν αὐτῷ τῷ μορίῳ, διαδοθείσης δέ τινος ἐπ’ αὐτὸν ἐν ἀκαρεῖ χρόνῳ δυνάμεως, οὕτω κἀπὶ τῆς καρδίας καὶ τῶν ἀρτηριῶν γίγνεται. ταῖς μὲν γὰρ δυνάμεσι τὸ τάχος τῆς κινήσεως ὁμολογεῖ, ταῖς δ’ ὕλαις ἀντιμαρτυρεῖ.

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ment of “material things” (ὗλαι), which occurs over time, and the transmission of capacities, which is immediate. Galen’s attention to the relative speeds with which capacities and materials (e.g. bodily fluids, air, etc.) are transmitted throughout the body is interesting for a host of reasons.40 However, one has special bearing on his discussion.

3

Galen on the Simultaneous Movement of the Arteries

The third point I wish to raise involves an acknowledged but underworked feature of Galen’s vascular physiology. On Galen’s view the arteries all pulsate simultaneously with one another, system-wide. This belief is among those defended in his suite of experiments on the heart and arteries.41 Due in part to this circumstance, it is associated with the femoral artery procedure although it is not necessarily a part of this demonstration. The relevance of the femoral artery experiment to Galen’s belief in the simultaneous movement of the arteries becomes clearer in light of the two references he makes to a stage of the experiment that is absent from his account in Anatomical Procedures. The first reference is made in passing; he writes that after the cannula is inserted into the artery but before a ligature is applied around it “you will see the whole artery pulsating, so long as you observe it under these circumstances (ἄχρι μὲν ἂν οὕτως ἔχουσαν ἐπισκέπτῃ, θεάσῃ σφύζουσαν ὅλην …)”.42 From a theoretical point of view, Galen’s view depends on two background beliefs: 1) the movement of the arteries is analogous to the movement of the heart and the lungs; 2) functional capacities flow instantaneously from their organic source to the physical extremities that they empower. Putting aside questions surrounding what Galen may have been seeing, it is worth remarking that this kind of belief about the simultaneity of the pulse was not uncommon in antiquity;43 it is shared, for example, by Herophilus as

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While I do not pursue it here, Galen’s claim about the immediacy with which capacities are transmitted suggests that capacities fulfill another explanatory role in Galen’s physiological theory. They account for the speed with which a wide range of bodily functions occur, which in antiquity would quite literally be immeasurable. The analogy to the movement of the toes is apt and helpful, since the seemingly instantaneous speed with which sensory-motor function occurs would have been puzzling in an ancient context and continues to be intuitive in a contemporary one. See, e.g., AA 7.14 (684–686 Garofalo = ii.635 K.). For Galen’s discussion of its place in his repertoire of cardio-arterial demonstrations, see AA 7.1 (620–622 Garofalo = ii.590 K.). Art.Sang. 8 (178.20–21 F-W = iv.733 K.). It is not difficult to observe a delay between the pulse at distant points of palpation on

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well as Aristotle.44 But, crucially, it was rejected by Erasistratus, who held the historically more unusual view that the pulse radiated from the heart and progressed through the arterial system toward the extremities as a wave, since it was caused by the movement of material through the vessels. This point brings us to Galen’s other reference, which adds important explanatory details: The things said by Erasistratus about the movement of the arteries are completely false. For in addition to the fact that the movement of the exposed artery ceases in the parts beyond the ligature, which should not occur [on his view], it is also possible to see all of the artery moving at one time before the ligature is applied to it, not one part first then another part later, as Erasistratus would have it.45 Galen includes Erasistratus’ belief among others held by Erasistrateans that he characterizes as outlandish (ἄτοπον δόξαν) and which compel his written account (τούτων τῶν δογμάτων ἠναγκάσθην) of the arterial demonstration.46 However, there is more at issue than a local theoretical point or professional polemic. Galen’s belief in the simultaneous movement of the arteries is an integral piece of evidence for a more fundamental theory in his respiratory physiology. According to Galen, the biological function of pulsation is not to move blood throughout the body but to regulate the life-giving heat that radiated from the heart. Indeed, although deeply counter-intuitive from a contemporary perspective, it is possible that the movement of the arteries and blood-flow had little to do with one another for him. Galen’s view that the pulsation of the arteries primarily regulates cardiac heat is deeply entangled with his belief that the pulse occurs simultaneously across the arterial system. If Erasistratus’ observation that the pulse moves

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the body, as for example between one of the carotid arteries and the ankle. This view is a powerful example of the effect that analogy, metaphor, and theoretical commitments all have in shaping observational results. See, e.g., Aristotle HA 3.19, 521a6–7 and Resp. 20, 479b26–480a15. I believe that Herophilus only makes the explicit claim in fr. 144 vS (= Diff.Puls. 4.6, viii.733 K.). However, Herophilus’ belief that the arteries are continuations of the heart and that the capacity for pulsation is transmitted to them from this organ offers strong additional evidence that he believed the movement of the pulse was simultaneous with the movement of the heart. Art.Sang. 8 (180.2–7 F-W = iv.734 K.): τὰ δ’ ὑπ’ Ἐρασιστράτου περὶ κινήσεως τῶν ἀρτηριῶν εἰρημένα ψευδῆ παντελῶς ἐστιν. πρὸς γὰρ τῷ παύσασθαι τῆς γεγυμνωμένης ἀρτηρίας τὴν κίνησιν ἐν τοῖς μετὰ τὸν βρόχον μέρεσιν, ὅπερ οὐκ ἐχρῆν γίγνεσθαι, καὶ πρὸ τοῦ βρόχον αὐτῇ περιβαλεῖν ἔνεστι θεάσασθαι πᾶσαν ἑνὶ χρόνῳ κινουμένην, οὐ τὸ μὲν αὐτῆς πρότερον μόριον, τὸ δ’ ὕστερον, ὅπερ Ἐρασίστρατος βούλεται. Art.Sang. 8 (178 F-W = iv.732 K.).

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through the arteries progressively, as a wave, is borne out by the femoral artery experiment, the result would call into question Galen’s belief in the active movement of the arteries on the grounds that their capacity for movement is transmitted instantaneously. Erasistratus’ reported result presents far more significant challenges for Galen. It threatens a number of his most fundamental views on arterial function and raises a host of difficulties for his broader physiological theory. An overview of these features of Galen’s vascular physiology will be helpful in order to examine the wide-ranging consequences of the femoral artery experiment to it.

4

Arterial Breathing and Pulmonary Respiration

It bears observing that for Galen the most important organs of the respiratory system are the thorax, lungs, and the heart. Second only to these in importance are the arteries.47 Pulmonary respiration consists in both dynamic and mechanical processes. First, the muscles of the thorax expand the chest, initiating a series of mechanistic events. The lungs dilate to fill the expanded chest cavity. Then the dilation of the lungs into the chest cavity draws in outside air through the trachea. Finally, their contraction expels it.48 The dynamic processes of pulmonary respiration center around pneuma.49 I will have more to say about pneuma in chapter seven; for now I will keep myself to a few points relevant to the present discussion. In those accounts—such as Galen’s—where pneuma plays an important physiological role, it does so chiefly to explain sensory-motor and cognitive functions broadly construed. As its etymological roots suggest, pneuma is strongly associated with air, typically in some form internal to the body. For Galen, inspired air undergoes an alterative process (ἀλλοίωσις) while in the lungs.50 During this process pneuma is drawn or elab-

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Galen divides arteries into two classes: the vessels that more or less map on to our arterial system and also the various respiratory channels in the nose and throat (e.g., the “rough artery” or τραχεῖα ἀρτηρία, from which our word “trachea” is derived). Here I only mean to discuss arteries in the more familiar sense. For the movement of these muscles and Galen’s appeal to the pull exerted by potential vacuum, see UP 7.4 (i.380 Helmreich = iii.523 K.) and 7.9 (i.397–399 Helmreich = iii.546– 549 K.). Singer (2020) offers a helpful and synoptic discussion of the role of pneuma in Galen’s physiology. On pulmonary elaboration of external air into pneuma and the role that the structure of the lungs plays in this process, see Rocca (2020). For the present, I leave to one side Galen’s belief that some pneuma is drawn directly into the ventricles of the brain through nasal breathing by way of perforations in the cribri-

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orated from the inspired air. When the heart expands in diastole, this pneuma is in turn drawn from the lungs into the left ventricle of the heart through the vein-like artery (our pulmonary vein).51 There the pneuma works in concert with the heart’s heat to elaborate blood present in the left ventricle in an alterative process called “coction” (πέψις). Aristotle’s view that pneuma is produced by the interaction of the body’s cardiac or vital heat with blood lies in the background here.52 Galen sometimes suggests that pneuma is the physiological end-product of blood properly altered by vital heat, as he does in On the Doctrines of Hippocrates and Plato: “Just as vital pneuma is produced in the heart and arteries, taking the material for its generation from inhalation and from the vaporization of the humors, so also psychic pneuma takes its genesis from vital pneuma that has been elaborated more”.53 The point in the quotation most relevant to this discussion involves the vaporization or pneumatization of blood—here the humors. Galen’s use of “inhalation” (εἰσπνοή) here is slightly ambiguous, and the ambiguity presents a point of interpretative difficulty for his physiological account of pneuma. This issue need not delay us, however, since it bears only very limited relevance to arterial breathing and the femoral artery experiment.54 In cardiac systole the pneumatized blood receives an initial impulse into the arterial system where it undergoes further alteration in the arteries. Some pneuma or pneumatic material passes from the left ventricle to the arteries as well, although Galen appears to be inconsistent on this point.55

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form plate. See, e.g., Ut.Resp. 5 (120–122 F-W = iv.502 K.) and Us.Puls. 2 (198 F-W = v.154 K.). See, e.g., Nat.Fac. 3.15 (SM 3, 253.3–10 = ii.209 K.); UP 6.16 (i.357–358 Helmreich = iii.490– 492 K.), 6.17 (i.362.14–20 = iii.497–498 K.), and 7.9 (i.396–399 = iii.545–549 K.). See, e.g., Aristotle GA 2.6, 741b37–742a16 and Iuv. 26, 479b30–32. See also Freudenthal (1995: 119–126, but especially 120–122). PHP 7.3 (CMG v 4,1,2 444.33–446.2 = v.608 K.): ὥσπερ δὲ τὸ ζωτικὸν πνεῦμα κατὰ τὰς ἀρτηρίας τε καὶ τὴν καρδίαν γεννᾶται τὴν ὕλην ἔχον τῆς γενέσεως ἔκ τε τῆς εἰσπνοῆς καὶ τῆς τῶν χυμῶν ἀναθυμιάσεως, οὕτω τὸ ψυχικὸν ἐκ τοῦ ζωτικοῦ κατεργασθέντος ἐπὶ πλέον ἔχει τὴν γένεσιν. While pneuma is sometimes the result of a physiological process in the cardio-arterial system, Galen is also committed to the view that during inhalation pneuma is drawn directly through the nasal passageways and into the brain through perforations in the skull called the “cribriform plate”. On this issue and the challenges it may present to Galen’s account of pneuma, see Rocca (2003: 224–237) and Singer (2020). On some occasions Galen appears to commit himself to the view that blood and pneuma, strictly speaking, cannot coexist in the same space. In contexts of this sort, Galen suggests that the substance or material of pneuma is not transmitted through the arteries, only certain thermal qualities associated with it. See, e.g., Art.Sang. 6 (166.14–168.8 F-W = iv.724 K.). This view is also supported, Galen says, by the observation that the quantity of air exhaled appears to be identical to the amount inhaled. See Ut.Resp. 5 (132.5–13 F-W = iv.511 K.). On other occasions, Galen says that pneuma passes materially from the lungs to

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Some of the sooty byproducts of its heating process are vented into the lungs, out of which they are released in exhalation. Some of these byproducts accompany the pneumatized blood into the arteries where, along with byproducts of analogous arterial processes, they are expelled from the body through the skin. Galen considered the arteries fundamentally to be extensions of the heart, growing out of it like the branches of a tree:56 The most important organs of pneuma are the lungs, heart, and thorax. Second to these are the two kinds of arteries: the first kind is distributed throughout the whole body from the left ventricle of the heart. All of these pulsate in time with the heart; there is one common trunk (πρέμνον) for all of them, the aorta (“the greatest artery”).57 This image illustrates functional and, to a lesser extent, structural continuities of the arteries with their source. We have already seen that the arteries’ capacity for active movement is derivative of the heart’s capacity to beat, in the way that the branches of a tree derive their biological capacities from the tree out of which they grow. The arteries, however, also engage in respiratory activities similar to the heart and in virtue of their close connection to it. The arterial analogue (διαπνοή) to cardio-pulmonary respiration (ἀναπνοή) can be conceptually muddled in part due to terminological issues.58 The term “διαπνοή”, often translated as “transpiration”, is well-attested in earlier Greek medical literature. However, it can pick out a broad range of respiratory views mostly involving a notion of body-breathing. Evidence for concepts of arterial breathing before Galen is slim and is non-existent before the Imperial Period. Consequently, it is important to distinguish Galen’s technical meaning with other meanings of the term, especially given Galen’s propensity to retroject his own theoretical views on earlier medical authors. This terminological ambiguity will prove to

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the left ventricle of the heart, and finally into the arterial system. See, e.g., UP 7.8 (i.393.23– 394.6 Helmreich = iii.541–542 K.). Cf. UP 6.10 (i.332.14–23 Helmreich = iii.455–456 K.) and 6.21 (i.371.1–4 Helmreich = iii.509–510 K.). See also UP 16.1 (ii.376.18–25 Helmreich = iv.264–265 K.) and 16.2 (ii.377.24–378.10 Helmreich = iv.266–267 K.). AA 7.1 (620 Garofalo = ii.589–590 K.): πνεύμων μὲν οὖν καὶ καρδία καὶ θώραξ τὰ κυριώτατα τῶν τοῦ πνεύματος ὀργάνων ἐστίν· ἐφεξῆς δὲ αὐτοῖς ἀρτηριῶν [τοὐς ἐκκοπεῖς] γένος δίττον· ἓν μὲν ἀπὸ τῆς ἀριστερᾶς κοιλίας τῆς καρδίας εἰς ὅλον τὸ σῶμα νενεμημένον, αἳ καὶ κατὰ τὸν αὐτὸν ῥυθμὸν πᾶσαι σφύζουσι τῇ καρδίᾳ· πασῶν δ’ αὐτῶν ἐστιν ἓν κοινὸν οἷόν τι πρέμνον ἡ ἀρτηρία ἡ μεγίστη. For a succinct account of arterial breathing in Galen, see Us.Puls. 5 (210–212 F-W = v.164– 166 K.). For further context and discussion, see Furley and Wilkie (1984: 3–9, 40–46).

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have special relevance to Galen’s use of the arterial experiment against Erasistratus, a point which I wish to signpost and to which I will return in chapter seven. Terminological issues aside for the present, Galen is clear on the following points. In arterial diastole, the arteries draw nearby material into themselves through pores in the arterial walls and through their terminations. In arterial systole, they expel waste through the same pores and terminal points. Those arteries near the skin draw ambient air into themselves through cutaneous pores, through which they expel the byproducts of respiration. This process, like its pulmonary counterpart, is wholly mechanical: And so, the arteries draw these [sc. ambient air, pneuma, or pneumatized blood] into themselves from all around (πανταχόθεν). The arteries that connect to the skin [draw in] the ambient air, seeing as this air is proximate and especially light. Of the other arteries, the one traveling upward from the heart to the neck, the one along the spine, and those arteries near these primarily [draw] from the heart itself. And those that are farthest away from the heart and from the skin, they must draw the lightest portion of the blood from the veins … for according to the principle that material is pulled in to fill a space as its evacuated, the lighter thing always follows first.59 The air and pneumatic material that Galen describes the arteries as drawing “from all around” (πανταχόθεν) plays two major roles in his arterial physiology. The inflow of fresh pneuma or air fans the vital heat conveyed by arterial blood through the arteries; its outflow expels byproducts that could stifle it. Arterial breathing assists in maintaining the heart’s vital heat throughout the body in the same manner as pulmonary respiration regulates vital heat in the heart itself (and to a lesser extent in the rest of the body). Indeed, on Galen’s view arterial breathing shares the same primary biological function—the regulation of internal temperature—as its more familiar pulmonary counterpart:

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Nat.Fac. 3.14 (SM 3, 250.5–13 … 25–26 = ii.205–206 K.): ταῦτ’ οὖν εἰς ἑαυτὰς ἕλκουσιν αἱ ἀρτηρίαι πανταχόθεν, αἱ μὲν εἰς τὸ δέρμα καθήκουσαι τὸν ἔξωθεν ἀέρα· πλησίον τε γὰρ αὐταῖς οὗτός ἐστι καὶ κουφότατος ἐν τοῖς μάλιστα· τῶν δ’ ἄλλων ἡ μὲν ἐπὶ τὸν τράχηλον ἐκ τῆς καρδίας ἀνιοῦσα καὶ ἡ κατὰ ῥάχιν, ἤδη δὲ καὶ ὅσαι τούτων ἐγγὺς ἐξ αὐτῆς μάλιστα τῆς καρδίας· ὅσαι δὲ καὶ τῆς καρδίας πορρωτέρω καὶ τοῦ δέρματος, ἕλκειν ταύταις ἀναγκαῖον ἐκ τῶν φλεβῶν τὸ κουφότατον τοῦ αἵματος· … ἀεὶ γὰρ ἐν τῇ πρὸς τὸ κενούμενον ἀκολουθίᾳ τὸ κουφότερον ἕπεται πρότερον.

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It is also manifest that there is nothing inconsistent with there being a single function for respiration and the pulse. Consequently, it is easy to conclude 1) that the pulse occurs for the sake of maintaining the heat in each part. So that, whatever [benefit] there is to the heart alone from respiration, there is to the heat throughout the whole animal from the pulse; and also 2) that some of the elaboration of psychic pneuma is common to both but it is mostly characteristic of the arteries …60 Here it is helpful to recall the explanatory power that the action of the bellows holds for Galen’s respiratory physiology.61 For Galen the heart is the source of innate or vital heat, which is the animating principle of the body. Pulmonary respiration regulates cardiac heat by fanning and cooling it. The heart radiates this heat to the rest of the body through the arteries, whose transpiration maintains vital heat throughout the body through the same process of fanning and cooling. In (2) above, Galen alludes to a further physiological activity performed by respiration in the lungs and pulsation in the arteries. Blood undergoes an alterative process in successive stages as it passes through the arterial system. The pulsation of the arteries continuously maintains the vital heat radiating from the heart through the arteries. As it makes its way through the body, arterial blood is infused with pneuma drawn in during arterial dilation and refined by its heat. Some of this blood makes its way to the meninges through a convoluted vascular tangle at the base of the brain known as the rete mirabile,62 where it is processed into highly pneumatic material called “psychic pneuma” that effectively fuels all brain and nerve function and comes to be fully elaborated in the ventricles of the brain.63 This process is interesting and important to Galen’s 60

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Us.Puls. 3 (206.17–7 F-W = v.160–161 K.): … καὶ φαίνεται μηδὲν ἐναντιούμενον τῷ μὴ μίαν εἶναι τῆν χρείαν τῆς ἀναπνοῆς καὶ τῶν σφυγμῶν, ἔτοιμον ἤδη συλλογίσασθαι, φυλακῆς ἕνεκα τῆς καθ’ ἕκαστον μόριον θερμασίας γεγονέναι τοὺς σφυγμούς. ὥσθ’ ὅπερ ἐκ τῆς ἀναπνοῆς τῇ καρδίᾳ μόνῃ, τοῦτ’ ἐξ ἐκείνων τῷ καθ’ ὅλον τὸ ζῷον ὑπάρχειν θερμῷ, εἶναι δὲ καὶ τὸ τῆς πέψεως τοῦ ψυχικοῦ πνεύματος κοινὸν μὲν ἀμφοῖν, ἀλλ’ ἰδιαίτατον τῶν ἀρτηριῶν … Cf. PHP 3.8 (CMG v 4,1,2 230.14– 27 = v.356 K.). Elsewhere Galen contrasts the action of the bellows and inflated bladders to illustrate a distinction between active and passive movements of certain organs. The determinative effect that the bellows metaphor seems to have on the fundamental terms in which Galen envisions physiological processes is difficult to overstate. In Greek the structure is called the δικτυοειδὲς πλέγμα or “net-like plexus”. The term is Herophilean in origin. See Us.Puls. 2 (200 F-W = v.155 K.). A small amount of pneuma also travels to the brain through the nasal passageways, where it is further refined into a substance called “psychic pneuma”, which is responsible for organism’s mental and sensory-motor functions. For the passage of pneuma to the brain

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neural physiology, but it only plays a secondary role in his respiratory physiology.64 Respiration is primarily a matter of maintaining the body’s vital heat at the temperature appropriate for life and only secondarily for the alteration of arterial blood.

5

The Movement of the Blood

Whereas it is difficult for a contemporary audience to dissociate arterial pulse from the movement of blood, it is clear that historical contingencies did not motivate such a close connection.65 This is the last piece of the theoretical picture I consider as standing in the background of Galen’s polemical use of the femoral artery experiment against Erasistratus. As we have seen, Galen mentions observing the simultaneous movement of the arteries as part of his narrative of the femoral artery experiment in Whether Blood is Naturally Contained in the Arteries.66 He also alludes to making this observation occasionally in the context of other cardio-arterial experiments. Galen offers a few reasons for his performance of one of these vivisectory experiments, among them: In order that, after exposing the aorta in the animal just as you have seen me expose the femoral artery, I may observe precisely whether the artery contracts when the heart expands, expanding when the heart contracts, or both the heart and the artery expand and contract simultaneously.67 The difference between Galen’s active model of arterial movement and the passive model that he rejects is not merely whether the arterial walls move under

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through the nasal passages and cribriform plate, see UP 8.6–7 (i.471.20–473.2 Helmreich = iii.650–652 K.) and Ut.Resp. 5 (122.5–9 F-W = iv.502 K.). Cf. Us.Puls. 3 (206 F-W = v.160–161 K.); and PHP 7.3 (CMG v 4,1,2 444.12–446.10 = v.606–609 K.). For a full discussion of the process, see Julius Rocca’s (2003) magisterial study, especially pp. 93, 123–128, and 226–234. Cf. UP 6.2 (i.301.3–10 Helmreich = iii.412 K.), where Galen discusses the importance of inspired air as a substance to be transformed in the body as secondary to its importance in the regulation of innate heat. Cf. Galen’s explanation for why venous walls do not move at UP 6.10 (i.327 Helmreich = iii.449 K.). Since the veins distribute highly concentrated blood, which contains very little pneuma, there is no need for them to pulsate. Art.Sang. 8 (180.5–7 F-W = iv.734 K.). AA 7.14 (686 Garofalo = ii.635 K.): δεύτερον δ’, ἵνα γυμνώσαντες ἀρτηρίαν μεγάλην ἐν τῷ ζῴῳ, καθάπερ ὁρᾶτέ με τὴν ἐν τῷ βουβῶνι γυμνοῦντα, κατανοήσωμεν ἀκριβῶς, εἴτε, καθ’ ὃν ἡ καρδία διαστέλλεται χρόνον, ἡ ἀρτηρία συστέλλεται, διαστελλομένη, καθ’ ὃν ἡ καρδία συστέλλεται, ἢ καὶ διαστέλλονται καὶ συστέλλονται κατὰ τοὺς αὐτοὺς χρόνους ἀμφότεραι·

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their own power or are moved by the force of their contents. On the passive model, the wave-like movement of the pulse reflects the passage of material from the heart through the arteries. On an active model, Galen could have explained the same wave-like progression of the pulse as an active contraction and dilation of the arteries that aids the movement of blood as a kind of peristaltic force. But he did not. Galen was strongly committed to the claim that the arterial pulse did not propagate as a wave. If, as he argues, arterial action consists in the synchronous movement of the heart and arteries as a cardioarterial system, their simultaneous contractions and dilations would at best poorly account for arterial blood flow. On the other hand, Galen’s view of arterial movement does effectively account for the respiratory functions of the cardio-arterial system. The arteries act like a vascular accordion or squeezebox, like the lungs and heart. Pneuma is drawn into the vessels as they actively expand, waste products are expelled as they contract. As we recall, venous blood was pneumatized already in the left ventricle of the heart. The result of this process is a mixture of pneuma and venous blood, to which Galen often refers simply as pneuma or as blood.68 Once the pneumatized or arterial blood travels away from the heart, it will cool at a distance from the source of the body’s innate heat. Arterial breathing infuses the pneumatized blood with fresh vital pneuma, whose thermal properties act as a sort of catalyst for the arterial walls to elaborate arterial blood further. Galen sometimes describes this elaboration as vaporization, a process in which vital pneuma in arterial blood is separated out as the raw material

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On arterial blood as a mixture of pneuma and venous blood, suitably elaborated, see, e.g., UP 6.21 (i.372.7–11 Helmreich = iii.511 K.) and Hipp.Elem. 11 (CMG v 1,2 142.17–144.7 = i.495–497 K.). Galen’s terminology is challenging. He refers to arterial content alternately as pneuma, blood, or blood that is pure (καθαρόν), fine (λεπτός), light (κοῦφος), or spiritous (ἀτμώδες). Galen discusses semen, which is also highly elaborated, in similarly fluid terms. For example, he refers to semen as a pneuma and as full of vital pneuma (UP 14.9, ii.315–316 = iv.183 K.). Cf. UP 6.17 (i.361.20–24 Helmreich = iii.496 K.), where it is important to note Galen’s claim that pure blood (καθαρὸν … τὸ αἷμα) is the raw material for psychic pneuma. Galen often discusses vital pneuma as the material that nourishes psychic pneuma, suggesting that the notions of vital pneuma, pure blood, and arterial blood are to some degree interchangeable for him. Indeed, Galen intimates that the various humors, fluids, and airlike contents found in the body’s organs and vasculature are distinguished primarily by the kind of material that predominates in the mixture under discussion (UP 6.16, i.358.3– 18 Helmreich = iii.491–492 K.). Galen writes that vital pneuma, phlegm, bile, and other humors are all contained in arterial blood. As part of their natural physiology, the arteries “respire” (ἀναπνέουσιν) or “pour them out” (ἀποχέουσαι) into suitable parts of the body. See UP 9.4 (ii.13.20–14.12 Helmreich = iii.701–702 K.).

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for further elaboration.69 The ultimate stage of its elaboration—into psychic pneuma—is of secondary importance to arterial function: Since I showed that the function of respiration—the chief and primary one—is the maintenance of innate heat, on account of which animals deprived of [respiratory] cooling immediately die; and since I said that the nourishment of psychic pneuma is a lesser and secondary …70 As in pulmonary respiration, the primary physiological function of the arteries and their movement is the regulation of vital heat.71 This account goes a long way in explaining the importance of a uniform pulse to Galen’s theory of arterial breathing but it is not helpful in explaining how blood passes through the arteries while it is being refined or pneumatized. A possible solution to this puzzle is suggested by another common technological metaphor to which Galen appeals when describing blood and its physiology.

6

Irrigation of the Body

Galen often describes the body as a city and the many vessels inside of it as Roman roads; but the urban metaphor is mainly anatomical. However, his preferred metaphor for vascular physiology is more horticultural: You can understand this point most clearly in the case of irrigation channels in gardens. For, while some moisture is distributed to all adjacent and nearby areas from these channels, it cannot reach areas further away. Consequently, people are required to manage the flow of water to every part of the garden with many small channels that are split off from a large

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See, e.g., Ut.Resp 5 (120–122 F-W = iv.502 K.), where Galen mentions that psychic pneuma is nourished both by pneuma that passes through the nasal cavities and by pneuma from “the exhalation of the blood” (κἀκ τῆς τοῦ αἵματος ἀναθυμιάσεως). Cf. PHP 7.3 (CMG v 4,1,2 444.29–446.3 = v.608 K.), where vital pneuma is produced by an analogous process. UP 7.9 (i.396.5–10 Helmreich = iii.544–545 K.): ἐπειδὴ γὰρ ἡ χρεία τῆς ἀναπνοῆς, ἡ πρώτη μὲν καὶ μεγίστη, φυλακὴ τῆς ἐμφύτου θερμασίας ὑπάρχειν ἐδείκνυτο, δι’ ἣν καὶ παραχρῆμα διαφθείρεσθαι τὰ ζῷα στερούμενα τῆς ἀναψύξεως, ἡ δ’ ἐλάττων τε καὶ δευτέρα θρέψις εἶναι τοῦ ψυχικοῦ πνεύματος ἐλέγετο … See also Caus.Resp. 1–2 (240–242 F-W = iv.465–467 K.) and Us.Puls. 2 (198 F-W = v.153–154 K.). Cf. Ut.Resp. 3 (108 F-W = iv.492 K.). While it is clear that the arteries are responsible for transmitting the vital heat of the heart to the organs and extremities of the body, it is less clear whether this heat is maintained only in the pneumatized blood they bear or also in their coats.

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one. They make the spaces between the channels as large as they estimate to be adequate for the spaces to benefit sufficiently when drawing in the moisture that is flowing all around them. This is how it is also in the bodies of animals: Many channels spread along all of their parts divert blood to them just like irrigation in gardens. And the spaces between these channels have been laid out marvelously by nature from the beginning [of life] for the intervening parts that draw blood to themselves neither to be supplied inadequately nor to ever be flooded by some amount of fluid waste flowing in at the wrong time.72 While urban metaphors can evoke the body’s organization, its complexity, and the importance of the brain, heart, and liver as hubs of activity, agriculture offers a better model for the movement and absorption of fluids in the body. Perhaps the first thing that one notes is that the distribution of water through irrigation channels is a mechanical process, while its absorption into soil beds is dynamic, at least in the metaphor. For Galen the mechanical principle underlying irrigation is the same as the one at work in respiration or suction: namely, that the evacuation of material draws in material to replace what is lost.73 Indeed, he introduces the irrigation metaphor quoted above to distinguish between the considerable distance at which the mechanical attraction of evacuation can exert pull and the limited distance at which dynamic attraction can do so.74 On the model of irrigation, venous and arterial blood move through the vessels of the body in virtue of mechanical forces, assisted by the body’s vascular architecture. Arterial blood is channeled from the larger aorta that ramifies into successively smaller arterial channels. Venous blood is channeled from the large hepatic vein in the same manner. The absorption of nutrients in the 72

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Nat.Fac. 3.15 (SM 3, 254.1–19 = ii.210–211 K.): σαφέστατα δ’ ἂν αὐτὸ μάθοις ἐπὶ τῶν ἐν τοῖς κήποις ὀχετῶν· ἐκ τούτων γὰρ εἰς μὲν τὰ παρακείμενα καὶ πλησίον ἅπαντα διαδίδοταί τις ἰκμάς, εἰς δὲ τὰ πορρωτέρω προσελθεῖν οὐκέτι δύναται καὶ διὰ τοῦτ’ ἀναγκάζονται πολλοῖς ὀχετοῖς μικροῖς ἀπὸ τοῦ μεγάλου τετμημένοις εἰς ἕκαστον μέρος τοῦ κήπου τὴν ἐπίρρυσιν τοῦ ὕδατος ἐπιτεχνᾶσθαι· καὶ τηλικαῦτά γε τὰ μεταξὺ διαστήματα τούτων τῶν μικρῶν ὀχετῶν ποιοῦσιν, ἡλίκα μάλιστα νομίζουσιν ἀρκεῖν εἰς τὸ ἱκανῶς ἀπολαύειν ἕλκοντα τῆς ἑκατέρωθεν αὐτοῖς ἐπιρρεούσης ὑγρότητος. οὕτως οὖν ἔχει κἀν τοῖς τῶν ζῴων σώμασιν. ὀχετοὶ πολλοὶ κατὰ πάντα τὰ μέλη διεσπαρμένοι παράγουσιν αὐτοῖς αἷμα καθάπερ ἐν κήποις ὑδρείαν τινά. καὶ τούτων τῶν ὀχετῶν τὰ μεταξὺ διαστήματα θαυμαστῶς ὑπὸ τῆς φύσεως εὐθὺς ἐξ ἀρχῆς διατέτακται πρὸς τὸ μήτ’ ἐνδεῶς χορηγεῖσθαι τοῖς μεταξὺ μορίοις ἕλκουσιν εἰς ἑαυτὰ τὸ αἷμα μήτε κατακλύζεσθαί ποτ’ αὐτὰ πλήθει περιττῆς ὑγρότητος ἀκαίρως ἐπιρρεούσης. It is unclear if Galen is speaking loosely here or if he in fact analyzes the flow of water through irrigation channels in terms of the drawing power of evacuation. Nat.Fac. 3.15 (SM 3, 253.16–254.1 = ii.210 K.) but see, particularly, 3.15 (SM 3, 253.17–19 = ii.210 K.).

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blood by the relevant organs is a dynamic process. It thus takes place gradually, and only in close proximity to the material being assimilated. For this reason, blood must be channeled through the body at a speed and over distances that allow for a cluster of related processes to occur—its elaboration, absorption of its nutrients, and the separation of waste products from it. A similar account obtains for the processes that pneuma undergoes in the arteries: For, indeed, [pneuma] cannot travel through them [the arteries of the retiform plexus] quickly, but it is slowed down, caught up in all kinds of ways along their longitudinal and latitudinal turns and bends, which are various and varied. With the result that it is elaborated while it remains in the these [arteries] for a very long time; and, once fully elaborated, it is driven out immediately into the ventricles of the brain. For it is necessary both that it not remain [in the arteries of the retiform plexus] any longer and that it not escape when it is incompletely elaborated.75

7

The Motile Properties of Blood and Pneuma

The relative speed of blood and vital pneuma is partly determined by intrinsic properties of each. In a passage from The Function of the Parts, Galen contrasts the physical properties of pneuma and blood to explain the structure of the vessels that contain them: I suppose there is no need to explain at length that it is better that blood is held in a thin and loose vessel throughout the body of an animal, while pneuma is contained in a thick and compact one. It is sufficient to recall the nature of each substance: blood is thick (παχύ), heavy (βαρύ), and slow to move (δυσκίνητον), while pneuma is fine (λεπτόν), light (κοῦφον), and motile (εὐκίνητον).76

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UP 9.4 (ii.14.20–15.1 Helmreich = iii.702 K.): οὐ γὰρ δὴ καὶ ταύτας γε δύναται ταχέως διεξελθείν, ἀλλ’ ἴσχεται κατά τε τὰς ἄνωθεν κάτω καὶ τὰς εἰς τὸ πλάγιον ἐπιστροφάς τε καὶ καμπὰς πολλάς τε καὶ πολυειδεῖς οὔσας παντοίως ἀλώμενον. ὥστ’ ἐν ταύταις μὲν χρόνῳ παμπόλλῳ μένον κατεργάζεται, τὸ κατεργασθὲν δ’ εὐθέως ἐμπίπτει ταῖς κοιλίαις τοῦ ἐγκεφάλου. οὔτε γὰρ τοῦτ’ ἔτι μέλλειν ἐχρῆν οὔτε τὸ ἀκατέργαστερον ἤδη φθάνειν. UP 6.10 (i.326.4–10 Helmreich = iii.446–447 K.): ὅτι μὲν δὴ καθ’ ὅλον τοῦ ζῴου τὸ σῶμα τὸ μὲν αἷμα λεπτῷ καὶ μανῷ περιέχεσθαι χιτῶνι, τὸ δὲ πνεῦμα παχεῖ καὶ πυκνῷ στέγεσθαι βέλτιον ἦν, οὐ μακρῶν οἶμαι δεήσεσθαι λόγων. ἀρκεῖ γὰρ ὑπομνῆσαι τῆς οὐσίας ἑκατέρου τὴν ἰδέαν, ὡς τὸ μὲν αἷμα παχὺ καὶ βαρὺ καὶ δυσκίνητον, τὸ δὲ πνεῦμα λεπτὸν καὶ κοῦφον καὶ εὐκίνητον.

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The walls of veins are relatively thin and elastic, since they must compensate for the viscosity and slow-movement of the blood in them, which contains very little pneuma. The arterial walls are thicker and more rigid in order to make up for the thinness and motility of arterial blood, which is highly pneumatic. Galen does not suggest that the movement of concentrated blood in the veins and pneumatized blood in the arteries is determined by the action of the vessels in which they are contained, or even significantly by the action of the heart and liver which are the source of those vessels. In both cases, Galen explains the movement of blood through the vasculature in terms of mechanical forces exerted during the active movement of vascular walls, the capacity of organs to draw materials indexed to them at a short distance, and intrinsic properties of the blood under discussion. In the example above, venous blood is thick (παχύ), heavy (βαρύ), and slow-moving or sluggish (δυσκίνητον), since it contains very little pneuma. In contrast and in virtue of the concentration of vital pneuma in its mixture, arterial blood is fine (λεπτόν), light (κοῦφον), and motile (εὐκίνητον). The motility of arterial blood is important in explaining its movement, since Galen estimates that the force exerted by the heart on its contraction is, all things considered, relatively weak. Consequently, cardiac systole does not play a significant role in the movement of blood out of the left ventricle and into the arterial system: “For these other things aside, we blow into a reed more forcefully through our mouths than the heart does into the arteries”.77 Furthermore, as we recall, when Galen discusses the ends of the active movements of the heart and the arteries he does not mention the distribution of blood among them. The reasons he gives for cardio-arterial dilation are 1) to maintain the body’s cardiac heat by drawing in external air and 2) to assist in the generation of psychic pneuma, while contraction of the heart and arteries functions to squeeze out the waste products generated in the pneumatization of arterial blood.78 Indeed, a necessary consequence of Galen’s system of capacities is that blood—arterial as well as venous—must spend a relatively prolonged amount of time in the vessels through which it travels.79 Since Galen is committed to the view that the body’s alteration and absorption of nutrients requires prolonged contact between an organ and the material it acts upon, venous blood and, to a lesser extent, arterial blood must have time in which to be consumed by organs that make use of them. Galen’s use of complex vascular networks, such as the rete mirabile and the epididymis, to explain the final elaborations 77 78 79

Art.Sang. 3 (152.5–154.1 F-W = iv.711 K.): τά τε γὰρ ἄλλα καὶ πολὺ σφοδρότερον διὰ τοῦ στόματος ἐμφυσῶμεν ἡμεῖς τοῖς καλάμοις ἢ ταῖς ἀρτηρίαις ἡ καρδία. See, e.g., PHP 8.8 (CMG v 4,1,2 528.30–34 = v.709 K.). See, e.g., PHP 6.6 (CMG v 4,1,2 398.7–10 = v.550–551 K.).

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of arterial blood into psychic pneuma and semen are further evidence that his physiological system required even pneumatized blood to remain in the arteries long enough for some of it to be absorbed by the body and for the rest to undergo gradual transformation.80

8

The Femoral Artery Experiment in Its Galenic Context

The consequences of the femoral artery experiment for Galen’s broader physiological theory are far-ranging. On Galen’s interpretation of its outcome, the most immediate consequence of the procedure was proof that the arteries pulsate actively. In turn, the active movement of the arteries supported Galen’s belief that organs each possess a cluster of capacities in virtue of which they perform activities that sustained them and contributed to the maintenance of the systems to which they belong. On Galen’s view these capacities are also characterized by the speed with which they are transmitted, flowing instantaneously from their source through the tissues that they empower. This belief is intended to explain, in part, the apparent simultaneity between thought and voluntary action. Paired with Galen’s conception of arterial physiology as fundamentally respiratory, the instant transmission of capacities strongly suggests that arterial movement is uniform throughout the arterial system. The exposure of an artery in this procedure (and others like it) afforded Galen the opportunity to observe arterial movement, which he describes as uniform rather than progressive. The threat of progressive arterial motion to Galen’s physiological theory is difficult to overstate. It would call into question the immediate transmission of capacities and perhaps even provide indirect evidence that the arteries do not move in virtue of capacities at all; but these conclusions are perhaps of secondary importance, since the results of the basic form of Galen’s experiment are intended to demonstrate the dynamic movement of the arteries. The progressive movement of the pulse presents a more acute threat to Galen’s theory of arterial breathing. It is far more conducive to a model of arterial physiology

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This point need not commit Galen to the view that arterial blood moves relatively slowly through the arteries. While it is not wholly implausible that he held such a view, Galen only commits himself to the weaker claim that blood—and vital pneuma—must spend a significant amount of time in the arteries in order to be prepared for its final elaboration into psychic pneuma in the brain and semen in the testicles. This is an important reason why Galen places such emphasis on the many and intricate convolutions of these respective vascular clusters—the retiform plexus and testicular plexus.

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in which the pulse is intimately linked to material moving through the main channel of the artery, whether it be arterial blood or pneuma, than a respiratory process. This final point bears emphasis, since it potentially explains the strong connection Galen makes with the procedure and the question of what is contained in the arteries. While this set of conclusions may help to explain its relevance to Galen’s physiological theory, it brings us back to one of the puzzles surrounding the longer history of the procedure. Galen’s accounts of the experiment in Whether Blood is Naturally Contained in the Arteries and Anatomical Procedures may give the impression that Erasistratus conceived of the experiment in the way he did. They underscore the close association Galen makes between Erasistratus’ views on the arterial content and function. In both treatises, as we have seen, Galen introduces the arterial demonstration to argue explicitly for the claim that arterial movement is active, on the model of an expanding bellows. However, the relevance of the demonstration to arterial content is implicit, arising mainly from surrounding context. In Anatomical Procedures, for example, the femoral artery demonstration concludes Galen’s account of the main respiratory organs. It is the crowning episode in a series of short and vivid anecdotes in which he publicly confounds and refutes second-century Erasistrateans for their view that the arteries contain only pneuma under healthy conditions.81 In Whether Blood is Naturally Contained in the Arteries, Galen also closes his discussion of the contents of the arteries and, indeed, the entire treatise with the experiment.82 Galen compares Erasistratean arguments about pneuma in the arteries to Eleatic rejections of change and motion, on the grounds that they reject what is observationally manifest (i.e., that one can simply see blood in the arteries) since these phenomena are underdetermined by available theoretical models. Some of the difficulties that he cites include explaining why two distinct vascular systems would appear to contain the same material, how the pneuma drawn from inspired air is distributed to the body through arteries that are clearly filled with blood, how voluntary motion occurs if pneuma is not so distributed to the body, and how pneuma and blood might mingle. What did Erasistratus see the experiment as doing? Did he also envision the arterial experiment as bearing on the question of arterial content? 81 82

AA 7.16 (694–696 Garofalo = ii.641–642 K.). His segue to the demonstration begins at Art.Sang. 6 (164–166 F-W = iv.721–722 K.).

chapter 7

Drawing Blood: Galen’s Use of the Arterial Experiment against Erasistratus As I mentioned at the outset of chapter six, the femoral artery demonstration predates Galen by roughly four centuries, when Erasistratus likely conceived of it. The life of the experiment after Galen and its association with him have been far more enduring. In the early modern period, Vesalius, Fallopius, and Harvey all describe the femoral artery experiment—and only as Galenic.1 Harvey denied that Galen and Vesalius could have conducted the procedure on the grounds that its technical challenges were too great. He demurred from any attempt at its (re)production.2 As late as the mid-twentieth century M.P. Amacher was writing about the history of the femoral artery demonstration in a short paper, entitled “Galen’s Experiment on the Arterial Pulse and the Experiment Repeated”. As the title suggests, Amacher treats Galen as its source.3 At roughly the same time, Rudolph Siegel followed suit in his discussion of the history of Greek pulse theories.4 Although pervasive, the historical identification between Galen and the femoral artery demonstration is not quite universal. C.R. Harris is, in one sense, an exception. In his history of Greek vascular theories, which post-dates the work of Amacher and Siegel by only a few years, he claimed that Galen devised the experiment. Yet, he also suggests that Galen was not the first to conduct it, and that it had already been performed by Erasistratus.5 1 See, e.g., Vesalius Fabrica (1543: 659–660); Fallopius De partibus similaribus (1575: ch. 13 = 1606: 15.168); Harvey De Motu, Prooemium (1628: 12–13); Harvey Ad Riolanum 2 (1649: 47–51). The text of Fallopius’ De partibus similaribus was published posthumously by one of his students, Volcher Coiter, in 1575. The edition has only chapter numbers; the relevant section is in chapter thirteen: De arteriis. The treatise is printed in expanded form in volume one of Fallopius’ 1606 Opera Omnia published in Venice, where the experiment is more fully described in chapter fifteen. 2 Harvey Ad Riolanum 2(1649: 47). 3 Amacher (1964). 4 See Siegel (1968: 92–95). 5 As far as I can understand, Harris holds inconsistent views about the origins of the experiment in Harris (1973: 378–388). He credits Galen with its invention: “He [sc. Galen] even devised a rather ingenious experiment, which again might, to our hindsight, have been expected to yield the answer, but as we shall see presently, either his observation was faulty, or his technique inadequate (378)”. Shortly afterwards, though, Harris suggests that the experiment was

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As we have seen, Galen himself is explicit on this score; he alludes to the earlier provenance of the demonstration in Anatomical Procedures.6 He closes his narrative of the procedure by saying that: “But Erasistratus made the opposite claim about it, saying that the section distal to the reed (κάλαμος) clearly continued to move”.7 The reference is slight but significant and unambiguous.8 While Galen claims only that Erasistratus performed the experiment, there are theoretical and chronological reasons to believe that Erasistratus was also the first to do so. If so, Galen’s refutation of Erasistratean arterial physiology— on the basis of the femoral artery experiment—becomes all the more cutting, since it shows that Galen’s understanding of the experiment and his observations of its results are more expert even than its inventor’s. Galen’s appropriation and reinterpretation of the femoral artery experiment in the framework of his own physiological theory introduces an important break into the history of the procedure, a term which I use deliberately to pick out more theoretically inert features of the experiment. I mean, for example, the basic steps an operator would take to perform the procedure, such as the dissection of an artery, insertion of a cannula, and ligation of the vessel. While these features are of course theoretically motivated, they are fairly untethered to a specific theory of arterial function or to the specific point the procedure is intended to test. Erasistratus’ aims in conducting the procedure and the theoretical framework in which he interpreted its results were so divorced from those of Galen—over four centuries later—that one might reasonably say we are discussing two different experiments.9 In part because of the historical

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an historical part of the Alexandrian medical curriculum: “It rather looks as if this experiment was a set exercise of the anatomy school in Alexandria, for Galen tells us that Erasistratus himself had performed it (380)”. AA 7.16 (700–704 Garofalo = ii.645–648 K.). Galen narrates a shorter version of the demonstration at Art.Sang. 8 (178–180 F-W = iv.733–734 K.). AA 7.16 (704 Garofalo = ii.648 K.): διηγεῖτό γε μὴν ἐναντίως ὁ Ἐρασίστρατος ὑπὲρ αὐτοῦ, φαίνεσθαι λέγων κινούμενον τὸ κάτω τοῦ καλάμου. Wilkie notes the reference to Erasistratus and acknowledges the earlier history of the experiment in a chapter on the history of experimentation in the Greek medical tradition before Galen. His interest in the reference is restricted, however, to the evidence it can provide for the view that “well-conceived experiments” were conducted as early as the mid-third century bce. See Furley and Wilkie (1984: 52). On Wilkie’s observation regarding experimentation in the third century bce, see von Staden (1975). This view is also one of those mentioned in Harris (1973: 380). Boylan (2015: 87–88) discusses the experiment and Erasistratus’ performance of it as an outgrowth of certain Greek empirical traditions. Von Staden (1975: 182–183) includes the procedure on the femoral artery in his analysis of experimentation in the Hellenistic period. He does not make the same distinction as I do here—between the procedure, as a set of operations, and the experiment, as that set of oper-

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tendency to read the femoral artery experiment in Galenic terms, scholars have taken it for granted that the procedure under discussion represents a consistent and unified experiment throughout its history. There are a number of reasons to suppose that it was not. The existence of such an experiment in the third century is strong evidence that the point it was designed to test was sufficiently contested by intellectuals in the early Hellenistic period so as to have warranted an empirical and formal proof. Determining the points at issue in such a debate and identifying some of its participants stand to illuminate the place that the experiment may have occupied in Erasistratus’ physiological system. And, while inquiry into Erasistratus’ physiological theory is worthwhile in its own right, understanding the procedure in its Erasistratean context also stands to illuminate some of its features that are difficult to explain from the point of view of Galen’s physiological theory. While in the context of this book my primary aim is to approach a more nuanced understanding of the polemical strategies that Galen adopts against Erasistratus and his system of physiology, it is necessary to develop a fuller picture of the theoretical framework that Galen has targeted—and erased—with his later iteration of the experiment. I turn first to the question of the demonstration’s origins.

1

Praxagoras and Some Rough Beginnings

The dates associated with the life of Praxagoras of Cos allow us to establish a terminus post quem for the experiment and the debate it addresses with some confidence. Whatever the aims of the demonstration, it is certain that they included questions about the arteries and the pulse. The work of Praxagoras, or perhaps that of his father, represents our earliest evidence for a range of theoretical innovations that were necessary preconditions for the framing of questions about arterial pulse. Therefore, the experiment could not have emerged before the very end of the fourth or the beginning of the third century bce.10 Among Greek theorists, Praxagoras is credited as the first to make a

10

ations taken in its theoretical context along with its argumentative aim(s). However, von Staden (183) hints at a similar distinction when he observes that Galen and Erasistratus may have performed the same test, although with different experimental aims. For Praxagoras’ dates, see Lewis (2017: 1–3). In ancient chronologies of physicians, Praxagoras is typically listed between Diocles of Carystus (a near contemporary of Aristotle’s) and Herophilus. Indeed, Galen refers to Herophilus as Praxagoras’ student (fr. 8.1–7 Lewis,

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formal anatomical distinction between arteries (ἀρτηρίαι) and veins (φλέβες). He appropriated the term ἀρτηρίαι for those vessels that branched from the left side of the heart and restricted the term φλέβες to those vessels branching from the right. Praxagoras also formulated a theory of arterial physiology, and he appears to have been the first to ascribe medical relevance to the pulse. Since Praxagoras set the terms for discussion of arterial content and function at about the beginning of the third century and Erasistratus was active some time in the middle of that century, the femoral artery experiment appears to have entered into the historical record within one or perhaps two generations of the views to which it responds. Here it will be helpful to lay out what we can about the theoretical landscape from which the procedure on the femoral artery emerged, then to ask what sorts of questions it may have addressed in its original context. Galen’s version of the femoral artery experiment, as we will see, aims to defend four theoretical points that are fundamental to his system of physiology: 1) the arterial walls actively expand and contract, 2) the arterial system contains either a mixture of blood and pneuma or pneumatized blood, 3) the arteries move in order to breathe in external air and breathe out waste products, and 4) the pulsation of the arteries is simultaneous with the beating of the heart. What relation do the aims of Galen’s femoral artery experiment in the second century bear to the aims of its Hellenistic counterpart? The main question that the femoral artery experiment is intended to address is about the nature and cause(s) of the pulse, both in its second-century Galenic iteration and in its Hellenistic context. In The Different Types of Pulse, Galen makes an important allusion to a historical debate that he traces back to Praxagoras over the cause of arterial function: From antiquity, there arose among physicians another and still greater difference of opinion regarding the arteries. Some, among whom was also Praxagoras, considered that the arteries pulsate under their own agency, possessing a type of inherent capacity like the heart’s. Others [believed] that they [sc. the arteries] pulsate when the tunic itself dilates and contracts, just like the heart, but that they do not have an inherent capacity through which they do this; rather, they acquire [this capacity] from the

Trem.Palp. 1, vii.584–585 K.). While his works, at least in part, were still available in the second century ce, none of them survive intact. Lewis (2017) collects his surviving fragments and testimonia as well as offering an overview of his theoretical views on the pulse, arteries, and pneuma.

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heart, an opinion which Herophilus also possessed. But Erasistratus held neither view.11 The allusion offers some hints at the nature of the dispute and the views its participants may have held. Praxagoras, according to Galen, explained arterial pulsation in terms of a faculty for pulsation in the arteries themselves. The Praxagorean position is a species of the more general view according to which the arteries play an active role in pulsation in virtue of a capacity (δύναμις) that they possess for pulsation. This is of course a version of Galen’s view.12 On Praxagoras’ more specific construal, the arteries’ capacity to pulsate is independent of the heart and the rest of the body. It was known that the heart continued to beat for a short while even after it was separated from the body, prompting Praxagoras to argue that the arteries should also exhibit this behavior by analogy to the heart. Praxagoras’ concept of arterial function was possible only in light of a further innovation, this time of a terminological and taxonomical nature. Before Praxagoras’ differentiation of the venous and the arterial systems the main word for blood vessels in Greek writing had been “phlebes” (φλέβες), whence our own word “phlebotomy”. The term “artēria” (ἀρτηρία) had been used in reference to various vessels by earlier authors, including blood vessels. It did not, however, pick out a specific system of them.13 Praxagoras is credited with sys11

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Fr. 9.9–14 Lewis (Diff.Puls. 4, viii.702–703 K.): ἔτι δὲ μείζων ἄλλη διαφορὰ τοῖς ἰατροῖς ἐκ παλαιοῦ περὶ τῶν ἀρτηριῶν ἐγένετο, τινῶν μὲν ἡγουμένων αὐτὰς ἐξ ἑαυτῶν σφύζειν, σύμφυτον ἐχούσας ὁμοίως τῇ καρδίᾳ τὴν τοιαύτην δύναμιν, ὧν ἐστι καὶ ὁ Πραξαγόρας, ἐνίων δὲ σφύζειν μὲν αὐτοῦ τοῦ χιτῶνος αὐτῶν διαστελλομένου τε καὶ συστελλομένου, καθάπερ ἡ καρδία, τὴν δύναμιν δὲ οὐκ ἐχουσῶν σύμφυτον ᾗ τοῦτο δρῶσιν, ἀλλὰ παρὰ καρδίας λαμβανουσῶν. ἧς γνώμης ἔχεται καὶ Ἡρόφιλος. Ἐρασιστράτῳ δὲ οὐδέτερον ἀρέσκει. As a cautionary note: Galen’s talk of a pulsative capacity should not be taken as obviously offering a Molière definition. He deploys the language of dunamis when he requires a placeholder for a phenomenon whose cause is unknown or unclear to him. See, e.g., Nat.Fac. 1.4 (SM 3, 107 = ii.9–10 K.) and Hankinson (1998: 396). Hankinson observes that these explanatory placeholders do not, in principle, serve a robust explanatory role so much as a point from which further inquiry may proceed. The relevant distinction here is between explanations of arterial function that appeal to intrinsic features of the arteries, even if by way of the heart, and those that appeal to mechanical laws independent of the body. So, for example, Carn. 5 (8.590.11 Littré = 191.20 Joly); Epid. 2.4.1 (5.124.3–4 Littré = 64.22 Smith); and Rufus Onom. 208–210 (163.3–12 Daremberg/Ruelle). Before Aristotle, the term typically refers to the windpipe. See, e.g., Sophocles Trach. 1054; Plato Tim. 70d2, 78c4–5; Aristotle HA 1.12, 493a8; and [Aristotle] Spir. 481a22, 481b13. By Erasistratus’ time and in technical contexts, “artēriai” referred exclusively to blood vessels, typically those sprouting from the left side of the heart. The term’s association with the windpipe was retained in

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tematically applying these terms to the two vascular systems he had identified. This classificatory innovation calls for some interpretative caution on our part. While Praxagoras’ vascular distinction appears familiar from a contemporary perspective, on his model the arterial and venous systems were functionally distinct. They bore different bodily substances; and, they were independent of one another. It is important to note that these vascular systems were, for all relevant purposes, thought to be independent of one another throughout the Greek and later Roman medical traditions. There is no hint of a theory of cardiovascular circulation in the historical record. This notion of vascular independence persisted to varying degrees until the seventeenth century, when William Harvey argued that the two systems were part of a unitary and closed circulatory system. Praxagoras’ observation that arterial vessels were perceptibly more sinuous than the vessels of the venous system probably contributed to this distinction.14 He is also said to have supported his argument for the arteries’ independence of the heart by devising a simple experiment, in which he excised a section of an artery and examined whether it continued to pulsate after its excision. Galen dismisses the results of this demonstration as laughable, since Praxagoras claimed that the artery continued to pulsate even after it was separated from the body. However, it is important to note that Galen accuses Praxagoras of faulty observation not of a failure to observe.15 Praxagoras’ appeal to empirical evidence in his argument for the independent pulsative capacity of the arteries—taken along with his observation of the tactile qualities of arterial tunics—shows that the discourse over the nature of arterial structure and physiology, to which the femoral artery demonstration belonged, was set in

14 15

the anatomical Greek phrase, “tracheia arteria” (ἡ τραχεῖα ἀρτηρία) or “rough artery” from which we derive our own “trachea”. The later usage is common. See, e.g., Rufus Onom. 24– 26 (136.7–10 Daremberg/Ruelle); Anon.Lond. 23.8–18 (30–31 Ricciardetto); and Caus.Resp. 2 (240.9–15 F-W = iv.466 K.). See fr. 3.17–24 Lewis (PHP 1.6, CMG v,4,1,1 82 = v.188–189 K.). See fr. 10 Lewis (PHP 6.7 CMG v,4,1,1 404.38–406.21 = v.560–562 K.). Galen’s dismissal bears more directly on a separate question: what is the difference between pulsation (σφυγμός) and palpitation (παλμός)? Galen argues that Praxagoras could not have observed an excised artery pulsating. He suggests that what Praxagoras took to be the pulsating artery was some residual movement or palpitation of the flesh excised with the arterial section. Galen’s broader criticism of Praxagoras was that he considered pulse, palpitation, and tremor to be degrees of the same phenomenon. See, e.g., fr. 6.19–40 Lewis (Diff.Puls. 4, viii.723–725 K.), fr. 7 Lewis (Ps.-Rufus of Ephesus, Syn.Puls. 2: 220.5–14). Here Galen also attributes this view to Phylotimus of Cos, who was said to be a student of Praxagoras. When he is mentioned it is often in the same breath as Praxagoras. His work is also fragmentary; its remains are collected in Steckerl (1958).

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experimental or at least empirical terms from its inception. That is to say, experimentation and demonstration, broadly construed, was a feature of this ancient intellectual tradition. It was therefore a rich vein for the pepaideumenoi of the second century, for whom intellectual authority was often bound up in antiquarianism, to mine as currency for their own demonstrations of their command of ancient knowledge and method.

2

Pneuma

Praxagoras further believed that venous system contained blood but that the arterial exclusively contained a substance called “pneuma” (πνεῦμα), at least under non-pathological conditions.16 In the previous chapter I discussed pneuma in the context of Galen’s physiology, focusing on its role in maintaining the body’s vital heat and in the elaboration of venous blood into arterial blood and finally into psychic pneuma.17 The belief that pulsation was an active movement of the arterial walls rather than a passive one formed the first pole of the debate over arterial function, a point of issue both for theorists of Erasistratus’ time and Galen’s. The belief that the arterial system was pneumatic establishes the second pole in the later debate Galen reports over arterial function, in which questions about the contents of the arteries were central to the dispute over their physiology. To what extent was this question a point at issue in the arterial experiment’s Hellenistic context? The word πνεῦμα can refer to a broad range of pneumatic phenomena, including winds, breezes, smells, and breath.18 It is this last valence of πνεῦμα that concerns us here. Although breath and breathing figure prominently in a number of Hippocratic texts, pneuma as such plays no explicit theoretical role in their accounts of life and disease.19 Certain treatises explain diseases in terms of air-related causes. The nature of these maladies can suggest that breath—sometimes although not invariably referred to as πνεῦμα—plays a cru-

16

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See fr. 12 Lewis (Dig.Puls. 4.3, viii.950 K.), fr. 14 Lewis (Dig.Puls. 4.2, viii.941–942 K.), and fr. 13 Lewis (Plen. 11, vii.573–574 K.). Praxagoras believed that the venous system contained blood. It is less clear whether he considered blood to be the only contents of the veins. See Lewis (2017: 230 n. 52). On the role of pneuma in Galen’s physiology, see the useful overview in Singer (2020). For a discussion of its conceptual and semantic range, see Lloyd (2007). Verbeke (1945) remains useful. For a more recent examination focusing on post-Aristotelian pneumatic theories, see Coughlin, Leith, and Lewis (2020). On pneuma and breathing in the Hippocratic corpus, see Thivel (2005). Cf. Lloyd (2007).

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cial part in sensory-motor physiology. The aetiological account of epilepsy in the Sacred Disease, for example, involves the obstruction of vessels leading out from the brain. These distribute pneuma throughout the body. When the passage of pneuma through the vessels is impeded, the parts of the body near the constricted vessels grow numb.20 Elsewhere in the treatise, the author also says that pneuma travels to the brain during respiration, where it is somehow responsible for consciousness. It then passes from the brain to the rest of the body, where its presence is at least a necessary condition of sensation.21 This account exhibits certain affinities with later concepts of pneuma and its explanatory role in animal physiology, such as Galen’s. It offers no evidence, however, for the wider theoretical framework in which these concepts may have been articulated. A second Hippocratic example provides an illustrative contrast. According to the author of Breaths, πνεῦμα is a general classification of air, to which belongs the narrower class of breaths (φῦσαι). These breaths were airs internal to the body.22 The difference in the semantic range of πνεῦμα in the two texts is marked. The differences in their implicit physiological conceptions, however, are more significant. The causes of disease in Breaths can be reduced to disturbances of internal airs. Unlike the account we see in the Sacred Disease, sensory-motor function in Breaths depends on blood not breath. Diseases like epilepsy are the manifestation of disturbances in the blood caused by the morbid action of certain physai (φῦσαι), which are characterized in the text as nutritious substances analogous to solids and liquids. Aristotle also does not present us with anything like a systematic theory for pneuma in his physiology. Indeed, for him pneuma was not just distinct from external air; it was largely if not wholly disconnected from respiration. In Generation of Animals, Aristotle appeals to the vital heat of pneuma present in water to explain spontaneous generation in the sublunary world.23 Likewise, it is the heat of pneuma in semen that is responsible for its generative power.24 This pneuma is the sublunary analogue to aither, the so-called fifth element, which is only found in the heavens and is responsible for the activity of celestial bodies.25 As in the work of later authors, Aristotle’s pneuma— called connate (πνεῦμα σύμφυτον)—is implicated in sensory-motor function, perhaps communicating sensations to the organs and initiating movement in

20 21 22 23 24 25

Morb.Sac. 4 (12.10–20 Jouanna = 6.368 Littré). Morb.Sac. 16 (29.4–30.2 Jouanna = 6.390–392 Littré). Flat. 3 (105.14–106.2 = 6.94 Littré). Aristotle GA 3.11, 762a18–28. Aristotle GA 2.3, 736b33–37. Aristotle GA 2.3, 736b37–737a1.

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some capacity.26 Mario Vegetti characterizes Aristotelian pneuma as “a semimaterial organic substance, innate air that was thus different from the external air, heated with a similarly innate heat that was not the same as fire, a mysterious cardiac ‘vapor.’”27 Although Aristotle refers to pneuma ubiquitously in discussions about the origins of life, he only makes occasional reference to it as explanatory of life.28 Pneuma is notably absent in On the Soul, a treatise that aims to examine formally the full range of life functions.29 By some time in the fourth century bce, however, a more technical sense arose among Greek philosophers and physicians, with clear affinities to Aristotelian usage.30 In this sense, pneuma was a material substance internal to the body, although not necessarily disconnected from external air. It was typically explanatory of certain physiological functions, especially those involved in perception and voluntary motion. Praxagoras’ account of arterial morphology and physiology marks the earliest point at which pneuma is proposed as the characteristic content of the arteries, intimately linking pneuma with the arterial system from its anatomical beginnings. Given the challenges that pneumatic accounts of vasculature can pose to contemporary anatomical and physiological perspectives and the tremendous weight of Galen’s later influence, these historical considerations are helpful to keep in mind. For many Greek medical theorists pneuma was not only an intuitive and explanatory feature of animal physiology; the notion that pneuma was coursing through a major vascular system in the body was unexceptional. This point will prove keenly important as we come to Galen’s polemic against Erasistratus and other proponents of the belief that the arteries exclusively contain some form of pneumatic material. On Praxagoras’ view of vascular function, insofar as it can be recovered, the arterial system branches from the left side of the heart beginning with the aorta or thick artery (ἡ παχεῖα ἀρτηρία).31 As we have seen, for Praxagoras arterial vessels characteristically possess an independent capacity by which their walls expand and contract. It is probable Praxagoras thought that the lungs take in external air and somehow alter it; the resultant pneuma is drawn through the pulmonary vein into the left side 26

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On pneuma as a vehicle for sensation, see Lloyd (1978: 222–223) and Freudenthal (1995: 132–133). For its possible role in motor function, see Nussbaum (1978: 156) and Freudenthal (1995: 134–137). Vegetti (1998: 77). Freudenthal (1995: 106–148) offers an overview of pneuma in Aristotle’s physiology. However, cf. Aristotle GA 2.6, 743b35–744a5 and Mot.An. 10. See also Harris (1973: 165–172), Berryman (2002), and Lloyd (2007: 140–141). See, e.g., Harris (1973: 106–108) and von Staden (2000). See fr. 1 Lewis (Rufus of Ephesus Onom. 208–211, p. 163.3–12 Daremberg/Ruelle).

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of the heart.32 The expansion of these arterial walls or tunics (χιτῶνες) draws pneuma from the left ventricle of the heart,33 which is then conveyed through the arteries to the rest of the body through arterial contraction: So, whenever they are at a loss for how pneuma will be borne to the whole body from the heart if the arteries are filled with blood, it is not difficult to resolve their confusion—by saying that [pneuma] is not sent out from the heart. It is drawn, rather, and not only from the heart but from all around (πανταχόθεν) as was the belief of Herophilus, Praxagoras before him, Phylotimus, Diocles, Pleistonicus, Hippocrates, and countless others.34 On those occasions when foreign substances, such as blood and other humors, enter the arterial system, these substances impede the flow of pneuma throughout the body. These obstructions are potential causes of illness, especially conditions of the sort to affect motor function and consciousness.35 As we can see, the model bears similarities to the aetiological account for epilepsy in the Sacred Disease mentioned earlier. It is worth lingering over the mechanics of pneumatic flow through the arteries and the important explanatory role of its obstruction to Praxagoras’ account of disease, although Galen does not draw attention to either of these points. In the passage just quoted, Galen writes that Praxagoras believed the arteries draw pneuma not only from the heart but from all over the body (πανταχόθεν), a view that he also attributes to Hippocrates, Diocles, Phylotimus, Herophilus, and others in this context. Orly Lewis argues that Galen is probably overgeneralizing here on the grounds that 1) he is clearly doing so elsewhere in this passage—specifically in regard to Praxagoras’ vascular views—and 2) that other surviving fragments suggest Praxagoras was focused on the heart as the

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See fr. 16 Lewis (Ut.Resp. 1–3, 80–110 F-W = iv.471–493 K.). See also Lewis (2017: 259– 275). For the heart as the source of the arteries and arterial expansion, see fr. 3.16–25 Lewis (PHP 1.6, CMG v,4,1,1 82 = v. 190 K.). Fr. 11.1–5 Lewis (Art.Sang. 8, 176 F-W = iv.731–732 K.): Ὥσθ’ ὅταν ἀπορῶσι, πῶς εἰς ὅλον τὸ σῶμα παρὰ τῆς καρδίας κομισθήσεται τὸ πνεῦμα πεπληρωμένων αἵματος τῶν ἀρτηριῶν, οὐ χαλεπὸν ἐπιλύσασθαι τὴν ἀπορίαν αὐτῶν, μὴ πέμπεσθαι φάντας, ἀλλ’ ἕλκεσθαι μήτ’ ἐκ καρδίας μόνης, ἀλλὰ πανταχόθεν, ὡς Ἡροφίλῳ τε καὶ πρὸ τούτου Πραξαγόρᾳ καὶ Φιλοτίμῳ καὶ Διοκλεῖ καὶ Πλειστονίκῳ καὶ Ἱπποκράτει καὶ μυρίοις ἑτέροις ἀρέσκει. See, e.g., fr. 25.2–4 Lewis (Anon.Par. 3: 18.11–14 Garofalo). The association of pneuma with sensation and consciousness emphasizes the important explanatory role that pneuma played in accounting for volition and reason in living beings in a wide range of Greek and later Roman medical traditions.

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source of arterial pneuma.36 When he writes that Praxagoras believed pneuma is drawn “not only from the heart, but from all around (πανταχόθεν)”, one notes that Galen is attributing a version of arterial breathing to him. I only mention the point here proleptically; I will discuss it in greater detail shortly. For Galen arterial action draws pneuma into the arteries and expels it through pores in the arteries that connect with pores in the skin; its role in arterial physiology is mainly to regulate the temperature of vital heat. There is no evidence that Praxagoras held a theory of cutaneous breathing, nor is one otherwise attributed to him. Moreover, his consideration of the heart as the source of arterial pneuma speaks strongly against the likelihood that he held such a view. Whether Galen means skin-breathing or a more general form of arterial breathing in the passage just quoted,37 he is investing this feature of his arterial theory with an ancient pedigree through Herophilus, to Praxagoras, and finally to Hippocrates. Praxagoras’ belief that the arteries do not contain blood would have been strongly motivated by the fact that, at any given time, most of the body’s blood supply is contained in the veins.38 Moreover, after death the pressure exerted by elastic fibers in the three layers of the arterial walls drives most of the blood still in the arteries into the veins.39 It is possible that an innovation in anatomical practice may have contributed further to this association between pneuma and the arteries. In his Historia Animalium, Aristotle reports that it is necessary to prepare animal subjects for dissection first by starving them to the point of emaciation and later by asphyxiating them in order to observe vascular morphology properly.40 He mentions that emaciation, which reveals vasculature close to the surface of the skin for external observation in cases of living subjects, was a common enough practice among earlier writers.41 However, Aristotle remarks that his method of preparation differs from his predecessors, who, he implies, exsanguinated their animal subjects while preparing them for observation.42 Since the walls of veins lack the smooth muscle and connective tissue that maintain the structural integrity of arter36 37 38

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Lewis (2017: 257–259). Cf. von Staden (1989: 262–264). For the former interpretation, see Harris (1973: 181). Since the walls of the vein are significantly more distensible than those of the arteries, the venous system contains roughly 75% of the body’s total blood supply at any given time. For this calculation, see Guyton and Hall (2016: 316). The absence of blood in the arterial system of cadavers is well documented. See also Vegetti (1998: 79). Aristotle HA 3.3, 513a12–15. Aristotle HA 3.2, 511b18–24. Aristotle HA 3.2, 511b10–18.

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ies even when they are emptied, the venous system of exsanguinated subjects collapses after death. The preparatory process that Aristotle describes allowed the observer to prevent the collapse of the venous system in animal subjects after death, since the body’s blood supply pools in the veins. Asphyxiation would drive even more of the small amounts of blood typically found in the arteries after death into the veins, the right side of the heart, and into the pulmonary artery.43 One of the procedures that may have permitted observers to distinguish between arteries and veins in the first place would also have resulted in phenomena that encouraged them to conclude that their contents were as distinct as the systems to which the belonged. At this stage in the history of Greek anatomy, nerves had not yet been distinguished from the body’s other vasculature, and especially the more sinuous arteries with which they were often associated. This innovation would have to wait for a generation, when Herophilus differentiated nerves from arteries, veins, and sinews. Consequently, early theories of the arterial system and its contents would have made these vessels attractive candidates for explanations of life functions such as voluntary movement and sensation.

3

Herophilus and an Emerging Tradition

Herophilus, who was one of Praxagoras’ students, also believed that the pulse was an active movement of the arteries. Whereas Praxagoras had believed that the arteries’ capacity for active movement was intrinsic to them and independent from the heart, Herophilus believes that the capacity for arterial function ultimately derived from the heart. Of course, the notion that the arteries move actively is not only central to Galen’s physiology but also to his dispute with Erasistratus over the function and contents of the arteries. Consequently, Galen represents Herophilus and Praxagoras as though they were in close agreement, since they shared the same general view on the active movement of the arteries. It is worth keeping in mind that Galen’s representation is a somewhat flattened version of their beliefs that he also attributes to all of the other “most authoritative” ancients. This is a typical tool in Galen’s rhetorical arsenal, requiring one to be aware that Galen will, when it serves his purposes, recast the views of his predecessors as though they are proto-Galenic. With the introduction of Herophilus one can perhaps begin to talk with detail about an emerging mainstream for theoretical positions on arterial func-

43

See Wilson (1959: 294).

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tion and vasculature more broadly, one that allows us to discern points of disconnect between antiquity and Galen’s presentation of antiquity. Like his teacher Praxagoras and the other earlier theorists I have mentioned, Herophilus’ work survives only in fragments, albeit far more of them, preserved largely in the pages of later authors.44 Consequently, while the picture we possess of Herophilus’ work is of much higher resolution there remain gaps in it, which are occasionally very large. He was an older contemporary of Erasistratus, active in the first half of the third century bce.45 Both he and Erasistratus are credited with an astonishing range of anatomical and physiological innovations, derived in part from the first and probably last systematic dissections and vivisections of human bodies in Greco-Roman antiquity.46 Herophilus argued explicitly for a difference between artery and vein on the basis of observations of the vessels’ anatomical structure.47 His observations of human and animal bodies led him to distinguish nerves from the body’s vasculature for the first time in Greek medical writing.48 In addition to his identification of the nervous system, Herophilus also differentiated between sensory nerves (νεῦρα αἰσθητικά) and motor nerves (νεῦρα προαιρητικά) on functional grounds.49 By analogy to other tubular structures in the body that contained and distributed material throughout the body, Herophilus supposed that at least some nerves were vessels for pneuma.50 While it is not possible to be certain what view he maintained in regard to the contents of the arterial system, it is likely that Herophilus disavowed Praxagoras’ view of the arteries as purely pneumatic vessels and believed that they contained blood as well as pneuma, in some form. The available positive evidence for the belief derives from a reference that is preserved in the medical papyrus Anonymus Londinensis; it is also supported by indirect evidence.51 44 45 46

47 48 49 50

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The fragments of Herophilus are collected in von Staden (1989). See von Staden (1989: 43–50). The primary textual evidence for human vivisection is found in Celsus De Medicina 1.pr.23–26. References to Alexandrian dissections of human bodies are more plentiful. In particular see von Staden (1989: 29–30, 144–153) and Nutton (2013: 130–134), but also Longrigg (1993: 179). See frs. 116 and 118 vS. See Solmsen (1961) and von Staden (1989: 159–160) with frs. 80–85. See fr. 81 vS. Cf. 125 vS. The only explicit ascription to Herophilus of the belief that the nerves carry pneuma is limited to the optic nerves. See frs. 140a and 85 (= 140b) vS with von Staden (1989: 252– 259). See Anon.Lond. 28–29 (40.46–41.34 Ricciardetto). Anonymus references Herophilus’ belief that the arteries, like the veins, carry nutriment (τροφή) in a discussion on the body’s absorption of nutrients. In the context, nutriment is plausibly understood as blood. Von

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There is far more evidence for Herophilus’ beliefs about the function of the arteries. In the passage from The Distinct Types of Pulse which I quoted earlier, Galen mentions that Herophilus was a proponent of the view that arterial pulsation is an active movement of the vessels, a general version of which Galen is quick to observe he shared with Praxagoras.52 Galen consistently ascribes to him a belief that the arteries’ capacity to pulsate derives from the heart. While the notion of a “vital capacity” for pulsation echoes Galenic usage, it has Hellenistic precedent and does explanatory work for Herophilus’ views on the diagnostic value of the pulse.53 Galen elaborates on the physiological processes involved in the theory later in The Distinct Types of Pulse: It is Herophilean doctrine that the arteries, being continuous with the heart (τὰς ἀρτηρίας συνεχεῖς οὔσας τῇ καρδίᾳ), possess a capacity that flows to them through their tunics. They use this capacity very much like the heart [does]. When they dilate they draw what completes their dilation from everywhere (πανταχόθεν) they are able. But when they contract they squeeze this out. Consequently, all the arteries are clearly seen dilating all at once and contracting all at once, keeping time with the heart with their two movements.54

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Staden (1989: 265–267) observes that Galen is silent on Herophilus’ views on the contents of the arteries. Since Galen is pointedly hostile to the view that the arteries do not contain blood, von Staden comes to the cautious conclusion that Herophilus likely believed that the arteries contained pneuma and blood, pneumatized blood, vel sim. Fr. 9.9–14 Lewis (Diff.Puls. 4, viii.702–703 K.). Fr. 164 vS (Diff.Puls. 3, viii.645 K.): “For Herophilus says that the strength of the artery’s vital capacity is the cause of a vehement pulse”. (Ἡρόφιλος μὲν γάρ φησι ῥώμην τῆς ἀρτηρίας ζωτικῆς δυνάμεως αἰτίαν εἶναι σφοδροῦ σφυγμοῦ). See also von Staden (1989: 274–275). However, cf. fr. 141 vS (Trem.Palp. 5, vii.605–606 K.), in which Galen criticizes Herophilus for treating the nerve as a cause of motion and not its instrument. Galen’s point is that Herophilus should have recognized a faculty for movement in the nerve that was the true cause of the activity. Galen’s criticism of Herophilus here may suggest that he envisioned the arteries as moving in a similar way, with the heart as the cause of the movement rather than a faculty for movement transmitted from a cardiac source. However, Soranus also ascribes capacities to Herophilus in fr. 193 vS (Gyn. 3, prooem. 3.4 = CMG iv 95), as does [Plutarch] in fr. 143b vS (Placita 4.22, Mor. 903F–904B, v.2.1 = 130–131 Mau). Fr. 144 vS (Diff.Puls. 4, viii.733 K.): τοῖς δὲ περὶ τὸν Ἡρόφιλον ἀρέσκει τὰς ἀρτηρίας συνεχεῖς οὔσας τῇ καρδίᾳ διὰ τῶν χιτώνων ἐπιρρέουσαν ἔχειν τὴν παρ’ αὐτοῖς δύναμιν, ᾗ χρώμεναι παραπλησίως αὐτῇ τῇ καρδίᾳ διαστελλόμεναι μὲν ἕλκουσι πανταχόθεν, ὅθεν ἂν δύνωνται, τὸ πληρῶσον αὐτῶν τὴν διαστολὴν, συστελλόμεναι δὲ ἐκθλίβουσι, καὶ διὰ τοῦτο φαίνεσθαι καθ’ ἕνα χρόνον ἅμα πάσας αὐτὰς διαστελλομένας τε καὶ συστελλομένας, τὴν αὐτὴν προθεσμίαν τῇ καρδίᾳ τῶν κινήσεων ἀμφοτέρων φυλαττούσας. See also fr. 154 vS (Us.Puls. 4, 208–210 F-W = v.163–164 K.) and fr. 155 vS (Diff.Puls. 3, viii.702–703 K.).

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In addition to the view that the arteries pulsate in virtue of a capacity for active movement and that this capacity is transmitted to the arteries from a single source, the heart, Galen attributes two further notions to Herophilus that do heavy lifting in his own physiological theory and inform his account of the arterial experiment: 1) the action of the heart is simultaneous with the action of the arteries and 2) the arteries expand and contract as part of a breathing process (sometimes called “transpiration”, “skin-breathing”, or “cutaneous breathing”).55 One notes that the venous system does not figure very much at all in this discussion. In nearly all relevant respects, ancient theorists considered it distinct and independent from the arterial system. The differences between the two systems extended, in large part, to their contents. Venous blood was fundamentally understood in alimentary terms. Even under physiological theories that explicitly incorporated pneuma into their analyses of bodily processes, venous blood either lacks pneuma altogether or—as for Galen—for the most part. We have already seen some of the work that simultaneous pulsation and arterial breathing do in Galen’s physiological theory as well as the role they play in his version of the femoral artery experiment and related demonstrations. To what extent, however, were these two well-articulated Galenic theories representative of Herophilus’ physiological views? More generally, how plausible is it that they were points of theoretical debate in the third century, such that the femoral artery experiment in its Hellenistic form might have addressed them?

4

The Simultaneous Action of Arterial and Cardiac Movement

According to the first view, the contraction and dilation of the arteries is simultaneous with cardiac systole and diastole. Furthermore, each cycle occurs all at once, system-wide, very much like the expansion and contraction of the lungs. The body pulsates as a whole. It is very likely that this view is, at least in part, a consequence of Herophilus’ conceptualization of the arterial system as an extension of the heart (τὰς ἀρτηρίας συνεχεῖς οὔσας τῇ καρδίᾳ), analogous to the action of the lungs.56 To be clear, Herophilus did not consider that

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See fr. 145a vS (Art.Sang. 8, 176–178 F-W = iv.731–732 K.). Harris (1973: 181) takes this passage as evidence that Herophilus endorsed some theory of cutaneous breathing. For some of the difficulties in the attribution, see the discussion in von Staden (1989: 263–264). Harris has drawn the conclusion about Herophilus that, in my view, Galen leads one to draw. See fr. 144 vS (Diff.Puls. 4.6, viii.733 K.) with fr. 143c vS (Ps.-Galen Hist.Phil. 103, DG 639 = xix.318 K.).

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activity of the heart played a direct role in the process of respiration. On this point he differs from Galen and, indeed, is very much in the minority among Greco-Roman theorists.57 The identification of the heart as a part of the respiratory system was widespread in the Greek medico-philosophical tradition along with the arteries (after their discovery), the lungs, and to some extent the thorax. This identification would have provided strong analogical incentives for Herophilus to suppose that the arteries and, by extension, the heart function very much like the other organs with which they had been traditionally associated. Herophilus’ belief that the capacity for pulsation flows to the arteries from the heart is an equal if not stronger motive to suppose that arterial action mirrored cardiac action. On this model, the capacity for their pulsation is transmitted through the arterial walls, which are continuous with the heart by way of the aorta. For all relevant purposes, one could conceive of the arterial system and the left side of the heart as a single pulsating organ.

5

Transpiration and the Arteries’ Attraction of Material from All Around

According to the second view, the arteries draw material into themselves not only from the heart but also from all around (πανταχόθεν). Like Praxagoras and Phylotimus, Herophilus conceptualized arterial action as drawing material into the vessels from the heart—although perhaps not only the heart, a point to which I will return in due course. The body’s pulse was the perceptible manifestation of this process as the arterial system actively contracted and released its vascular walls.58 However, in the passage quoted from The Distinct Types of Pulse Galen mentions that Herophileans and perhaps Herophilus (the locution “τοῖς … περὶ τὸν Ἡρόφιλον” admits of either reading) believed that arterial dilation draws material into the arteries from all around (πανταχόθεν). This reference has led some scholars to suppose that Herophilus endorsed a form of transpiration (διαπνοή), and, indeed it seems to me that Galen’s account

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See fr. 143a–b vS (Aetius Plac. 4.22.3 = DG pp. 413–414 = [Plutarch] Placita 4.22 (Mor. 903F– 904B, v.2.1 = 130–131 Mau)). Herophilus considered that, properly speaking, the activity of the arteries consisted in arterial systole. Arterial diastole was a return to their neutral state, a view supported by the distension of the arteries in corpses. See fr. 157 vS (Diff.Puls. 4, viii.747 K.). However, Herophilus appears not to have made this distinction consistently. See fr. 158 vS (Diff.Puls. 4, viii.754 K.).

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encourages this view.59 As we have seen, in Galen’s work the term διαπνοή can often refer to an elaborated theory of arterial breathing, in which the expansion of the arterial walls pulls nearby material into the arteries and their contraction vents waste products into adjacent spaces. When this process occurs near the skin, the arteries draw in ambient air that interacts with blood in the arteries so as to pneumatize or vaporize it. The “fuliginous” (λιγνυώδη) waste products of that process are then exhaled through pores in the skin. For various reasons, however, it is unlikely that Herophilus held such a view. The point bears directly on whether Erasistratus’ arterial demonstration could have had such a view in its experimental sights. The term “transpiration” (διαπνοή) can have a broad semantic range. In its most general sense, transpiration comprises a set of views according to which material passes through vents or pores in the skin. This process may convey material out of the body through the skin, into it, or both. It may take place only at the level of the skin or, as in Galen’s physiological system, it may include the arterial system in the cutaneous respiratory process. In the passages where Galen discusses Herophilus’ views on the source(s) of arterial content, it is not immediately clear which of these views Galen ascribes to him.60 According to one set of views sometimes attributed to Herophilus, breathing all around (πανταχόθεν) should be taken expansively; that is, one should understand the process as taking place through cutaneous pores in addition to the lungs and wind-pipe, perhaps also involving the arteries in the respiratory process.61 On this model, in addition to drawing pneumatic material from the left ventricle of the heart the arteries draw pneumatic material from the outside air, first through pores in the skin, then through pores in the arterial walls that connect to their cutaneous counterparts. Since Galen’s meaning in The Distinct Types of Pulse is not entirely clear it is helpful to consider a similar claim that he makes in Whether Blood is Naturally Contained in the Arteries: … it is not difficult to resolve their [sc. Erasistrateans’] puzzlement by remarking that [pneuma] is not propelled by but drawn from the heart and not only from the heart but from everywhere (πανταχόθεν) as is doc-

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See Steckerl (1958: 21); Harris (1973: 181); and Furley and Wilkie (1984: 26). The more specific view that Harris as well as Furley and Wilkie ascribe to Herophilus is that this skinbreathing also occurs at the level of the arteries. This is only the roughest of sketches; I will have more to say about the place of transpiration in the femoral artery demonstration subsequently. See Debru (1996: 178–210). See Harris (1973: 181).

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trine for Herophilus and before him Praxagoras, Phylotimus, Diocles, Pleistonicus, Hippocrates and countless others.62 In Whether Blood is Naturally Contained in the Arteries, it is at least certain that Galen ascribes the Herophilean view in question to Herophilus himself, suggesting that Galen’s reference to “τοῖς … περὶ τὸν Ἡρόφιλον” in the earlier quotation of The Distinct Types of Pulse includes the founder of the sect as well as its later adherents.63 There is every reason to exercise interpretative caution over what these references reveal about the beliefs of the theorists on which Galen reports. At first glance this passage seems to get us no further in establishing what, precisely, Galen means when he writes that Herophilus and the others in his list of earlier medical theorists believed that the arteries draw their contents from all around (πανταχόθεν). For instance, the views on the source of arterial pulsation that Galen ascribes to Praxagoras in The Distinct Types of Pulse are inconsistent with his reports of Praxagoras’ beliefs elsewhere in the corpus to a degree that makes Galen’s report of them unreliable.64 Lewis observes that features of Praxagoras’ pathological views that take the heart to be the primary if not sole source of pneuma for the arterial system also argue against ascribing transpirational processes to his physiology.65 Elsewhere in Galen’s work, the word I have translated “from all around” (πανταχόθεν) commonly refers either to the way in which organs—especially the digestive organs—envelop materials that they alter or to the way in which this sort of material is surrounded by an organ altering it.66 In this sense,

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Fr. 145a.3–7 vS (Art.Sang. 8, 176 F-W = iv.731–732 K.): οὐ χαλεπὸν ἐπιλύσασθαι τὴν ἀπορίαν αὐτῶν, μὴ πέμπεσθαι φάντας, ἀλλ’ ἕλκεσθαι μήτ’ ἐκ καρδίας μόνης, ἀλλὰ πανταχόθεν, ὡς Ἡροφίλῳ τε καὶ πρὸ τούτου Πραξαγόρᾳ καὶ Φυλοτίμῳ καὶ Διοκλεῖ καὶ Πλειστονίκῳ καὶ Ἱπποκράτει καὶ μυρίοις ἑτέροις ἀρέσκει. Galen also uses this language to describe the views of Praxagoras and other early medical theorists. See, e.g., Art.Sang. 8 (176 F-W = iv.731–732 K.). See Lewis (2017: 258–259). Lewis (2017: 258). For the relevant pathological fragments, see frs. 25 and 27 Lewis. This sort of view was probably also held by Diocles of Carystus. See, e.g., fr. 80 vdE (Anon.Par. 5, 30.14–23 Garofalo). Cf. fr. 98 vdE (Anon.Par. 3, 18.10–20.6 Garofalo). Establishing Diocles’ dates is difficult. Van der Eijk (2001: xxxi–xxxiv) tentatively places him some time in the first half of the fourth century. There is only the most tenuous evidence that Diocles endorsed any transpirational theory: He is said to have recommended cleaning the skin to ensure pores remain unclogged and promote some sort of effusion (τοὺς πόρους καθαρωτέρους καὶ εὐπνοωτέρους) in fr. 182.37–38 vdE (Oribasius Inc. 40, CMG vi 2,2 141.10–146.4). For the general case, see Nat.Fac. 3.11 (SM 3, 232.10–24 = ii.181 K.). For organs surrounding material when exercising their retentive capacity, see the bladder at Nat.Fac. 1.13 (SM 3,

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Galen probably means that arterial diastole draws material from the structures immediately surrounding the arteries. After the material undergoes alteration in the arteries, it is expelled by arterial systole again into nearby structures. Skin-breathing is therefore a subset of Galen’s more general belief that in transpiration arterial action draws material from nearby vessels or hollow organs and then expels it into them. Arteries near the heart draw pneumatic blood primarily from the heart. The cardiac valves for the most part prevent the arteries from expelling material back into the left ventricle. Arteries near the intestines likewise draw suitable material into themselves, but because they exert greater pull on lighter material they also draw pneumatic blood mainly from the heart. In the case of arteries near the surface of the skin, the systolic cycle releases byproducts of arterial alteration through neighboring vessels, here cutaneous pores, out of the body. Galen seems to have just this sort of account in mind in The Distinct Types of Pulse where he reports that Herophilus believed, “when [the arteries] dilate they draw what completes their dilation from all around (πανταχόθεν) as they are able, completing their dilation. When they contract they squeeze it out”.67 There are reasons to suppose that these beliefs about arterial function are inconsistent with Herophilus’ physiological views, as expressed in the surviving fragments and testimonia. Despite the detail of these accounts of cardiac anatomy and respiration, Herophilus only mentions the heart as a source of arterial pneuma in them. He offers no hint of a theory of arterial or skin breathing.68 There are further reasons to be careful in ascribing a theory of transpiration, much less a consistent one, to Herophilus as well as to these other earlier figures on the grounds of Galen’s oblique reference.69 Evidence for theories of tran-

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125–126 = ii.34 K.); the uterus and stomach at 3.3 (SM 3, 207 = ii.147 K.), 3.3 (SM 3, 208.24– 209.6 = ii.149 K.), 3.4 (SM 3, 211.11–19= ii.152–153 K.); the stomach at 3.4 (SM 3, 214.21–215.5 = ii.157 K.), 3.13 (SM 3, 245.11–17 = ii.199 K.) and again at UP 4.7 (i.205.23–206.3 = iii.280– 281 K.); the arteries at Nat.Fac. 3.14 (SM 3, 250.1–6 = ii.205 K.), et passim. Cf. Nat.Fac. 1.13 (SM 3, 127.19–21= ii.37 K.), the peritoneum at UP 4.9 (i.214.2–6 Helmreich = iii.291–292 K.); the pericardium at AA 7.3 (628–630 Garofalo = ii.596 K.); and the hand grasping at UP 1.5 (i.7.16–18 Helmreich = iii.10 K.). Fr. 144.4–5 vS (Diff.Puls. 4, viii.733 K.): … διαστελλόμεναι μὲν ἕλκουσι πανταχόθεν, ὅθεν ἂν δύνωνται, τὸ πληρῶσον αὐτῶν τὴν διαστολὴν, συστελλόμεναι δὲ ἐκθλίβουσι … This inconsistency has prompted von Staden (1989: 263–264) to argue that Galen “seems to be conflating several authors’ views in a misleading manner”. Von Staden (1989: 263–264) is more skeptical that Herophilus included transpiration in his theory of respiration on the grounds that 1) Herophilus makes no mention of transpiration in his surviving fragments on respiration, which are otherwise detailed and 2) it is likely that other authors in this list did not believe in transpiration through the skin, whether it involved the arteries or not.

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spiration, especially on Galen’s model, are not well attested among theorists before the Imperial Period. Indeed, it is worth noting in this regard that Galen’s system of transpiration is the earliest systematic account of such a process. Moreover, the earliest surviving technical definition of transpiration predates Galen’s work by only a generation or so, in the pseudo-Galenic treatise, Medical Definitions, which is dated to some time in the late first century ce.70 It makes no mention of the arteries’ involvement in such a process: Transpiration (διαπνοή) is an involuntary attraction of air by the natural heat that occurs through the surface of the body together with the release of its effluvia. Another definition: transpiration is an attraction of external air aided by a natural tendency through the whole body (δι’ ὅλου τοῦ σώματος) and then its expulsion back out again through the body’s vents.71 Transpiration, however, is a fundamental process in Galen’s physiological theory whereby the arterial system draws small amounts of pneuma into itself and expels certain waste products or perittōmata through pores in the skin. As with so many later theoretical views, Galen ascribes his own theory of transpiration to certain canonical palaioi, ancient authors to whose intellectual lineage he fashions himself as heir. We have already seen this tendency in Galen’s attribution to Praxagoras of his model for the transmission of capacities, through the body’s vessels from a source-organ. Galen also attributes a view of skin breathing to Hippocrates on the basis of an unlikely line in Epidemics vi.72 A

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These are the dates given to [Ps.-Galen] Def.Med. by Kollesch (1973: 60–66). The text is something of a disaster, however. As of yet there is no critical edition available, although Kollesch has completed one for the CMG. [Ps.-Galen] Def.Med. 109 (xix.375 K.): Διαπνοή ἐστιν ὁλκὴ ἀέρος ἀπροαίρετος ὑπὸ τοῦ φυσικοῦ θερμοῦ διὰ τῆς ἐπιφανείας ἅμα τοῖς συναπερχομένοις αὐτοῦ σώματος γινομένη. ἑτέρως. διαπνοή ἐστιν ἐκ τοῦ σώματος ὁλκὴ ἀέρος μετ’ ὀρέξεως φυσικῆς δι’ ὅλου τοῦ σώματος καὶ πάλιν δι’ ἐξόδων ἀπόκρισις. Epid. 6.6.1 (5.323 Littré): “Flesh draws from the diaphragm and from outside. It is clearly observed that there is exhalation and inhalation”. Σάρκες ὁλκοὶ καὶ ἐκ κοιλίης καὶ ἔξοθεν· δῆλον αἴσθησις, ὡς ἔκπνοον καὶ εἴσπνοον … On the basis of other references in Galen, Wenkebach introduced the phrase ὅλον τὸ σῶμα after εἴσπνοον. There is no manuscript support for the reading in the direct transmission of the text. Indeed, Galen does not include the added phrase in his commentary on the passage or in its lemma. See Galen Hipp.Epid. 6.6.1 (CMG v 10,2,2 321 = xviib.311–312 K.). For a brief discussion of some other textual and interpretative issues with this line, see Debru (1996: 180 with n. 9–10). Traditionally, the locus classicus for cutaneous breathing is a fragment of Empedocles (B100 DK = Aristotle Resp. 473b9–474a6). It is uncertain, however, whether Empedocles is describing a view of cutaneous breathing in this passage and, if he is, what sort

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transpirational view is represented in Plato’s Timaeus, perhaps drawing from the work of his rough contemporary Philistion of Locri.73 And although Galen is critical of certain features of the account, he nonetheless sees it as reflecting his own,74 going so far as to offer his own definition of respiration and transpiration as an elucidation of Plato’s in his commentary on sections 79a5–c7 of Plato’s Timaeus: Thus, as I have said, I call the process that consists of inhalation and exhalation ‘respiration’ (ἀναπνοήν) when both these things happen through the mouth, but ‘transpiration’ (διαπνοήν) then they occur through the whole body (καθ’ ὅλον τὸ σῶμα).75 On the one hand, Galen’s comments in The Distinct Types of Pulse and Whether Blood is Naturally Contained in the Arteries take an overly synoptic view of transpiration in the Hellenistic period. For that reason, they may be shaky evidence for establishing whether Herophilus was committed to a particular form of it. They are rather better evidence, however, for what physiological views Galen sought to invest with the authority of antiquity, when he attributes them to Herophilus and “before him Praxagoras, Phylotimus, Diocles, Pleistonicus, Hippocrates and countless others”. It is difficult to sketch a picture of the theoretical landscape of arterial physiology at the very end of the fourth century bce and the beginning of the third in Greek science writing, in part because of the outsized influence that Galen’s reports have on the available evidence and in part because of the paucity of what sources we do have. With this significant caveat in mind, let us summarize what can be said about the status of four issues on which Galen’s femoral artery experiment turns in the context of its Hellenistic iteration: 1) the active movement of the arteries, 2) their contents, 3) whether they are involved in arterial breathing, and finally 4) if their pulsation is simultaneous with the heart’s beat. Galen is consistent in ascribing a view of the pulse 1) as an active movement of the arteries not only to Praxagoras, but also to Phylotimus, Pleistonicus, and Herophilus.76 There is more textual evidence for Herophilus’ adherence to a

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he is describing. See Furley and Wilkie (1984: 3–6) for a brief discussion of the interpretative difficulties posed by the fragment. See Plato Tim. 77d–79a and Anon.Lond. 20 (27.45–47 Ricciardetto). See, e.g., PHP 8.8–9 (CMG v 4,1,2 528–538 = v.707–719 K.). Plat.Tim. CMG Suppl. i.22.32–34: καλοῦμεν γὰρ οὕτως ἡμεῖς τὸ μὲν ἀναπνοήν, ὡϲ εἴρηται, τὸ συγκείμενον ἐκ τῆς εἰσπνοῆς τε καὶ τῆς ἐκπνοῆς, ὅταν διὰ τοῦ στόματος ἄμφω γίνηται ταῦτα, τὸ δὲ διαπνοήν, ὅταν καθ’ ὅλον τὸ σῶμα. Cf. Symp.Diff. 5 (CMG v 5,1 246 = vii.75 K.). For Galen’s reference to the complete group, see Art.Sang. 8 (176–178 F-W = iv.731–732 K.).

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view of active arterial movement.77 Much of it survives in Galen of course; but, on this issue there is not much reason to doubt Galen’s reports, which are consistently uniform on this point.78 In addition, a range of other vascular views Herophilus is reported to have held depend on the active movement of the arteries (e.g., the synchronous movement of the heart and arteries). Finally, there is indirect evidence for the view in pseudo-Galen and Rufus of Ephesus.79 This is all to say that there is reason to suppose an active model of arterial motion was a (if not the) mainstream position from the time of Praxagoras’ identification of arteries and an arterial system through that of Herophilus. Evidence for 2) views of arterial content in Greek writing in the short span of time between Praxagoras and Erasistratus is threadbare. There are only four authors in the first half of the third century bce to whom any views on the contents of the arteries are attributed: Praxagoras, the author of On Breath, Herophilus, and Erasistratus.80 The more common view among them was that

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This reference is the same as the one in which Galen attributes a form of transpiration to all of these authors. Consequently, it should not be accepted out of hand. It seems to me that while Galen does frequently recast the beliefs of other authors in the terms of his own theoretical views, the difference between an active model of arterial pulsation and the mechanical explanation put forward by Erasistratus is fundamental enough that it would have been difficult to elide. There is no evidence outside of Galen’s report for Pleistonicus’ views on arterial movement or Diocles’. However, Diocles predates Praxagoras and therefore cannot be expected to have had a theory of arterial movement for that reason. Galen’s attribution of the view to Hippocrates is a typical retrojection of a belief that Galen champions on to the most authoritative of ancient physicians. For Diocles, see van der Eijk’s commentary on fr. 33 (2001: 67–69). Cf. Diocles’ explanation of certain pathological conditions as caused by the obstruction of the flow of pneuma (frs. 95 & 102 vdE). For Praxagoras and Phylotimus, see Lewis’ commentary on frs. 9–10 (2017: 133–139) along with her explanation of the difficulties surrounding fr. 11 (2017: 140–142). See, e.g., frs. 143c, 144, 145a, 149, 154, 157 vS. Von Staden (1989: 270–273) and (1991) provide helpful context. In fr. 143c vS, [Ps.-Galen] ascribes to Herophilus the view that arteries and muscles possess a capacity for active movement along with nerves. In fr. 149 vS, Rufus of Ephesus attributes to Herophilus the view that the pulse occurs only in the arteries and in the heart. Herophilus is also said to contrast the movement of the pulse in the heart and arteries with voluntary movement. Both attributions suggest that Herophilus conceived of the arteries as moving actively. On the first view, the movement of the arteries is like the movement of the heart. On the second view, the involuntary movement of the pulse is compared directly to voluntary motion. The treatise On Breath (De Spiritu), not to be confused with On Breaths (De Flatibus), is generally believed to have been written in the early Hellenistic period by an author with some Peripatetic connection. While the author distinguishes artēriai from phlebes, the artēriai in his system are a broader category of vessel or duct that includes the windpipe,

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the arteries were ducts or channels for the transmission of pneuma throughout the body.81 Indeed, the view that the arteries contain blood is only attributed to Herophilus. In all likelihood Herophilus believed that the arteries contain either a mixture of pneuma and blood or pneumatized blood, on a model similar to Galen’s own. As we have seen, 3) there is also evidence that some of these authors believed in a form of transpiration. There is none, however, that any held a version of Galen’s theory of arterial breathing. Finally, 4) while we only have evidence for Herophilus’ view on the rhythm of the pulse relative to the heart-beat, he did hold the view that the two movements were synchronous. It is against this backdrop that Erasistratus and his femoral artery experiment come onto the scene in the third century after the known views of Praxagoras and Herophilus.

6

Erasistratus and Mechanism

Along with Herophilus, Erasistratus is associated with the brief efflorescence of human dissection and, in all likelihood, vivisection in the first half of the third century bce.82 He is also associated with experimental activity. One example, in which Erasistratus endeavored to demonstrate that living bodies are diminished by the release of imperceptible material, will be most relevant to our discussion of the femoral artery experiment. I will return to this demonstration shortly; for now, it is necessary to explain some of the physiological commitments that lay behind Erasistratus’ arterial experiment. While Erasistratus shared the belief that the arteries contained only pneuma with others, he explained the pulse as a passive movement of the arterial walls caused by the rapid flow of pneuma through the arterial system.83 That is to say, for Erasistra-

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bronchi, and at least some of the vessels that would later be identified as arteries in the more familiar sense. The author of On Breath treats artēriai as channels that contain only pneuma. He seems to have believed in a form of transpiration (4, 483b15–19), with which he did not associate the pulse (4, 482b36–483a5). Indeed, he did not think that the pulse served a purpose (4, 483a5–8). For the medical background and context of On Breath, see Gregoric, Lewis, and Kuhar (2015) and Gregoric and Lewis (2015). The most up to date critical edition is Roselli (1992), which includes commentary. While pneumatic theories of arterial content become rarer in medical writing, they persisted through the Roman period. Pliny NH 11.89, for example, mentions that the arteries contain pneuma as though casually reporting received wisdom. See, e.g., von Staden (1989: 139–153) and (1992); Flemming (2003); and Nutton (2013: 130– 141). See, e.g., fr. 111 Garofalo (Diff.Puls. 3.2, viii.645–646 K.); Us.Puls. 5 (214 F-W = v.167–168 K.).

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tus the pulse reflected the work of mechanical principles rather than the activity of capacities internal to the organ(ism). As a consequence of this mechanical view, Erasistratus also believed that the phases of arterial cycles were inverse to the phases of the cardiac cycles; cardiac systole expelled pneuma into the arterial system, causing arterial diastole. The passing of pneuma through the arteries resulted in arterial systole. This belief is contrary to the one attributed to Herophilus and held by Galen that the arteries expand and contract actively and that their movements are simultaneous with those of the heart.84 The fragmentary nature of the remains of Erasistratus’ writing leaves wide lacunae in our understanding of his theoretical and practical work but our sources do offer us a consistent picture of certain aspects of his thought that inform the theoretical background of his physiological beliefs. The doxographical tradition associates Erasistratus with the early Peripatos, variously as a student of Theophrastus or a relative of Aristotle’s.85 Scholars have plausibly argued that he derived some of the mechanical principles underlying his physiological theory from Strato of Lampsacus, another early Peripatetic who studied under Theophrastus, if not from Strato himself.86 This association may be prima facie puzzling to readers of Galen, since he frequently hectors Erasistratus and Erasistrateans for their alleged hostility toward teleological explanations of the body’s physiology. Whatever the historical reality underlying the tradition, Galen’s repudiation of the connection is worth examining, since it reflects what Galen characterizes as a central philosophical difference between him and Erasistratus, as well as later Erasistrateans. Galen is sensitive to Aristotle’s teleological commitments, of which he approves in the main. On those occasions when he faults Aristotle’s teleology, he does so only on the grounds that it is insufficient. However, Galen characterizes Erasistratus as eschewing teleological accounts in favor of mechanistic explanations of biological processes, merely offering a pretense of valuing goal-directed explanations. It is worth noting, however, that mechanistic and teleological accounts are not contraries, and that these sorts of accounts were not always treated as contraries by Greek and Roman philosophers and physi-

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See, e.g., Us.Puls. 5 (214 F-W = v.168–169 K.) and AA 7.14 (684–686 Garofalo = ii.635 K.). See fr. 5 Garofalo (Sextus Emp. Adv.Math. 1 258 Mau); fr. 6 Garofalo (Nat.Fac. 2.4, SM 3, 166 = ii.90 K.); fr. 7 Garofalo (D.L. 5.57); and fr. 8 Garofalo (Pliny NH 29.5). For an overview of the sources, see Garofalo (1988: 17–22). On Erasistratean claims about Erasistratus’ Peripatetic lineage, see Art.Sang. 7 (174 F-W = iv.729 K.); Nat.Fac. 2.4 (SM 3, 165.7–12 = ii.88 K.); and Diogenes Laertius 5.57. See also Scarborough (1985b) and von Staden (1997b). See von Staden (1992).

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cians.87 Von Staden makes the point that Galen’s attacks against Erasistratus, on the grounds of his perceived opposition to teleological arguments, target Erasistratus as a surrogate for Aristotle, whose teleological commitments were unimpeachable from a historical perspective but were less thoroughgoing than Galen’s.88 Aristotle occupies a place of intellectual importance in Galen’s writing, as well as among many of the elite Romans in whose circles Galen traveled.89 Targeting Erasistratus and his alleged teleological failings allowed Galen to inveigh against the weaker teleology of Aristotle and ideas held by contemporary Peripatetics without impugning Aristotle himself. This accusation is one of a series that lies in the background of Galen’s account of the demonstration. Here it will be fruitful to revisit the sketch of issues in third-century physiological theory I have drawn, since it is to this picture that Erasistratus would have been responding. One point of confusion in our discussion of the femoral artery experiment has been over its bearing on the question of arterial content in its Hellenistic incarnation. I have argued that in Galen’s work the experiment is bound up with at least one other in a complex of demonstrations aimed at second-century Erasistrateans.90 Galen does not deny that the arteries contain pneuma; he denies that they only contain pneuma. The denial arises in part from the brute observation that when arteries are perforated, they bleed. It is also deeply rooted, however, in Galen’s rejection of a model of arterial movement in which their pulsation is progressive and is caused by the rapid movement of arterial content. There would have been little reason, or indeed 87

88 89

90

For discussion of the opposition between teleology and mechanism as a relatively modern phenomenon, see Berryman (2002) and von Staden (1997b: 183–196). The argument examines some of Aristotle’s own use of mechanical explanations at a local level in support of global teleological principles in biological and astronomical contexts. Von Staden argues for a strand of Hellenistic scientific activity, to which Erasistratus belonged, that embraced this feature of Aristotelian inquiry into animal bodies. See von Staden (1997b: 197). Figures such as Flavius Boethus and Eudemus played central roles in the advancement of Galen’s professional career in Rome. As I have mentioned, Boethus was such an important figure in Galen’s professional that Galen dedicated many of his anatomical treatises to the man. I mean here the ancillary demonstration mentioned in Art.Sang. 6 (168–170 F-W = iv.723– 725 K.), in which Galen ligates the artery at two points and then dissects the segment between the ligatures to show that the artery contained blood before it had been cut. The Kühn reference to this passage requires brief explanation. At some point in the Greek manuscript tradition, a few pages of Whether Blood is Naturally Contained in the Arteries seem to have been moved out of order. Kühn’s pagination reflects the shuffled pages. Arabic manuscripts fill in some lacunae and allow the pages to be reordered. These issues do not affect the reference directly, but they do result in some confusion with the pagination. See Furley and Wilkie (1984: 265 n. 44).

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occasion, for Erasistratus to defend his belief that the arteries are pneumabearing under non-pathological circumstances. While the pneumatic view of the arteries may not have been universal, as we have seen it did lay squarely in the mainstream. Therefore, there is no antecedent reason to link theoretical differences over the cause of arterial pulsation in the Hellenistic period with disputes over their contents, which are better attested in later centuries. Simply put, in the third century bce the belief that the arteries contained only pneuma would not have been a controversial one. Without such a motive, there is little cause to suppose that Erasistratus’ experiment aimed beyond defending the more heterodox features of his account of arterial function. If we put the question of arterial content to one side for a moment, we are left with the following points on which Erasistratus seems to have deviated from earlier theorists: 1) the pulse is a passive movement of the arteries that is a consequence of mechanical forces affecting the vascular walls; 2) in response to these forces each phase of the arterial cycle alternates with the corresponding phase of the cardiac cycle; and 3) to explain arterial action in these mechanical terms the arteries must be impermeable, or at least they must be impermeable to any substance that might escape them.91 On a straightforward reading, the experiment is constructed as an effective refutation of Erasistratus’ opponents on all three of these points. The cannula allows material to continue to flow through the arterial lumen, while isolating the potential for the active movement of the arterial walls. Thus it demonstrates 1) whether arterial pulsation reflects the pressure exerted by the movement of the vessel’s contents. All other things being equal, the truth of 2) follows from the truth of 1), and plausibly requires the truth of 3). The experiment derives its probative force by examining a single question: do the arterial walls play a necessary part in whatever physiological process underlies the pulsation of the arteries?92

7

Erasistratus and Void

The notion that the arterial walls moved only passively in response to the force of their contents, and the related claim that their pulsation advanced progressively throughout the body required an explanatory principle to account for 91 92

See, e.g., Garofalo (1988: 34). The demonstration in Whether Blood is Naturally Contained in the Arteries, to which the narrative of Anatomical Procedures refers, suggests that Galen considered it to be evidence against the view that the contents of the arteries caused pulsation. See, e.g., Art.Sang. 8 (178 F-W = iv.732 K.). Cf. Us.Puls. 5 (214 F-W = v.167–168 K.).

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the movement of pneuma. Erasistratus believed that many if not most physiological processes involved the mechanical principle PTKA (πρὸς τὸ κενούμενον ἀκολουθία), according to which more rarefied material is always displaced by denser material on the grounds that voids, at least massed ones, do not naturally occur.93 Galen summarizes the view in On the Natural Faculties, where he relays an Erasistratean demonstration of it in action: [Erasistratus] believes it is true above all that if something flows out of the veins one of two things must be the case: the space [left behind] will be a massed void or there will be a continuous and proportionate influx to fill the vessel being emptied … for in the case of reeds and pipes that are submerged in water it is true to say that if the air contained inside of them is evacuated, then there will either be a massed void [left behind] or a continuous influx [of water] will follow [the evacuation of the air]. However, in the case of veins [the argument] no longer follows since their walls can collapse on themselves. For this reason they can cave in the interior channel [of the veins]. Consequently, the—by god, I cannot call it a demonstration rather the—Erasistratean assumption about influx toward what is evacuated (PTKA) is false.94 On Erasistratus’ view, the chest or thorax expands after exhalation. In virtue of PTKA, air is drawn into the lungs through the trachea and bronchial tubes

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For a detailed discussion of PTKA, see Furley and Wilkie (1984: 32–37); Garofalo (1988: 33–35); Berryman (1997); and Lehoux (1999). See also Vallance (1990: 62–79), from whose work on Asclepiades of Bithynia the abbreviation and its rationale derive. These processes include respiration and the movement of blood through the venous system, the so-called anadosis of nutriment and the expulsion of residues or waste. See fr. 74 Garofalo (Nat.Fac. 1.16, SM 3, 146–147 = ii.62–63 K.). For a representative sample of the principle as attributed to Erasistratus, see fr. 74 Garofalo (Nat.Fac. 1.15–16, SM 3, 145–150 = ii.60–67 K.), fr. 136 Garofalo (Nat.Fac. 2.1, SM 3, 155 = ii.74–78 K.); fr. 49a Garofalo (AA 7.16, ii.648–649 K.); fr. 109 Garofalo (Art.Sang. 3, 150 F-W = iv.709 K.); fr. 110 Garofalo (Diff.Puls. 4.2, viii.703 K.); fr. 198 and 212 Garofalo (Ven.Sect.Er. 3, xi.153–156 K.); and fr. 93 Garofalo (Purg.Med.Fac. 2, xi.328 K.). Nat.Fac. 2.1 (SM 3, 155.17–21 … 25–156.8 = ii.75–76 K.), which includes fr. 136 and fr. 95 Garofalo: καίτοι γ’ οἴεται παντὸς μᾶλλον ἀληθὲς ὑπάρχειν, ὡς, εἴπερ ἐκ τῶν φλεβῶν ἀπορρέοι τι, δυοῖν θάτερον ἢ κενὸς ἔσται τόπος ἀθρόως ἢ τὸ συνεχὲς ἐπιρρυήσεται τὴν βάσιν ἀναπληροῦν τοῦ κενουμένου … ἐπὶ μὲν γὰρ τῶν καλάμων καὶ τῶν αὐλίσκων τῶν εἰς τὸ ὕδωρ καθιεμένων ἀληθὲς εἰπεῖν, ὅτι κενουμένου τοῦ περιεχομένου κατὰ τὴν εὐρυχωρίαν αὐτῶν ἀέρος ἢ κενὸς ἀθρόως ἔσται τόπος ἢ ἀκολουθήσει τὸ συνεχές· ἐπὶ δὲ τῶν φλεβῶν οὐκέτ’ ἐγχωρεῖ, δυναμένου δὴ τοῦ χιτῶνος αὐτῶν εἰς ἑαυτὸν συνιζάνειν καὶ διὰ τοῦτο καταπίπτειν εἰς τὴν ἐντὸς εὐρυχωρίαν. οὕτω μὲν δὴ ψευδὴς ἡ περὶ τῆς πρὸς τὸ κενούμενον ἀκολουθίας οὐκ ἀπόδειξις μὰ Δί’ εἴποιμ’ ἂν ἀλλ’ ὑπόθεσις Ἐρασιστράτειος.

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to fill space that might be left in the lungs as they expand. Some bodily heat and waste leftover from the respiratory process are expelled in the contraction of the lungs. Erasistratus appears to have believed that cardiac movement was active, unlike that of the lungs and arteries.95 When the heart expands in diastole, some pneuma that is processed air or extracted from the air (the details of his account do not survive), is drawn into the left ventricle through our pulmonary vein, their “vein-like artery” (φλεβώδης ἀρτηρία).96 This pneuma is then worked up into vital (ζωτικόν) pneuma by the left ventricle of the heart, whose systole expels it into the arterial system with tremendous force.97 The arterial system conveys pneuma to the muscles, whose contraction and relaxation Erasistratus conceived as pneumatic.98 Pneuma is also conveyed to the brain, where Erasistratus believed it was processed into “psychic pneuma”.99 The psychic pneuma is distributed from the brain throughout the nervous system by PTKA.100 The movement of pneuma throughout the arterial system is effected by mechanical forces exerted by cardiac systole; however, it is also likely that it occurs in accordance with PTKA—by analogy to the movement of blood in the veins and psychic pneuma in the nerves.101 Fresh pneuma rushes in to replace any spaces that might be left behind by whatever pneuma the body uses.102

95 96

97 98 99 100

101 102

See AA 7.4 (630.23–632.4 Garofalo = ii.597 K.). On Erasistratus’ pneumatic theory, see Leith (2020). See, e.g., Anon.Lond. 23 (31.12–36 Ricciardetto); Art.Sang. 2 (148 F-W= iv.706 K.); and PHP 6.6 (CMG v 4,1,2 396.3–33 = v.548–550). Cf. Nat.Fac. 2.1 (SM 3, 156.21–157.4 = ii.77 K.). For the most part, Greek anatomical writing identifies what we call the “pulmonary artery” as the “arterial vein” (ἀρτηριώδης φλέψ) and what we call the “pulmonary vein” as the “veinlike artery” (φλεβώδης ἀρτηρία). The terminology is attributed to Herophilus, who explicitly refers to the ἀρτηριώδης φλέψ in fr. 117 vS (Rufus Onom. 203–204 = 162 Daremberg/Ruelle). See von Staden (1989: 240 n. T117). See fr. 105 Garofalo (Loc.Aff. 5.3, viii.316 K.). See fr. 54 Garofalo (Loc.Aff. 6.6, viii.429 K.). See fr. 112 Garofalo (Ut.Resp. 5, 122 F-W = iv.502 K.) and fr. 112b Garofalo (PHP 2.8, CMG v 4,1,2, 164 = v.281 K.). On Galen’s report, Erasistratus’ views on the source (archē) of the nervous system developed over time. Initially he believed that the nerves originated in the dura mater, but later came to hold that that they radiated from the brain itself. See PHP 7.3 (CMG v 4,1,2 440.20– 442.18 = v.602–604 K.) and Hipp.Aph. 50 (xviiia.86 K.). Cf. von Staden (2000: 93). See fr. 99 Garofalo (Ut.Resp. 2, 80 F-W = iv.471 K.). Erasistratus’ view on the function of respiration as a replenishment of used pneuma bears affinities with surviving reports of Praxagoras’ and Phylotimus’ beliefs (Ut.Resp. 2, 96 F-W = iv.483 K.). In contrast to more typical Greek models of respiration (e.g., those of Philistion, Diocles, Aristotle, and to a certain extent Galen), in which the air or pneuma involved in the respiratory process serve to regulate internal temperature.

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Since on this model the pulse is caused by the movement of pneuma from the heart through the arterial system, it is perforce progressive. It also follows from a progressive model that diastole at a given point in the system is preceded by systole at earlier points. This mechanical explanation of arterial function and its consequences was rebarbative to Galen,103 who argued that mechanistic accounts failed to be explanatory of the body’s reaction to select stimuli. As we have seen, Galen was committed to the additional view that organs possess a suite of capacities in virtue of which each organ operates.104 In order for pneuma to course through the arterial system through the forces exerted by cardiac systole and PTKA, the vessels containing pneuma cannot be permeable to it. At the very least they cannot allow pneuma to escape in significant quantities, nor can they allow the entrance of foreign material under healthy circumstances.105 Consequently, the demands of Erasistratus’ vascular physiology bar all of the views of arterial breathing that Galen groups under the broad class of transpiration (διαπνοή), a point that is crucial to understanding Galen’s use of the femoral artery experiment as a defeater of Erasistratus’ theory of the pulse. Indeed, Erasistratus’ criticism of Plato’s theory of circular breathing independently suggests that he denied the permeability of the arterial walls.106 At its most expansive, transpiration can accommodate a cluster of beliefs that includes Galen’s complex theory of arterial breathing, the looser notion of cutaneous breathing, respiration through the whole body (καθ’ ὅλον τὸ σῶμα), and the imperceptible emanation of effluvia (κατὰ τὴν ἄδηλον καλουμένην διαπνοήν).107 Erasistratus’ belief that the body releases imperceptible material through the surface of the skin does not commit him to a

103 104

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For recent discussion of the theoretical issues at stake for Galen over the precise explanatory power of PTKA, see Adamson (2014). The organ has capacities for 1) drawing beneficial material to itself (ἑλκτική), 2) retaining this material (καθεκτική) while altering it (ἀλλοιωτική), and finally 3) expelling the byproducts of alteration (ἀποκριτική). See, e.g., Nat.Fac. 3.1 (SM 3, 204–205 = ii.143–145 K.), 3.9 (SM 3, 230 = ii.178 K.); and Symp.Diff. 4 (CMG v 5,1 228.19–230.2 = vii.63 K.). Cf. UP 7.8 (i.392.25–393.6 = iii.540 K.). See fr. 113 Garofalo (Plat.Tim. 3.18 and 3.19, CMG Supp. 1 24.21–25 and 25.21–24). My point here is an extension of Leith’s (2020: 135) observation about this reference, which he takes to suggest that Erasistratus did not appeal to a theory of cutaneous breathing in his account of respiration. Galen also refers to these imperceptible emanations as “invisible to perception” (ἄδηλον αἰσθήσει) and “perceptible to reason” (λόγῳ θεωρητόν); see Hipp.Epid.6.4.22 (CMG v 10,2,2 232–233 = xviib.193–194 K.). Galen writes that this form of emanation has no name because it is not commonly known or discussed (San.Tu. 1.12, CMG v 4,2 31 = vi.67 K.). On invisible perspiration or effluvia, see Renbourn (1960) and Debru (1996: 184–187).

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version of cutaneous breathing, and it cannot commit him to one in which the breathing of permeable arteries played a role. The common conflation of these three views—arterial breathing, cutaneous breathing, and the emanation of effluvia—with one another in antiquity elides an important distinction between Galen’s and Erasistratus’ competing theories of arterial physiology. On Galen’s model, the physiological process underlying the pulse is qualitative. Its primary role is the regulation of the body’s innate heat. Pneuma in the lungs alters blood in the heart during respiration. The arteries draw this blood into themselves and elaborate it further through metabolic processes involved in arterial breathing. The simultaneous expansion and contraction of the arteries is an integral part of this respiratory process.108 Galen’s physiological model envisions the movement of blood through the arterial system as a process distinct and, as far as I can tell, at least somewhat unrelated to the movement of the arterial walls. Pneumatized blood moves through the arteries in virtue of the force exerted by a mechanical principle of attraction analogous to PTKA, as well as by the attractive capacity of different organs to draw suitable materials to themselves when they are nearby. Galen’s typical models for arterial blood flow are irrigation networks and hearths that radiate heat throughout a home, in some instances through pipes. He is consistent in saying that the arteries pulsate in service to the maintenance of the body’s vital heat, which is carried from the heart in the blood and vital pneuma of the arteries. The intake and expulsion of pneumatic materials during arterial breathing aids in the stoking of innate heat in the blood stream and in the elaboration of blood but not in its movement. Consequently, Galen’s model requires that the arteries be permeable and that, like the lungs, they contract and expand all at once. By contrast, on the Erasistratean model the physiological process is quantitative, analogous to the body’s absorption of nutrients. During respiration, fresh pneuma is supplied from the heart through the arterial system to replace pneuma consumed by the living body. The force of pneuma coursing through

108

In diastole they take in small amounts of pneuma through pathways connecting cutaneous and arterial pores. In systole the arteries expel waste products that arise from further changes in the blood as it is processed in the arteries. Galen refers to these waste byproducts as vaporous (ἀτμώδη) and fuliginous (καπνώδη) in UP 9.1 (ii.2.18 Helmreich = iii.686 K.). They are formed by a heating process that takes place in the heart and arteries; finally they are expelled through sutures in the cranium and soft tissues. See UP 9.1 (ii.3–4 Helmreich = iii.687–688 K.).

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the arterial system causes the vessels to pulsate, in a wave-like motion that radiates from the heart. This process consists in the systolic activity of the heart and in accordance with PTKA. It therefore requires impermeable or nearly impermeable vessels for its operation, since permeable vessels would allow material from other sources besides the heart to enter their channels interfering with the course of its pneuma. If one elides these important differences between Galen’s theory of arterial breathing and the other views that belong in the conceptual orbit of transpiration, it becomes easy to overlook the force of the femoral artery experiment in Galen’s attack against Erasistratus’ physiological theory. It likewise becomes more difficult to appreciate the significance of drawing the right sorts of conclusions from the experiment for Galen’s own theory of respiratory physiology.

8

Erasistratus, the Bird, and the Bear

Erasistratus believed that bodies continually emanated material that was not perceptible by direct observation, a belief that bears a superficial resemblance to Galen’s system of arterial breathing. Armelle Debru has argued that the general association between a range of transpirational views may be explained by a tendency of the expiratory phase of cutaneous respiration to be conflated with other kinds of exhalations from the body, such as the emanation of bodily effluvia.109 The issue of permeability has significant bearing on both Erasistratus’ and Galen’s models of arterial physiology. Galen’s view of arterial function of course requires that the arterial walls be at least semi-permeable. As we have seen, Erasistratus’ belief that the body releases imperceptible effluvia need not commit him, crucially, to the view that the arterial walls are permeable. Indeed, on this view it is important that they not be, since the arterial walls must retain their pneumatic contents even under the tremendous pressure of the heart’s bolus and the full movement of pneuma through the vessels requires interstitial vacuum for its operation. The details of Erasistratus’ belief in bodily effluvia are reported in Anonymus Londinensis. They arise in a broader discussion of other ancient emanation theories that aimed at explaining a range of phenomena, such as evaporation and the ability of hounds to track by scent. Here, Anonymus reports a famous experiment to whose results Erasistratus appealed as evidence that living bodies must release invisible effluvia:

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Debru (1996: 184).

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And Erasistratus attempts to establish the proposition this way: if someone takes an animal (e.g., a bird or any animal of about the same size), places it in a cauldron for some time while withholding food, and then weighs it along with the waste it has perceptibly evacuated, that person will find that it is far lesser in weight. [Therefore] it can be perceived clearly by reason that a significant emanation (ἀποφορά) has occurred.110 The experiment is important for a series of reasons, two of which concern the present discussion. The first is methodological and bears on the more general picture I am sketching of Erasistratus’ approach to experimentation. One can observe that the animal effluvia experiment bears structural affinities to the femoral artery demonstration. Both are empirical tests conducted under artificial conditions. They aim to support theoretical explanations of physiological phenomena, such as the operation of the pulse and, in this case, whether the process of absorbing nutrients results in the loss of some bodily substance. Each experiment attempts to control for at least some variables that might otherwise underdetermine the experimenter’s conclusions. In the case of the pulse experiment, the demonstration attempts to interrupt any capacity that might flow through the arterial walls while allowing for the free movement of their contents. The effluvia experiment attempts to isolate perceptible sources of the subject’s material diminution. For reasons I have already mentioned, I think it very likely that Erasistratus devised the femoral artery experiment. Regardless of the truth of this belief, however, Anonymus’ attribution of the effluvia experiment to him offers a sense of Erasistratus’ association with demonstrations of this sort in the medical doxographical tradition at about Galen’s time. The second and more immediate reason for the relevance of the effluvia experiment to this discussion is what it permits us to say about the kinds of theoretical commitments that Erasistratus may have had to any of the different beliefs that fall under the umbrella of transpiration. Minimally, the effluvia experiment commits Erasistratus to the view that under healthy conditions the body sheds or emanates material, a process that is only perceptible through 110

Anon.Lond. 33.44–51 (48.44–51 Ricciardetto): καὶ Ἐραϲίϲτρατο[ϲ] πειρᾶται κ(ατα)ϲκευάζειν τὸ προ[τ]ε̣θ̣(έν̣ ̣)· Ἐἰ̣ γ(ὰρ) λάβοι τιϲ ζῶιον οἷον ὄρνιθα ἤ τι τ(ῶν) παραπληϲίων, καταθ̣οῖτο δὲ τοῦτο ἐν λ̣ έβητι ἐπ̣ ί τ̣ιναϲ χρ̣ο̣ν́ ̣ο̣υ̣ϲ μὴ δοὺϲ τροφήν, ἔπειτα [ϲταθ]μ̣ ῆ̣ ϲ̣α̣ι ̣ ϲυ̣ ̣̀ν̣ [τ]ο̣ῖς ϲκυβάλοιϲ τοῖϲ αἰϲθη(τῶϲ) [κε]κ̣ ενωμένο̣ι ̣ϲ̣, εὑρήϲει παρὰ πολὺ ἔλαϲϲο̣ν̣ τ̣οῦτο τῶι ϲταθ̣μῶι τῶι δηλον πολλὴν ἀποφορὰν γεγενῆϲθαι κ(ατὰ) τὸ λόγωι θεωρητό̣ν.

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reason (κ(ατὰ) τὸ λόγωι θεωρητό̣ν).111 Such a process need not occur through cutaneous pores. However, this seems precisely to be the sort of view that Galen ascribes to Erasistratus: Erasistratus says this [sc. that hibernating animals can survive without taking food] and also offers the explanation. For he says that every animal naturally breathes (διαπνεῖσθαι) along the outer surface of its skin, either more or less, relative to its permeability … And for this reason hibernating animals do not need food, seeing as nothing flows out [of the surface of their skin] since they become cold, slow, and thick throughout their bodies because of inactivity and the outer surface of their skin constricts in the wintertime cold (in which season animals hibernate). Therefore, there is no need to replenish an evacuation. This is the purpose of nourishment and it is for this reason that animals remedy the loss [of material] due to evacuation with food.112 Although it is worth being cautious about Galen’s accounts of other authors’ theoretical views, his report of the mechanism underlying the loss of invisible material in the process of emanation in living bodies is reasonable.113 Furthermore, details in Galen’s reference to hibernation strengthen the association 111

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Galen often uses this locution in the context of vascular anatomy and physiology, and in discussions of Erasistratus’ views on the subject. He does so throughout Nat.Fac. 2.6, but see especially 2.6 (SM 3, 171.5–10, 171.26–172.3, 173.9–15, 177.4–10 = ii.96, ii.97, ii.99, ii.104– 105 K.). Also see UP 7.8 (i.390.21–391.7 Helmreich = iii.537–538 K.). Unsurprisingly, in Galen’s system the phrase is associated with theoretical structures such as cutaneous poroi that help to explain the process of transpiration (diapnoē). See, e.g., MM 13.2 (x.876 K.). He attributes the terminology to the so-called modern (neōteroi) physicians (Hipp.Epid. 6.4.22, CMG v 10,2,2 232.20–233.4 = xviib.193–194 K.). Ven.Sect.Er. 9 (xi.183–184 K.): … καὶ τοῦτ’ αὐτὸς ὁ Ἐρασίστρατος λέγει καὶ τὴν αἰτίαν προσθίτησιν. ἅπαν γὰρ, φησὶ, ζῷον [τὸ]* κατὰ τὴν ἐκτὸς ἐπιφάνειαν διαπνεῖσθαι πέφυκεν, ἀλλ’ ἢ πλέον ἢ ἧττον, ὡς ἂν καὶ μανότητος ἔχει … καὶ διὰ τοῦτο μὴ δεῖσθαι τροφῆς τὰ φωλεύοντα. ἅτε γὰρ ψυχρῶν μὲν καὶ ἀργῶν καὶ παχέων τῶν καθ’ ὅλον τὸ σῶμα διὰ τὴν ἡσυχίαν γιγνομένων, πυκνουμένης δὲ τῆς ἐκτὸς ἐπιφανείας ἐν τῷ χειμερινῷ κρύει, καθ’ ἣν ὥραν φωλεύει τὰ ζῷα, μηδὲν ἐκτὸς ἀπορρεῖν. οὐκοῦν οὐδὲ τοῦ πληρώσοντος τὸ κενούμενον δεῖσθαι. χρεία δ’ ἦν αὐτῇ τροφῆς καὶ διὰ τοῦτ’ ἐπ’ αὐτὴν ἔρχεται τὰ ζῷα τὴν ἐκ τῆς κενώσεως ἔνδειαν ἰώμενα. *I read ἅπαν γὰρ, φησὶ, ζῷον [τὸ] rather than Kühn’s ἅπαν γὰρ, φησὶ, τὸ following Brain (1986: 36, n. 60). However, the context of Anonymus’ discussion suggests that Erasistratus’ experiment was intended to be explanatory of phenomena in which one could not appeal to cutaneous pores, such as evaporation and the heat-loss of bread. It is of course possible that Galen is merely recasting an Erasistratean theory in more Galenic terms, or that Anonymus has stretched the explanatory ambit of Erasistratus’ effluvia experiment beyond its original bounds. The latter seems more probable given that Erasisistratus’ intellectual interests, as reported in surviving fragments and testimonia, are so focused on living bodies.

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between emanation and nutrition as parts of a single physiological process, also made by Anonymus in the broader context of his discussion of the effluvia experiment. The picture that emerges from these accounts is fundamentally digestive, aimed at explaining the body’s absorption and evacuation of nutritional foodstuffs. Indeed, as the quoted passage shows, Galen himself reports that Erasistratus intended the bear observation as evidence to support his theories of digestion and nourishment. The mass lost by the body during emanation and other evacuations is the sort as to be replaced by foodstuffs. Pneuma does not appear in these contexts nor is it suggested that pneumatic material is among those non-visible effluvia evacuated from the body. Indeed, while the effluvia experiment conspicuously controls for the materials contained in food and all visible excreta, it is neutral to the possible relevance of the animal’s breathing. Neither Anonymus nor Galen intimates that Erasistratus conceived of emanation as a respiratory process in these passages. These examples also lack the exchange of material through the skin that figure so prominently in the definitions of cutaneous breathing (διαπνοή) in Medical Definitions, both of which pair the exhalation of material through cutaneous pores with a corresponding inhalation: Transpiration (διαπνοή) is an involuntary attraction of air by the natural heat that occurs through the surface of the body together with the release of its effluvia. Another definition: transpiration is an attraction of external air aided by a natural tendency through the whole body and then its expulsion back out again through the body’s vents.114 If we distinguish Erasistratus’ belief in the body’s loss of imperceptible effluvia from other transpirational views, it becomes easier to see how out of place cutaneous and arterial breathing are in an Erasistratean physiological system. Galen’s theory of respiration, through the lungs and the arteries, is a primarily alterative not additive process. The thermal qualities of pneuma interact with the body’s innate heat so as to maintain it. But, no appreciable amount of ambient air or pneuma passes into the body beyond the barrier of the lungs and left ventricle of the heart. The loss of effluvia is quantitative; the body is diminished in size. Like his model of respiration, Erasistratus’ model for the body’s loss of imperceptible matter supposes that the physiological processes add material to replace material that the body consumes or is lost in some other fashion. 114

[Ps.-Galen] Def.Med. 109 (xix.375 K.): Διαπνοή ἐστιν ὁλκὴ ἀέρος ἀπροαίρετος ὑπὸ τοῦ φυσικοῦ θερμοῦ διὰ τῆς ἐπιφανείας ἅμα τοῖς συναπερχομένοις αὐτοῦ σώματος γινομένη. ἑτέρως. διαπνοή ἐστιν ἐκ τοῦ σώματος ὁλκὴ ἀέρος μετ’ ὀρέξεως φυσικῆς δι’ ὅλου τοῦ σώματος καὶ πάλιν δι’ ἐξόδων ἀπόκρισις.

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Erasistratus and the Femoral Artery Experiment

In its original third-century context, there is no evidence that the question of whether the arteries contain pneuma was a flashpoint for debate. Indeed, it is implausible that it would have been. While Herophilus may have believed otherwise, his view was an outlier; pneumatic models of arterial vessels had been common enough among medical theorists from the time that Praxagoras distinguished arterial from venous systems. Erasistratus’ model of the arterial system would, therefore, have fallen well within the intellectual mainstream. In light of this observation, it is noteworthy and should occasion little surprise that no surviving references to Erasistratus’ experimentation or to the views he challenged suggest that he addressed or attempted to refute a view like the one Galen attributes to Herophilus. There is, of course, ample evidence that later Erasistrateans offered arguments in defense of the pneumatic view of arterial contents. These arguments, however, reflect the changing theoretical landscape of arterial function in the Imperial Period. With the question of arterial content to one side, it is possible to offer the following account of the Hellenistic arterial experiment. Erasistratus would have deployed the experiment to support his belief that the arteries pulsate passively and to refute the claim that pulsation is an active movement of the arterial walls, a claim to which Herophilus adhered. The explanatory core of Herophilus’ account of arterial action was in agreement with Praxagoras’ views. Both believed that the arteries pulsated in virtue of a capacity for movement, even if Herophilus disagreed with his teacher over the capacity’s source. Erasistratus’ explanation of the cause of the pulse, however, ran against the fundamental grain of these competing accounts of the pulse. His predecessors seem to have agreed on the kind of mechanism responsible for pulsation. Erasistratus’ account rejected it in favor of an entirely different physiological process that operated on mechanical rather than dynamic principles. Crucially, these principles were inherent neither to the arteries nor to the heart. As a result, Erasistratus not only introduced a novel causal mechanism for the perceptible motion of the arteries, he also had to defend it. The experiment that defended Erasistratus’ mechanical explanation of arterial function is conceptually effective as a refutation of the view that the arteries pulsate actively. It would have taken a capacity for movement transmitted through the arterial walls as a necessary condition for pulsation. The cannula inserted into the artery provides a hard surface on the inside of the artery against which a ligature, placed on the outside of the vessel, could be tightened without obstructing its lumen. Should there be a pulsative capacity in the arteries, the procedure would interrupt its transmission through the arterial walls.

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One can presume, by minimal appeal to the principle of charity, that Galen’s later description of the pulsative capacity as “flowing” (ἐπιρρέουσα) more or less captured the way in which the capacity was conceived by these earlier authors as extending throughout the arterial system.115 If this report is accurate, Erasistratus could isolate the arterial walls while allowing for the movement of material through the artery itself. On the active Herophilean model, transmission of a pulsative capacity is necessary for pulsation. By modus tollens, for Herophilus’ argument to hold, the experiment must demonstrate that pulsation distal to the point of interruption ceases. On the Erasistratean view, there is no capacity transmitted through the arterial walls. The movement of pneuma through the arteries is a consequence of the forces exerted by cardiac systole and PTKA. Therefore, so long as the inserted tube did not obstruct the lumen or channel of the artery, one should expect to observe the continued pulsation of the arteries beyond the ligatures. According to Galen, Erasistratus conducted the experiment and observed that the artery under examination continued to pulsate on the distal side of the ligatured cannula, refuting both Herophilus’ and Praxagoras’ etiologies of the pulse.116 This, I argue, was the aim of Erasistratus’ version of the experiment. If this argument is correct, Erasistratus’ experiment is not just a corroborative test of his own theory of arterial pulsation.117 It is an early attempt to falsify the claims of other theorists through experimental means, placing evidence for at least some experimental falsification long before Galen marshaled such evidence to disprove Erasistratus’ explanation of the arterial pulse. From a formal point of view, Galen’s iteration of the arterial experiment is not especially effective at refuting Erasistratus’ theory of vascular physiology. In my view, this fact is a probable outgrowth of the demonstration’s Erasistratean origins. In the event that the arteries cease to pulsate distal to the ligated section it is more difficult to say what if anything has been proven. This result,

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For some representative examples, see Nat.Fac. 3.14 (SM 3, 249.14–17 = ii.204 K.); AA 7.4 (630.23–32.9 Garofalo = ii.597 K.); Foet.Form. 5 (CMG v 3,3 82.18–84.6 = iv.679–680 K.); PHP 7.1 (CMG v 4,1,2 428.17–21 = v.587 K.), 7.4 (CMG v 4,1,2 448.4–24 = v.611–612 K.), and 7.5 (CMG v 4,1,2 454.29–456.4 = v.620–621 K.); Caus.Symp. 1.8 (vii.140 K.) and 2.2 (vii.159 K.); and Diff.Puls. 4.6 (viii.733 K.). AA 7.16 (704 Garofalo = ii.648 K.). Von Staden (1975: 180, 182–183) understands Galen’s femoral artery experiment as an attempt to refute Erasistratus’ theory of arterial pulsation. While he is agnostic about Erasistratus’ experimental aims, given the available evidence, von Staden suggests that Erasistratus’ femoral artery experiment was a corroborative test for some hypothesis having to do with his arterial theories, like his effluvia experiment and most other early ancient experiments.

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which Erasistratus did not observe, is consistent not only with the interruption of a capacity’s transmission through the artery, but also would follow from any interference in the flow of pneuma or blood through the artery. Indeed, this has been the precise stumbling block for modern attempts at replicating the procedure. Galen, however, can construe the results of his experiment as a far more effective refutation of the Erasistratean position. Interference with the flow of material through the artery is less problematic to Galen’s arterial physiology, since for him the primary physiological role of the pulse is to draw in material surrounding the arteries and expel the byproducts of its alteration in the vessels. The movement of arterial blood through the vessels is a matter of lesser importance, accomplished in large part through the capacity (ἑλκτικὴ δύναμις) of different organs to draw suitable materials to themselves and through a set of mechanical principles similar to Erasistratus’ PTKA. Galen repositions the Erasistratean procedure in his own theoretical frame, reformulating the experiment in Galenic terms. Consequently, the results of the procedure can offer him a binary interpretation. If the pulse ceases, it must be caused by a capacity for arterial movement. If it does not, it must be caused by mechanical forces. Provided that the operation of the pulse is distinct from arterial flow through the vessel’s lumen, the question of obstruction has far less bearing on Galen’s interpretation of the procedure’s results. Galen’s version of the experiment has further ramifications for his physiological system in part because so many features of that system depend on the active movement of the arteries.118 If the arteries do not move actively, 1) the pulse should be seen as moving progressively; 2) as a consequence, arterial diastole should correspond to cardiac systole; and 3) it now becomes difficult if not impossible for him to explain the pulsation of the arteries in terms of a theory of arterial breathing. Finally, 4) the passive movement of the arteries would support a primarily mechanical explanation of arterial function, rather than the sort of dynamic account that Galen holds as a central explanans in his physiological theory. The consequence of 1–4 would be devastating for Galen’s theory of arterial breathing, his theory of capacities, and ultimately for his theory of vascular physiology. Galen’s appropriation of Erasistratus’ demonstration on the femoral artery and his use of it against his Erasistratean contemporaries proved to be a powerful polemical strategy. From a historical vantage point, Galen’s success was complete. Readers throughout the Renaissance and up to the present have read 118

There is no reason to suppose that Herophilus’ and Praxagoras’ broader physiological systems would have been necessarily threatened in the same ways as Galen’s, despite their shared belief in the arteries’ active movement.

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the femoral artery procedure in Galen’s terms and within the framework of his physiological theory. Erasistratus’s place in its history is frequently overlooked. When it is remembered, the Erasistratean experiment is assumed to have been identical with its Galenic counterpart—including its polemical, heuristic, and theoretical viscera. In recasting Erasistratus’ procedure in the framework of his own physiological theory, Galen engages in the kind of doxographical polemic that I have discussed earlier in this book. Galen’s narrative of his femoral artery experiment allows him to assert his intellectual authority over the past and, in virtue of its cultural cachet, over his contemporary rivals. He fashions himself, first and foremost, as an expert interpreter of Erasistratus’ writing—indeed, more expert than Erasistrateans of his day. Galen is no mere logiatros, though. He presents himself as capable of reproducing Erasistratus’ technically challenging demonstration, in contrast with his Erasistratean rivals who cannot deliver on their experimental promises. Galen’s strategy is more pointed still. In correcting Erasistratus’ observational results, Galen positions himself not only as an expert exegete of the ancient Greek intellectual tradition, but also as an equal to antiquity, the palaioi from whom so much of cultural and intellectual authority in the world of the second century flowed. Indeed, the strategy was so powerful that it was itself appropriated nearly thirteen centuries after Galen’s death by Vesalius, who fittingly turned the cannons of expert exegesis and the reinterpretation of Greek antiquity against Galen himself.

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De Galeni corporis fabrica: Writing Galen and the Greek Past in Vesalius’ Fabrica The publication of Andreas Vesalius’ De humani corporis fabrica in 1543 is often marked as a dramatic rupture with the past, not only in anatomical knowledge but also in anatomical method. Just over two centuries earlier in 1315, Mondino de Luzzi had famously conducted the public dissection of a human cadaver in Bologna. Mondino lectured on select anatomical passages—often Galenic. A second assistant indicated the anatomical structures under discussion to the audience. This assistant directed a third, who actually performed the manual dissection. Far removed from the learned physician, the body’s subordination to the book was brought into sharp relief by the physician’s title, lector or “reader”. Mondino’s demonstration ultimately provided the model for human dissection as it became a part of medical education in European universities. Vesalius, in the letter to the Habsburg emperor Charles v that prefaces the Fabrica, frames his own work as a necessary corrective to contemporary anatomical practice, the practice of 16th century Galenists, whose anatomical performances were infrequent and highly ritualized. Vesalius characterizes this break as both a return to ancient Greek medical practice and an advancement of it, especially as it was exemplified in the writing of Hippocrates and Galen. Historians of medicine have traditionally focused on how and to what degree Vesalius differs as an anatomical practitioner from his predecessors in the Fabrica. Until the end of the 20th century, this focus has typically been manifested in histories of physio-anatomical discovery and the revision of past ideas. More recently, scholars have come to examine not only Vesalius’ methodological debt to Galen but also his performative one. In discussing Vesalius’ vivisectory practice,1 for example, Andrew Cunningham puts the point nicely: This is all very exciting; it is brilliant theatre. In its way it is also very moving: feel with your own hands, and trust them. But why was Vesal1 On Vesalius’ approach to the performance of vivisections (on non-human animals), see De humani corporis fabrica libri septem 7.19 (1543: 658–661, [662–663]) = (1555: 818–824). For my style of reference for Vesalius, see p. 200, n. 7. Unless mentioned otherwise, all references to the published writing of the other 16th and 17th century physicians discussed in this chapter are to their original editions.

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ius performing vivisection demonstrations at all? Why these particular ones? And why was he saying ‘feel with your own hands, and trust them’? Because Vesalius as a vivisectionist was simply Galen restored to life. The use of vivisection to demonstrate certain phenomena was a technique employed to stunning effect (if we may trust his own account of it) by Galen in second-century Rome. And as we saw when discussing Galen, these particular things—the recurrent laryngeal nerves, whether the arteries pulsate of themselves or from the impulse of blood into them—these were Galenic specialities, to make Galen points against Erasistratus. And the rhetoric of participation, feel with your own hands and trust them, this too is the Prince of Physicians himself speaking. All this had been pioneered by Galen and performed by him publicly in Rome fourteen hundred years before.2 While Cunningham observes Vesalius’ emulation of Galen’s live anatomical demonstrations, his observation can and should, in my view, be extended to Vesalius’ emulation of Galen as a writer of anatomy. The close parallels between Vesalius’ presentation of himself in his written work—as a figure of both rupture and continuity—and Galen’s professional self-presentation have not received sufficient scholarly attention. For my purposes, these parallels underscore the tremendous influence that Galen’s polemical voice had on his later elite readers, in addition to the influence of his systems of anatomy, physiology, and nosology. Indeed, the polemical strategies that Vesalius deploys against Galenists of his day are fittingly modeled on Galen’s own, in particular what I have termed his doxographical polemic. Vesalius’ appropriation of this strategy is a key feature of Galen’s reception in his work, one which is perhaps obscured by Vesalius’ trenchant criticism of contemporary Galenists and his relatively more restrained correctives of Galen himself. As I have argued is the case for Galen, a crucial feature of Vesalius’ engagement with his opponents in the Fabrica is subtly to position himself as an ancient author redivivus by laying claim to what the “true” methods, practices, and ideas of Greco-Roman antiquity were.3 The strategy has the salutary effect of putting one’s erudition or paideia on display and of assuming the mantle of ancient authority.

2 Cunningham (1997: 115). 3 Cf. Cunningham (1997: 116): “He [Vesalius] was not just following what Galen said one should do in anatomy, but trying to be Galen in the present. This was the new Renaissance achievement of Vesalius: to emulate Galen the Ancient, in his own practice—not just to acquire a firm grasp of Galen’s doctrines by consulting the dissected body with book in hand …”.

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In Galen’s Rome of the second century, displays of cultural erudition served not only to authorize the medical practitioner but also to legitimize his practice of medicine.4 The same authorizing and legitimizing procedure held true for Vesalius and his anatomical practice in the 16th century. Although it is his anatomical illustrations that are often the focus of scholarly discussion, Vesalius, like Galen, was keen to establish and expand his professional authority through the sophisticated use of writing and written technology. The printing technologies available to Vesalius allowed him to put these illustrations to groundbreaking and well-documented effect in establishing his professional authority for an elite audience, in whose orbit was included Charles v himself. Like Vesalius’ appropriation of Galen’s doxographical polemic, the Fabrica shares in the basic project I have argued is a prominent and sophisticated aspect of Galen’s written work. It reperforms the credentialing features of public anatomical demonstrations in a written medium, through which Vesalius could expand his sphere of professional influence—as Galen had—beyond the limits of live performance.

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Books and Book Production

In 1525 the works of Galen were published in Greek for the first time by the Aldine press in Venice, appearing for the first time in print. They were followed by the works of Hippocrates in the next year. Physicians such as Niccolò Leoniceno and Thomas Linacre promoted the view that the many perceived errors of the Greco-Roman medical tradition were due to distortions introduced by later copyists and translators, especially in medieval European and Arabic translations but even earlier Roman ones.5 The fount of Greco-Roman antiquity, and in particular Greek antiquity, was pure. Its streams had merely become turbid with the shaky work of later hands. Consequently, philological acumen became a powerful tool of scientific discovery. The privileged position of paideia in Europe of the sixteenth century bore a close affinity to its place in intellectual culture of Rome in the second. Credentialing strategies followed suit. Not only was Vesalius well-positioned both to appreciate and to replicate Galen’s polemical method, but the stars of historical circumstance were also aligned.

4 The social status of medicine and the physician in the Roman west during the Imperial period could be precarious. See, e.g., Pleket (1995) and Temkin (1991: 59–60). Cf. Pliny NH 29.15–18. 5 See, e.g., Nutton (2014: lxxvi–lxxvii), (1989), and (1987: 26–27, 40–44). Cf. Cunningham (1997: 77–84) and French (1986: 256–281).

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The translation of Anatomical Procedures into Latin by Johann Guinther in 1531 had effectively introduced the treatise to contemporary European readers for the first time, since most could not read ancient Greek. By the time that Vesalius arrived at the University of Paris in 1533, the university’s recent acquisition of the Greek Aldine edition had ushered in a renewal of Galenic scholarship.6 Vesalius, who had been educated in Greek and Latin, was himself a part of the scholarly rush. While working on the Fabrica, he was involved in revising the Latin translations of Galen’s anatomical works in the 1541–1542 Giunta edition, most notably the 1531 translation of Anatomical Procedures written by his onetime mentor Guinther.7 In chapter one I discussed Galen’s careful attention to the production and dissemination of his written work. Galen would have copies of his writing made, which he then had deposited at provincial libraries so that they could be copied in turn. In at least some cases, Galen’s writing production was a serial process. He would “publish” books belonging to a larger treatise while still composing other sections of it, in an effort to promulgate and preserve his written work. When works or parts of them were lost, Galen would rewrite what had been lost to save his writing from the fire, so to speak. In a related vein, Galen took pains to organize his writing in autobibliographical treatises that not only contained an authorized catalogue of his written work, but also instructed the reader on how it should be read. The evidence for Vesalius’ attention to the production and distribution of his written work, now more properly thought of as publication, is far greater than it is for Galen even if only by dint of the comparatively greater amount of historical evidence we possess. The Fabrica is a massive book, whose construction, price, and language combined to exclude all but very well-heeled intellectuals from enjoying its contents. It ranked as among the most expensive volumes in the libraries of a number of prominent 16th century physicians, if not often the most expensive.8 The Fabrica runs to 663 folio pages, is about fifteen and a half inches in length (ca. 43cm), ten and a half inches in width (ca. 26.5 cm), and over three inches deep (ca. 8cm).9 The language in which it is composed is the elevated humanist Latin of the highly educated, whose interpretative challenges to 16th century readers are underscored by the far simpler Latin of its cheaper com-

6 On the proliferation of translations of Galen’s work in the first half of the 16th century, see Fortuna (2012: 391–407). 7 See O’Malley (1964: 101–108). On the Giunta editions of Galen, see Garofalo (2004). On Vesalius’ use of Galen as a source in the preface of the Fabrica, see Boudon-Millot (2016). 8 See Nutton (2014: lxxxv). 9 See Nutton (2014: xcii).

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panion volume, the Epitome, which was intended for a wider medical audience. Much scholarship on the Fabrica discusses its frontispiece and illustrations; here I limit myself to a few brief observations that highlight the efforts Vesalius took to maintain control over the production and dissemination of his writing. The frontispiece is a carefully constructed document that is replete with symbolic and historical images, pairing among other images the scalpel and pen with which Vesalius, like Galen, conducted his professional life. Galen, Aristotle, and probably Hippocrates look on at Vesalius approvingly as, in Cunningham’s words, a “modern ancient”.10 The highly detailed woodcuts included throughout the Fabrica distinguish it sharply from earlier anatomical treatises, which either lacked illustrations altogether or in some cases contained only far cruder drawings.11 Vesalius invested considerable money and effort in cutting the woodblocks and transporting them to Basle, where the Fabrica was published by Oporinus and could be more easily distributed throughout Europe.12 One copy of the Fabrica, in particular, deserves further mention in light of what it reveals about Vesalius’ attention to the audience for his work. Vesalius prepared this copy—printed on vellum, hand-colored, and bound in purple silk—for Charles v, to whom the preface is addressed and the Fabrica is dedicated. In addition, Vesalius created an Epitome of the larger treatise. It was abridged, printed on less expensive paper, and contained only a handful of illustrations some of which were created specifically for the smaller handbook. Finally, Vesalius’ changed the register of the Latin in his Epitome for ease of reading among prospective students of his anatomy. The Fabrica, its Epitome in Latin, and a German translation were all published near simultaneously in 1543, each intended for a different reading audience—Renaissance humanists, anatomical students, and the German reading public.13 In comparing Vesalius’ attention to the dissemination of his written work to Galen’s, I do not intend to 10 11

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Cunningham (1997: 126–127). I pass over the debate about the identity of the artist responsible for the illustrations. Suffice it to say that whether or not the illustrator was associated with the school of Titian, the controversy speaks to the artistry and professional execution of the illustrations in the Fabrica. Before the advent and proliferation of the printing press in 15th century Europe, reproduction of accurate and detailed illustrations was logistically prohibitive. Anatomical authors, therefore, did not rely for the most part on illustrations as faithful representations of complex anatomical structures. In the early 14th century, for example, Mondino did not include any illustrations in his anatomical work as visual aids, merely the occasional depiction of the performance of a dissection. Berengario’s anatomical writing in the second quarter of the 16th century is perhaps the chief exception to this claim, including as it did a number of illustrations of muscles, the skeleton, and certain viscera. See Nutton (2014: lxxx). See Nutton (2014: lxxx).

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make the claim that Galen was Vesalius’ model in this regard although it is not implausible that he may have been. Rather, I wish to offer Vesalius’ approach to the publication of his anatomical work as a useful lens through which to consider the plausibility of two of my broader arguments in this book: First, that Galen uses writing to reperform the credentialing functions of his live anatomical performances for a reading audience unbound by spatio-temporal constraints and, second, that the efficacy of this strategy is bound up in Galen’s self-conscious use of technologies of writing and distribution in the second century to disseminate his ideas and expand his professional authority. The strategy is similar to one that Cunningham argues Vesalius employs in the Fabrica, when he writes that the Fabrica is “Vesalius’ own Bologna demonstrations turned into text”.14 In the case of Vesalius’ text, illustration works alongside the written word to recreate the public anatomical demonstration for a reading audience.

2

Vesalius’ Appropriation of Galen’s Polemical Strategies

The preface to the Fabrica begins with an archaeology of Greco-Roman medicine. While Vesalius’ Latin is highly Hellenized, he writes that medical subdisciplines in antiquity formed a therapeutic tripod consisting of dietetics, pharmacology, and surgery in accordance with the division made by Celsus, the first-century Roman encyclopedist, in his De Medicina.15 Each of these legs was logically distinct but therapeutically dependent on the other two. According to Vesalius’ archaeology, the tripod was universally embraced by Greco-Roman physicians; and, while all three legs depended on one another, surgery stood out as primary and most ancient of the subdisciplines. He writes: Although once there were three medical sects, namely the Dogmatists, Empiricists, and Methodists, nevertheless their proponents set the goal of the entire art of medicine as the preservation of health and the destruction of disease. Bringing to bear on this point all the things that they individually reckoned were necessary for the art in their respective sects, they implemented a triple apparatus for treatments, of which the first was a regimen of living, the second every use of drugs, and the third surgery (manus opera = cheirourgia) … This triple method of healing was equally 14 15

Cunningham (1997: 120). Cf. Celsus De Medicina 1.pr.9: in tres partes medicina diducta est, ut una esset quae uictu, altera quae medicamentis, tertia quae manu mederetur.

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familiar to the physicians of each medical sect;16 and applying their own hands to healing in accordance with the nature of the symptoms, they expended no less effort in working with these [hands] than in establishing a regimen for living or in recognizing and preparing drugs.17 Of course, Vesalius’ archaeology is ahistorical.18 However, it is ahistorical in interesting ways. The three medical sects that he presents as constitutive of a monolithic medical tradition were active simultaneously only in the Imperial Period, when Galen was also active. Medical Empiricism did not emerge until the Hellenistic Period and Methodism was a product of the Roman Empire. Furthermore, in antiquity theoretical divisions between the medical sects ran deep. Vesalius passes over the epistemological debates that so dominate ancient accounts of the medical sects with a sophisticated blurring of the phrase manus opera, which translates the Greek cheirourgia (χειρουργία), whence our own “surgery” that in turn derives, ironically, from the perfectly respectable Latin term chirurgia. Vesalius’ phrase calls pointed attention to the Greek source of the term.19 As we will see, the trajectory of this foundation narrative finds its end in Vesalius’ anatomical practice. Moreover, while not exclusive to him by an means, the strategy is also recognizably Galenic. It must be said that surgery did have a very ancient pedigree—in its more general incarnation as cheirourgia. The anatomical knowledge that Vesalius takes to be an integral part of surgical method, however, was a relatively late arrival. As we have seen, evidence for the systematic dissection of animals emerges first in the work of Aristotle and other Peripatetics in the fourth century bce, well after many of the treatises of the Hippocratic Corpus were com16 17

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Cf. Vesalius’ “triplex haec medendi ratio”, which resembles Celsus’ “multiplex ideo medicina” at De Medicina 1.pr.5. A. Vesalius, De humani corporis fabrica libri septem (1543: fol. 2r): quamuis enim tres medicorum sectae olim extiterint, Logica videlicet, Empirica et Methodica, nihilominus tamen illarum autores uniuersae artis scopum ad conseruandum sanitatem, morbosque profligandos direxerunt. deinde huc omnia, quae singuli in suis sectis arti necessaria existimabant, referentes, triplici auxiliorum instrumento utebantur, quorum primum uictus fuit ratio, secundum omnis medicaminum usus, tertium manus opera … Triplex haec medendi ratio, cuiuscunque sectae medicis aeque erat familiaris, ipsique proprias manus pro affectuum natura curationi accomodantes, non minorem industriam in illis exercendis impenderunt, quam instituendae uictus rationi, aut medicamentis dignoscendis, ac componendis … On Vesalius’ narrative of decline and his reimagining of the therapeutic tripod, see Lo Presti (2010). Contrast the avoidance of Celsus De Medicina in etymologizing the term: 1.pr.9, “tertia quae manu mederetur” and 7.pr.1, “tertiam medicinae partem, quae manu curet”.

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posed. Evidence for human dissection must wait until at least the first quarter of the third century in the work of Herophilus and then Erasistratus, where it ends just as abruptly as it began. Indeed, the emergence of medical Empiricism as a response to theoretical activity of the third century correlates with this precipitous decline in anatomical research, which was rejected by Empiricists and Methodists alike.20 As a careful reader of Celsus and Galen, Vesalius would have been keenly aware of this fact that appears so prominently in both authors. Vesalius’ picture of the medical sects projects a homogenous medical past in which anatomical knowledge held a place of privilege. The kind of anatomical inquiry that the Fabrica endorses and, to a great extent, undertakes is precisely the sort that ancient Empiricists and Methodists considered to be pointless therapeutically and therefore medically. By eliding the epistemological differences between the medical sects and the historical distinction between surgery—broadly construed—and anatomical inquiry, Vesalius constructs a theoretically unified Greco-Roman medical past that also holds the project of his Fabrica at its core. The examples Vesalius cites to support his point reflect this elision, in whose space he positions the methods of his own anatomical project. The art of medicine, he laments, was lost as the surgical knowledge on which it depended decayed, left in the hands of uneducated non-elites: Medicine, at last, has come to be mutilated because its primary instrument, the healing hand, is so neglected that it almost seems to have been entrusted to people wholly uneducated even in the disciplines that undergird the art of medicine.21 The turn of phrase is no accident. Vesalius’ reconstruction of the history of Greco-Roman medicine centers around the practice of the hand, cheirourgia, the manual practice of which our “surgery” was only a part. While taking pains to place all three legs of the therapeutic tripod on equal footing, Vesalius not only figures surgery as the primary but also the most ancient and even the most philosophical branch of medicine:

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Von Staden (1975) argues that the correlation may have been causal and that the growing popularity of Empiricist practice may have had a stifling effect on systematic anatomical inquiry. A. Vesalius, De humani corporis fabrica libri septem (1543: fol. 2r): medicina eousque lacerari cepit, quod primarium eius instrumentum manus operam in curando adhibens, sic neglectum est, ut ad plebeios ac disciplinis medicae arti subseruientibus neutiquam instructos, id quasi uideatur esse demandatum.

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But they have cast aside the rest of medicine to those they call “cheirourgoi” and regard barely as fit for slaves, shamefully tearing from themselves the most ancient arm of the medical art, and the one which inclines to the investigation of nature most of all (if anyone does).22 While some of Vesalius’ claims echo Celsus’ in the surgical books of De Medicina,23 Galen had also taken pains to align anatomical inquiry (and medicine in general) with philosophical activity, in part to lend medicine the elite cultural cachet that Greek philosophy already possessed in the Roman Imperial Period. Vesalius’ reappropriation of the practice of dissection from specialists follows a similar pattern. For example, Vesalius cites the Hippocratic texts On Surgery, On Fractures, and On Joints as evidence for the medical centrality of surgery and anatomy in antiquity. And of course, while these treatises do reflect surgical practice in the Classical Period, they crucially do not offer evidence of robust internal anatomical knowledge or of systematic anatomical research during that time. Vesalius pairs these Hippocratic texts with two episodes in Galen’s work: his advice on preparing animal subjects for dissection in Anatomical Procedures and his appointment as gladiatorial physician at Pergamum.24 Linking Galen and Hippocrates so closely associates Galenic surgical practice, which did involve anatomical research and did reflect a rich tradition of anatomical knowledge, to Hippocratic practice which did not. Galen’s anatomical knowledge and method effectively bleed through the historical record into pages of the Hippocratic Corpus. The linkage also gives Vesalius more freedom to criticize Galenism and, to a lesser extent, Galen himself while drawing on the authority of Galenic practice dressed in Hippocratic vestments.25 This rhetorical strategy is exquisitely characteristic of Galen, who makes similar use of ancient authors in order to establish his authority over secondcentury contemporaries—especially Hippocrates, Plato, and Erasistratus as we have seen. Following Galen, Vesalius interprets the history of medicine as a decline from a valorized Classical past to an intellectually and morally degen22

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A. Vesalius, De humani corporis fabrica libri septem (1543: fol. 2r–2v): reliquam autem medicinam, iis quos Chirurgos nominant, uixque famulorum loco habent, relegarint, turpiter a se quod praecipuum et antiquissimum est medicinae membrum, quodque naturae speculationi (si modo quod aliud) in primis innititur, depellentes … See, e.g., Celsus’ unusual claim about the antiquity of surgery in De Medicina 7.pr.2. On this issue, see von Staden (1999, especially 255–256). See AA 1.3 (102–104 Garofalo = ii.233–234 K.) and Comp.Med.Gen. 3.2 (xiii.599 K.). Cf. Opt.Med.Cogn. 9.4–7 (CMG Suppl.Or.iv 103.10–105.19), although it is worth noting that Vesalius did not have access to the text of Recognizing the Best Physician. On the history of Galenism, see Temkin (1973).

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erate present. Vesalius goes so far as to draw on specific Galenic narratives. So it is for him also that the primacy of anatomy among the branches of medicine is underwritten by the authority of none other than Hippocrates and Plato: This wholly ruinous scattering of the tools for healing to different specialists has brought on an even more execrable collapse and a far more severe injury to that part of natural philosophy to which Hippocrates and Plato especially attributed such importance that they did not doubt it should be assigned the first position among the parts of medicine, since it encompasses the study of human beings, is the most stable foundation of the entire art of medicine, and is properly considered fundamental to its constitution.26 Vesalius’ references to Hippocrates and Plato would be familiar to his Galenist rivals, as well as to other Renaissance humanists. Already eighteen years before the publication of the Fabrica, in 1525, the Aldine press had reintroduced Galen’s work to western Europe in its original Greek. In 1534, Galen’s massive philosophical treatise, On the Opinions of Hippocrates and Plato, was translated into Latin and became accessible to a wider non-Greek reading audience. As I mentioned earlier, throughout the 1530s Renaissance scholars feverishly engaged with Galen’s work, first in their original Greek and shortly afterwards in new Latin translations. The loss and later recovery of these ancient texts meant that the Renaissance scholar could coherently produce new and exciting intellectual work while drawing on the weight of ancient tradition. Vesalius’ depiction of Hippocrates and Plato—as adherents of the view that anatomy was a fundamental branch of medicine and natural philosophy—merely follows suit with Galen’s earlier refashioning and appropriation of these classical figures. Later in the preface, Vesalius writes a brief apologia for his choice to include illustrations in the Fabrica. Critics, he writes, accuse him of discouraging readers from engaging in the direct anatomical activities that he claims are necessary for medical education by introducing pictures of the body into his work:

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A. Vesalius, De humani corporis fabrica libri septem (1543: fol. 2v): Caeterum perversissima haec curationis instrumentorum ad uarios artifices diductio, adhuc multo execrabilius naufragium, ac longe atrociorem cladem praecipuae naturalis philosophiae parti intulit, cui quum hominis historiam complectatur, firmissimumque totius medicae artis fundamentum, ac constitutionis initium iure habenda sit, Hippocrates et Plato tantum tribuerunt, ut illi inter medicinae partes, primas esse adscribendas non dubitarint.

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The degree to which illustrations aid in understanding these things [anatomical matters] and present the subject before the eyes more precisely than even the most explanatory account will be familiar to anyone who is familiar with geometry and the other fields of mathematics. Moreover, my illustrations of the parts of the body will be very pleasing to those who do not always have the opportunity to dissect a human body or, if they do have the occasion, to those who are endowed with a nature so delicate and ill-suited to a person of medicine that they cannot bring themselves to go even to the occasional dissection, although they may have a marked interest in knowledge of the human person—most delightful since it bears witness to the wisdom of the boundless creator of the world (if anything does). As the case may be, I have made it my singular aim throughout this entire work to be helpful to a great number of people in a pursuit that is extremely recondite and no less rigorous: as accurately and completely as possible to conduct an investigation of the construction of the human body, which is not made up of ten or twelve parts (as it appears to someone who sees it in passing) but of some thousand different ones. I also aim to provide a benefit that is not to be spurned for students of medicine trying to understand the books of Galen still preserved for posterity, which along with the other records of this divine man demand the attention of an instructor.27 Vesalius responds in a recognizably Galenic voice. The analogy Vesalius draws between medicinal and geometric explanations is an important theme in Galen’s work, although it has to be said that the appeal to the diagrams in geometric writing is a straightforward one. Vesalius’ passing comment on the impoverished anatomical awareness of people who see the parts of the body 27

A. Vesalius, De humani corporis fabrica libri septem (1543: fol. 4r): Quantum uero picturae illis intelligendis opitulentur, ispoque etiam uel explicatissimo sermone rem exactiùs ob oculos collocent, nemo est qui non in geometria, aliisque mathematum disciplinis experiatur: praeterquam quod nostrae partium imagines illos impense oblectabunt, quibus non semper humani corporis resecandi datur copia: aut si datur, tam delicata atque in medico parum probanda praediti sunt natura, ut etsi iucundissima hominis cognitione, immensi rerum Conditoris sapientiam (si quid aliud) attestante, insigniter capiantur, eo tamen animum inducere nequeunt, ut uel sectioni aliquando interiint. Utcunque uero sit, toto opere id unice studui, ut in negocio longe reconditissimo, neque minus arduo, quamplurimis prodessem, humanique corporis fabricae non decem, aut duodecim (uti obiter spectanti apparet) sed aliquot mille diuersis partibus extructae historiam, quam uerissime atque absolutissime pertractarem, ac intelligentis Galeni libris posteritati adhuc asseruatis, atque inter caetera diuini eius viri monumenta praeceptoris operam requirentibus, non spernendam frugem medicinae candidatis adferrem.

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only on occasion is perhaps also an echo of Galen’s explanation in the first book of Anatomical Procedures for the need of repeated observation in anatomical study: “And for this reason also we quickly recognize those people whom we often encounter, but we pass by someone seen once or twice after a while has passed, neither recognizing him at all nor even recalling what he looked like before …”.28 The main point to which I would like to draw attention, however, is Vesalius’ emphasis on the usefulness of his illustrations for readers who are not able to participate in live anatomical demonstrations. Galen, we may recall, had offered a similar justification for writing about anatomy in book eight of Anatomical Procedures: And as I have said before, since the task before me is not only to reach you, for whom this treatise is a reminder [of what you already know], but also to reach everyone else, however many are serious about dissections, it is necessary that I write the book in such a way that its contents are as clear as possible even to people who have never seen the dissections.29 Vesalius’ self-conscious discussion of his use of images in the Fabrica in order to recreate his demonstrations in writing and for readers—“Vesalius’ own Bologna demonstrations turned into text”30—mirrors the use that I argue Galen has made of writing to effect a similar recreation in his own work. According to both authors, the choice to write as they do would not be necessary were it not for the degenerate state of contemporary medical training. Like Galen, Vesalius adopts a rhetoric of compulsion as a defense against charges of selfaggrandizement. Both men lament that times are such that they have no choice but to engage in intellectual debates with their rivals, whose intellectual and moral errors require correction. Indeed, the great cultural decline from the Greek past to their respective presents has been so headlong that they must turn to writing in the hopes of preserving the vanishing knowledge of antiquity. The ancients, Vesalius writes, trained their children at home and so had no need of illustrations. Anatomical treatises were unnecessary for similar reasons. Ancient physicians did not begin writing about dissection until the art of 28

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AA 1.2 (90 Garofalo = ii.224 K.): καὶ διὰ τοῦτο καὶ αὐτῶν τῶν ἀνθρώπων ἐκείνους τάχιστα γνωρίζομεν, οἷς πολλάκις συνεγενόμεθα, τὸν δ’ ἅπαξ ἢ δὶς ὀφθέντα διὰ χρόνου πλείονος θεασάμενοι πάλιν παρερχόμεθα, μήτε γνωρίζοντες ὅλως, μήτε ἀναμιμνησκόμενοι τῆς ἔμπροσθεν θέας … AA 8.1 (710 Garofalo = ii.651–652 K.): ἐπεὶ δ’ οὐχ ὑμῶν μόνον, οἷς ἀνάμνησίς ἐστιν ὁ λόγος ὅδε, πρόκειταί μοι στοχάσασθαι, καθότι καὶ πρόσθεν εἶπον, ἀλλὰ καὶ τῶν ἄλλων ἁπάντων, ὅσοι σπουδάζουσι περὶ τὰς ἀνατομάς, ἀναγκαῖόν ἐστιν οὕτως γράφειν αὐτόν, ὡς ἂν καὶ τοῖς μηδὲ πώποτε θεασαμένοις αὐτὰς ὅσον οἷόν τε μάλιστα γενέσθαι σαφέστατα. Cunningham (1997: 120).

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medicine was no longer taught at home. As the art of medicine fell outside the exclusive control of the Asclepiads, it came to decline over the course of generations. Anatomical writing emerged to fill the void left behind by the silenced oral tradition. Vesalius adopts this narrative whole-cloth from Galen, who explains the absence of any anatomical treatises from the Classical period in his own apologia for writing Anatomical Procedures:31 I do not blame the ancients for their failure to write on anatomical procedures, and I commend Marinus for having done so. For the ancients it was superfluous to write memoranda (ὑπομνήματα) for themselves or others, since they were trained by their parents from childhood in anatomy, just as they were in reading and writing. For the ancients competently pursued anatomy, not the doctors alone but also the philosophers. There was no more fear that anyone who learned in this manner would forget how to conduct anatomical procedures than those who learn how to write the letters of the alphabet from childhood [would fear to forget] these things too. But, as time went on, they began to believe it was a good idea to share the art not only with relatives but also with people outside the family. Right from the outset the custom [of anatomical training from childhood] was lost; for they were now sharing the art with adults whom they esteemed for their virtue. Once training from an early age was lost, it followed as an immediate and necessary consequence that their understanding worsened. The ancients seem to me to have shown clearly how much [training from an early age] matters in all things, when they called not only people who were skilled in the arts “educated” (πεπαιδευμένοι) but also anyone at all who had maintained a good reputation throughout an entire lifetime, just as [they called] their opposite counterparts “uneducated” (ἀπαίδευτοι). And so once the art fell out of the hands of the Asclepiads and then became continually more degenerate with every generation, there arose a need for memoranda (ὑπομνήματα) to preserve its doctrines.32 31 32

Galen’s full account appears in AA 2.1 (174–178 Garofalo = ii.280–283 K.). AA 2.1 (174–176 Garofalo = ii.280–281 K.): Οὔτε τοῖς παλαιοῖς μέμφομαι μὴ γράψασιν ἀνατομικὰς ἐγχειρήσεις, καὶ Μαρῖνον ἐπαινῶ γράψαντα. τοῖς μὲν γὰρ περιττὸν ἦν αὑτοῖς ἢ ἑτέροις ὑπομνήματα γράφεσθαι παρὰ τοῖς γονεῦσιν ἐκ παίδων ἀσκουμένοις, ὥσπερ ἀναγινώσκειν καὶ γράφειν, οὕτως ἀνατέμνειν. ἱκανῶς γὰρ ἐσπουδάκασιν οἱ παλαιοὶ τὴν ἀνατομὴν, οὐκ ἰατροὶ μόνον, ἀλλὰ καὶ φιλόσοφοι. οὔκουν φόβος ἦν ἐπιλαθέσθαι τοῦ τρόπου τῶν ἐγχειρήσεων οὐδενὶ τῶν οὕτω μαθόντων, οὐ μᾶλλον ἢ τοῦ γράφειν τὰ περὶ φωνῆς στοιχεῖα τοῖς ἀσκηθεῖσιν ἐκ παίδων καὶ ταῦτα. ἐπεὶ δὲ, τοῦ χρόνου προϊόντος, οὐ τοῖς ἐγγόνοις μόνον, ἀλλὰ καὶ τοῖς ἔξω τοῦ γένους ἔδοξε καλὸν

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In order to establish its ancient genealogy, Vesalius invokes Homer as a witness to the ancient pedigree and disciplinary primacy of surgery where, in Iliad 11, Idomeneus announces that an iatros was worth many men.33 The reference recalls a similar reconstruction of early Greek medicine in Celsus’ prooemium. However, in the Fabrica the Homeric reference is repurposed further. In its original context and in Celsus, the iatros merely excised arrows from the flesh of other heroes and applies healing ointments to their wounds. Vesalius’ Homeric physician is fundamentally Galenic, responsible for the treatment of dislocations, fractures, wounds, and so-called “dissolutions of continuity”, in Latin “solutiones continuitatis”. While it had become standard by the Renaissance, this disease class, the dissolution of continuity, is a taxonomical innovation explicitly coined in Galen’s treatises on the nature and taxonomy of disease.34 Vesalius transposes the conceptual domain of Galenic surgery onto the Homeric iatros. On this model, borrowed from Galen among others, the impetus to write is corrective and suitably modest. The world of knowledge corresponds to the world of ancient knowledge. For the physician, access to antiquity through proficiency in ancient languages and philological technique, in short through an elite humanistic education, was a necessary and powerful tool of scientific discovery. This education was insufficient, however, unless paired with practical medical and especially anatomical experience. Two themes that we have already encountered dominate Vesalius’ preface and arise from the needs of this model. First, a yawning distance had come to separate the medical present from its past. And second, this chasm could only be bridged through philological and practical, especially manual, expertise. Practitioners had lost touch with the art of medicine, which required reconstitution at the hands of Renaissance humanists. After the Gothic invasions of the fifth century, Vesalius writes, practitioners allowed themselves to specialize in one of the three legs of the

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εἶναι μεταδιδόναι τῆς τέχνης, εὐθὺς μὲν τοῦτο πρῶτον ἀπολώλει [τὸ μηκέτι ἐκ παίδων ἀσκεῖσθαι τὰς ἀνατομὰς αὐτούς]· ἤδη γὰρ τελέοις ἀνδράσιν, οὓς ἐτίμησαν ἀρετῆς ἕνεκα, ἐκοινώνουν τῆς τέχνης. εὐθὺς δ’ ἐξ ἀνάγκης εἵπετο καὶ τὸ χεῖρον μανθάνειν, ἀπολωλυίας γε τῆς ἐκ παίδων ἀσκήσεως. ἣν, ὅσον εἰς ἅπαντα δύναται, δοκοῦσί μοι σαφῶς ἐνδείξασθαι πάντες οἱ παλαιοὶ, μὴ μόνον τοὺς ἐν ταῖς τέχναις ἀγαθούς, ἀλλὰ καὶ σύμπαντας ἁπλῶς τοὺς καθ’ ὅλον τὸν βίον εὐδοκιμοῦντας ὀνομάζοντες πεπαιδευμένους, ὥσπερ γε τοὺς ἐναντίους αὐτῶν ἀπαιδεύτους. ἐκπεσοῦσα τοίνυν ἔξω τοῦ γένους τῶν Ἀσκληπιαδῶν ἡ τέχνη, κᾄπειτα διαδοχαῖς πολλαῖς ἀεὶ χείρων γιγνομένη, τῶν διαφυλαξόντων αὐτῆς τὴν θεωρίαν ὑπομνημάτων ἐδεήθη. Il. 11.514–515, ἰητρὸς γὰρ ἀνὴρ πολλῶν ἀντάξιος ἄλλων / ἰούς τ’ ἐκτάμνειν ἐπὶ τ’ ἤπια φάρμακα πάσσειν. Cf. Il. 4.193–218. See, e.g., CAM 5 (CMG v 1,3 66.5–17 = i.238 K.) and Caus.Morb. 1 (vii.2 K.). On the taxonomy of dissolutions in Galen’s nosology, see Salas (2019).

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therapeutic tripod at the expense of the others. Then, these specialists lost practical knowledge of their specialty by delegating to their assistants any tasks they took to be menial. Like the narratives of decline common among the Greeks and Romans themselves, the fount of medical knowledge was purest at its source and had only grown muddied by the intervening centuries. As the practical aspects of dietetics were delegated to attendants, pharmacology to druggists, and surgery to barbers, the physician was left with little else beyond the direction of subordinate practitioners, themselves lacking the proper humanistic education to understand their branch of the medical art. In his lament over the loss of pharmacology to the ravages of time, Vesalius faults physicians’ delegation of the preparation of medicines to pharmacopolae, druggists and quacks, who lacked the erudition to understand Greek and Latin, the languages of ancient drug recipes. Vesalius’ reference to druggists and the consequences of their poor linguistic education is not only in line with a powerful philological movement that began at about the turn of the 16th century, but also closely aligned with Galen’s polemical strategies in the second. By showing that many errors in Greek texts could be explained by the faulty translations of Arab, Medieval, and even ancient Roman scholars, Niccolò Leoniceno argued that rigorous philological work could remove centuries of accretions under which lay the untarnished knowledge of ancient Greece.35 By pairing the loss and recovery of anatomical knowledge with pharmacology, Vesalius establishes the importance of his own philological work on anatomical subjects. While the common pharmacopoles lacked the erudition necessary for medical practice, his elite counterpart had grown so far removed from practice that he was no more than a book doctor, what Galen might have derisively called a logiatros. Vesalius repeatedly invokes physical distance as a metaphor to explain decline. The physician is far removed from practice, he no longer has a hand in the art of medicine—so also for surgery. Physicians no longer performed surgical procedures nor did they conduct practical anatomical research. They had delegated cheirourgia, the work of the hand, to barbers who just like the druggists lacked the humanistic education needed to understand ancient knowledge:

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See, e.g., Leonicenus De Plinii et plurium aliorum Medicorum in medicina erroribus, libri quatuor, 1 (1532: 4r–5r) and 2 (14v–15r), originally published in 1509. The reference here is to Leoniceno’s 1532 Opuscula, which reprints the 1509 publication. The latter work consisted of four separate tracts mainly targeting Pliny’s knowledge of Greek philology, medicine and philosophy that were originally published in 1492, 1493, 1503, and 1507.

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So far off is this class of people from preserving the most difficult and esoteric art handed down to them; so far is this contagious dispersal of the healing art from keeping this abominable ritual from coming into our universities, by which some attend to the dissection of a human body, while others are accustomed to give an exegesis of its parts. The latter, with their eminent arrogance, crow from high up in their chairs about things they have never done but only about things they commit to memory from other people’s books or about the texts they hold before their eyes. The former are so illiterate that they are unable to explain what they dissect to onlookers; and they mutilate what they were to demonstrate on the instruction of a physician who so superciliously navigates out of a book subjects that he has never attended to with the dissection of a body by his own hand.36 Vesalius’ disdain for armchair physicians, his erudite Galenists, finds close parallels in Galen’s contempt for rivals who lacked direct experience of anatomical practice. Indeed, as we have seen this pattern of attack is central to Galen’s polemical engagement with second-century Erasistrateans in Rome. In a section of Galen’s Anatomical Procedures that I quoted earlier in this chapter and to which Vesalius also makes repeated reference, Galen warns the reader that anatomical expertise is impossible without knowledge of both the body and the book. Like the faces of near strangers and close friends in a crowd, Galen writes, the practitioner comes either to recognize the structures of the body or to wander past them only through direct acquaintance and repeated exposure. There is a more striking verbal parallel found in a later passage from Anatomical Procedures, where Galen is criticizing medical Empiricists for their disavowal of dissection. He chastises them for being so reckless as to reject the value of deliberate and invasive anatomical inquiry while pretending to medical knowledge:

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A. Vesalius, De humani corporis fabrica libri septem (1543: fol. 3r): tantum abest, ut difficillimam abstrusissimamque artem manu ipsis traditam, id hominum genus nobis asseruaret, utque haec pestilens curatiuae partis dispersio detestabilem ritum in Gymnasiis non inueheret, quo alii humani corporis sectionem administrare, alii partium historiam enarrare consueuerunt. his quidem graculorum modo, quae nunquam aggressi sunt, sed tantum ex aliorum libris memoriae commendant, descriptaue ob oculos ponunt, alte in cathedra egregio fastu occinentibus: illis autem adeo linguarum imperitis, ut dissecta spectatoribus explicare nequeant, atque ex physici praescripto ostendenda lacerent, qui manu corporis sectioni nunquam adhibita, tantum ex commentario nautam non sine supercilio agit. See also, 2.31 and 6.16.

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One would be amazed at their recklessness! For one could hardly learn from [just] the sight of wounds, when even those who have applied themselves with great devotion to dissection of these parts have not made exact observations. So, someone sitting high atop a chair can talk about anatomical matters to students, but he cannot instruct them on the practical aspects of the Art, since he himself is an ignoramus of the first rank regarding all the parts of the animal’s organs I have mentioned.37 Like Vesalius’ crowing Galenists, Galen’s Empiricists sit atop chairs far from the body over which they claim to possess knowledge. In the previous passage, Vesalius also adopts a favorite Galenic topos, the practitioner who is like a sailor navigating out of a book. This interesting simile is rare in Greek and largely survives in Galen’s work.38 One of its attestations occurs in Galen’s Composition of Drugs According to Kinds in the broader context of a discussion on the unity of medicine. Galen reiterates the importance of dissection to medical practice and hectors medical Empiricists for their use of adventitious anatomy in place of invasive anatomical research: In these matters, many of the most well-respected physicians have said it very well, just as with many other things also, that the parts of medicine depend on one another. I mean the surgical part, the pharmacological part, and the dietetic part; and the part that has to do with surgery depends on the other two especially. So, if you frequently see the size and position of each tendon and nerve in cases of apes, take rigorous note. If you ever manage the dissection of a human body you can quickly find each thing you had seen [i.e., in the ape]. If you were wholly untrained, you would not benefit at all from such an opportunity, just like the physicians in the Germanic war who had license for the dissection of the barbarians’ bodies learned little more than what cooks know. For the adventitious anatomy of the Empiricists is a load of nonsense, like (the story about) the goats who couch their cataracts with sharp brambles. Even more absurd than this, learning through anatomical treatises seems like those who, according to the proverb, are said to navigate by the book.39 37

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AA 2.3 (186 Garofalo = ii.289 K.): τούτους μέν γε θαυμάσειεν ἄν τις τῆς προπετείας. ὅπου γὰρ οὐδ’ οἱ μετὰ σχολῆς πολλῆς ἐπὶ τὴν ἀνατομὴν αὐτῶν ἐλθόντες ἠκριβώκασι τὴν θεωρίαν, σχολῇ γε ἄν τις ἐκ τῆς τῶν τραυμάτων θέας διδαχθείη. ταῦτ’ οὖν ἐπὶ μὲν τοῦ θρόνου τις ὑψηλὸς καθήμενος δύναται λέγειν τοῖς μαθηταῖς, ἐπ’ αὐτῶν δὲ τῶν ἔργων τῆς τέχνης οὐ δύναται διδάξαι, πρῶτος αὐτὸς ἀγνοῶν ἅπαντα τῶν εἰρημένων ὀργάνων τοῦ ζῴου τὰ μόρια· See pp. 84–87. Comp.Med.Gen. 3.2 (xiii.604–605 K.): κάλλιστα τοίνυν ὥσπερ ἄλλα πολλὰ καὶ ἐπὶ τούτων

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The importance of the reference lies in Galen’s dismissal of the adventitious anatomy permitted by Empiricist epistemological commitments—on the grounds that it was haphazard, superficial, and governed by chance. However, anatomical knowledge by acquaintance, even of this sort, was preferable to anatomical training gained exclusively through the book. Galen’s use of the simile has special bearing on this discussion. His reference to it as a “proverb” (παροιμία) suggests that the expression is, in a sense, authorless; and, indeed, Galen does nothing to disabuse the reader of this sense. There is reason to think, however, that it may have its origins in Empiricist criticisms of Dogmatists, for their reliance on arguments that depended on theoretical structures, which were hidden (ἄδηλα) from direct observation. The exquisite irony of Galen’s use of this simile—Empiricist by provenance or by strong association—against Empiricists themselves has to my knowledge gone unnoticed.40 It is very much in line, however, with the polemical use of doxography that I have argued is characteristic of Galen’s writing. Vesalius’ methodological debt to Galen is apparent in his use of Galen against the Galenists of his time, a debt which he alternately acknowledges and minimizes throughout the Fabrica. The Fabrica ends as it began—with Galen. Vesalius closes book seven with “some remarks on vivisection” (de vivorum sectione nonnulla). Dissection, he writes, teaches us the morphology and location of the internal parts of the body. Vivisection instructs us on their physiology—their functions. So it is that the student of anatomy must begin with the study of dead animals, and afterwards turn to the study of live ones. Vesalius’ narrative is a paraphrase of Galen’s instructions to the reader in book nine of Anatomical Procedures—in the last pages of the treatise to have survived in Greek and therefore the final pages of the treatise as Vesalius would have read it.41 This closing chapter of book seven,

40 41

εἰρήκασιν ἰατροὶ πολλοὶ τῶν δοκιμωτάτων, ὡς ἀλλήλων δεῖται τὰ μέρη τῆς ἰατρικῆς, τό τε χειρουργικὸν λέγω καὶ φαρμακευτικὸν καὶ διαιτητικὸν, καὶ μάλιστά γε τὸ κατὰ χειρουργίαν ἀμφοτέρων τῶν ἄλλων. ἐὰν οὖν ἐπὶ τῶν πιθήκων ἴδῃς πολλάκις ἑκάστου τένοντος καὶ νεύρου θέσιν τε καὶ μέγεθος, ἀκριβῶς μνήσῃ, κᾂν ἀνθρώπου ποτὲ σώματος ἀνατομῆς εὐπορήσῃς, ἕκαστον ὡς ἐτεθέασο ταχέως εὑρεῖν. ἀγύμναστος δὲ παντάπασιν ὢν οὐδὲν ἂν ἐκ τῆς τοιαύτης εὐπορίας ὠφεληθείης, ὥσπερ οὐδ’ οἱ κατὰ τὸν Γερμανικὸν πόλεμον ἰατροὶ ἔχοντες ἐξουσίαν ἀνατομῆς σωμάτων βαρβαρικῶν ἔμαθόν τι πλέον ὧν οἱ μάγειροι γινώσκουσιν. ἡ μὲν γὰρ τῶν ἐμπειρικῶν κατὰ περίπτωσιν ἀνατομὴ λῆρός ἐστι μακρὸς, ὅμοιος ταῖς παρακεντουμέναις αἰξὶν ὁλοσχοίνοις ὀξείαις. ἔτι δὲ ληρωδεστέρα ταύτης ἡ διὰ τῶν ἀνατομικῶν συγγραμμάτων μάθησις ἐοικυῖα τοῖς κατὰ τὴν παροιμίαν λεγομένοις ἐκ βιβλίου κυβερνήταις. On the association of the goat with couching, see also Aelian De natura animalium 7.14. See my discussion of these points in pp. 84–85. The passage can be found at AA 9.1 (792 Garofalo = ii.707–708 K.).

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chapter nineteen, is unusual in a number of ways. While it is appended to the final book, Vesalius may have intended it to be a series of insertions, and at one point he mentions inserting a section at the end of book four or perhaps at the very start of book five.42 In the Fabrica of 1543, the page numbers in this chapter are continuous through page 661, when the numbering of the final two pages (658–659) repeats those earlier page numbers. For my purposes, however, two points are most striking about the close of book seven. First: the Fabrica closes with Vesalius’ accounts of a series of experiments: the demonstration on the femoral artery, which as I wrote earlier he attributes to Galen;43 the procedures to expose the heart mentioned in book seven of Anatomical Procedures, as well as the reasons for its exposure;44 and finally, Galen’s famous experiment on the recurrent laryngeal nerve intended to demonstrate that the brain is the seat of the control center (hēgemonikon) of the animal body.45 Vesalius accompanies his account of the recurrent laryngeal nerve experiment with a brief narrative about how one should perform Galen’s demonstration for a public audience. This account and its accompanying narrative bring me to the second point I wish to observe: the illustration with which Vesalius brings the Fabrica to a close recreates a famous scene for the reader. It is also represented in the historiated initial with which Vesalius’ letter to Charles v and the Fabrica itself begin. It depicts a pig tied to a plank, in preparation for its public vivisection. The image is immediately arresting to the reader of Galen, who will recognize his careful written instructions to the reader made into an image: the wooden board to be used for anatomical demonstrations, the holes that must be bored through them, and the intricate loops and knots that effective anatomical performance requires. Indeed, Vesalius’ image does not merely depict the prelude to a public demonstration; it depicts the prelude to a Galenic demonstration, since his own subject of choice (and the typical subject of Renaissance demonstration on non-human animals) was the dog.46 I began this chapter with a reference to Vesalius as a figure of both rupture and continuity with the medical past. My aim at the local level has been to show how Vesalius’ polemical strategies in the preface of his Fabrica are a continua-

42 43 44

45 46

See Garrison and Hast (2014: 1330, n. 1) and A. Vesalius, De humani corporis fabrica libri septem (1543: 659) = (1555: 819). A. Vesalius, De humani corporis fabrica libri septem (1543: 659) = (1555: 819). A. Vesalius, De humani corporis fabrica libri septem (1543: 660–661) = (1555: 821–822). See also (1543: 658 [662]) = (1555: 824) for his demonstration on varieties of the pulse and whether the cardio-arterial system pulsates synchronously. A. Vesalius, De humani corporis fabrica libri septem (1543: 661–658 [662]) = (1555: 822–823). See French (1999: 195, fig. 6.1 and 206–210).

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Details from Andreae Vesalii Bruxellensis, scholae medicorum Patavinae professoris, de Humani corporis fabrica Libri septem. Basileae, [Anno salutis reparatae 1543] universitätsbibliothek basel. shelf mark: ubh an i 15

tion of Galen’s own approach to his medical past and present. It is fitting that some fourteen centuries earlier, Galen had used his paideia to interpret—and to reconstruct—the history of medicine for the sake of establishing his authority and undermining that of his contemporary rivals, as well as to a lesser extent the authors to whose writing they appealed. Vesalius drank deeply from the cup of Galen’s polemical prose, using his own erudition and philological talents as an exegete of Galen’s work and the writing of Greco-Roman antiquity to leverage their cultural weight against contemporary Galenists and against Galen himself. My broader aim at the close of this chapter, however, has been to draw attention to Vesalius as a deep and careful reader of Galen who studied and emulated him not only as a doctor and anatomist, but also as a sophisticated author and polemicist—for whom experimentation, its reperformance in writing, and its dissemination to a reading audience were central to the expansion and maintenance of medical authority.

Conclusion Over the course of this book, I have argued that Galen’s highly polemical engagement with his second-century rivals and their ancient predecessors should be read against the background of Greek intellectual discourse. From an early stage in that tradition, intellectual and professional authority was constantly renegotiated in the agonistic crucible of live demonstrations. Galen’s sharp public engagements with his opponents were not merely a reflection of his contentious personality, an observation still made with some frequency by scholars. They were an important part of his medical practice. If this were all there had been to Galen’s career, as a physician and an intellectual, he might be no more to us than Quintus—the greatest doctor of his time and all but a name in the history of medicine, a shadow in the pages of Galen’s work. As Galen said about his own writing, in the epigraph to this book: I am writing this treatise [sc. Anatomical Procedures] for a good reason— if it were possible for people to preserve these things by passing them down [sc. orally] from generation to generation, writing would be superfluous. Consequently, I have disseminated everything I have come to know from the beginning to those who ask for it, since if it is possible I want all people to learn it. And I see already that some of those who have received instruction from me rankle at communicating it. If after I die, they suddenly die too, my research will be lost.1 Galen was right. And yet, despite the singular fecundity of his written output, only a fraction of his research has survived his death to reach us. Galen’s attention to the dissemination of his ideas throughout the Roman world aimed at insuring that they would not be lost after his death, as most of Quintus’ came to be. In his lifetime, Galen deposited his writing in public libraries. The regional diffusion of his completed manuscripts assured that the written Galen was widely available in the Roman world. And his deposition of writing in serial installments pulled some of his texts from the fire even in his lifetime, whether

1 AA 2.1 (176–178 Garofalo = ii.282–283 K.): εἰκότως ὑπομνήματα γράφομεν, ὡς, εἴ γε τῇ παρ’ ἀλλήλων διαδοχῇ τοῖς ἀνθρώποις ὑπῆρχε διασῴζειν αὐτὰ, περιττὸν ἂν ἦν τὸ γράφειν. ἐγὼ μὲν οὖν ἁπάντων, ὧν ἐξ ἀρχῆς ἔγνων, ἐκοινώνησα τοῖς δεομένοις, βουλόμενος, εἰ οἷόν τε, πάντας ἀνθρώπους ἐκμαθεῖν αὐτά. τῶν δ’ ὑπ’ ἐμοῦ διδαχθέντων ἤδη τινὰς ὁρῶ φθονοῦντας ἑτέροις μεταδιδόναι, οἷς ἐὰν ἐξαίφνης ἀποθανεῖν συμβῇ μετ’ ἐμὲ, συναπολεῖται τὰ θεωρήματα.

© Luis Alejandro Salas, 2020 | doi:10.1163/9789004443860_011

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this was Galen’s intention in doing so or not. The level of deliberate control that Galen exercised over the distribution of his writing was matched by the care with which he constructed a written world of medicine at Rome, and in the ancient Greek past. The four experiments that I have taken as case studies in Galen’s experimental writing underscore the sophistication of his intellectual and written practice. His experiments on voice production set their sights against cardiocentrists in the ancient debate over the location of volition and identity (to hēgemonikon) in the body. From a purely formal point of view, the experiment is a devastating demonstration that nerve function radiates from the brain and is responsible for voice production. Galen’s methodical isolation of the nerves through their interruption in order to demonstrate that the brain was necessary for nerve function is breathtaking evidence of his anatomical method. Galen’s urgent commitment to the pervasive teleological structure of the natural world stands at the center of the remaining cases. His experiments on the ureters and ureterovesical junction target contemporary Asclepiadeans ultimately for their denial of the kidneys’ functional contributions to the body. Likewise, Galen’s alleged dissection of the elephant’s heart is not merely a confirmation of its anatomical structure. The procedure is a test of the goal-directed structure of animal bodies and a repudiation—both of Aristotle’s more qualified teleological views and his cardiocentrism. Galen’s experiment on the femoral artery appropriates a procedure pioneered by Erasistratus, recasts it in a different theoretical framework, and then turns it against its author in an attempt to demonstrate the inadequacies of purely mechanical explanations for the processes of the body. Galen’s refashioning of Erasistratus’ experiment was so effective that its association with Erasistratus and its earlier theoretical aims are all but erased from the history of medicine. Among Galen’s great successes as an author was to translate the social context of his live demonstrations into a written one, to reenact in texts the familiar mechanisms through which Greek and Roman intellectuals were credentialed and legitimized. Galen recreates the technical virtuosity and spectacle of these experiments for a reading audience, taking pains to draw in the actual reader as a virtual witness and participant in their performance. Through Galen’s written experiments, a reader can clearly perceive structures too minute to be seen in a large public demonstration, but also those too minute to be seen by the naked eye in a more intimate setting. Galen’s attention to writing and the technologies surrounding it was deliberate, elegant, and probably innovative. His suite of experiments on voice production is in many ways the cornerstone and crowning achievement of his anatomical demonstrations. Their written analogues invoke the authority of the most elite Roman luminaries to underwrite

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Galen’s success as a physician and philosopher, subtly inviting the reader to join them in acclamation and imagine that (s)he too belongs—or can belong— to Galen’s inner circle of pepaideumenoi. His experiments on the ureters and ureterovesical junction are rigorous and technically accomplished. The written experiments respond to an Asclepiadean, who Galen figures as a bad actor. They recall the little book (βιβλίδιον) in On the Power of Cleansing Drugs that Galen imagines as chasing down another Asclepiadean who has tried to escape a debate with Galen. But Galen extends their debate into a written context, from which his opponent cannot depart. Galen’s written demonstration is reified into a little book, only to be reconstituted in his writing as a metaphor: the winged words of his book pursuing his rivals. Galen’s written experiments on voice production, the heart bone, and the femoral artery deftly exploit writing as a tool for visualizing phenomena that could not otherwise be seen in antiquity. And, in the case of the heart bone, Galen’s writing is able vividly to conjure for the reader a part of the body that does not exist. His account is replete with the competitive gestures common to live demonstrations. After all, it is Galen’s close connection to the imperial family that allows him to call for an elephant’s heart from the kitchens of the emperor. This episode, along with that of the femoral artery, demonstrate the efficacy of Galen’s doxographical polemics. Galen attacks his opponents for their lack of anatomical training and a failure to understand the writings of their intellectual predecessors. Where his opponents fail, Galen succeeds. He turns to the reader to show that only he can properly read the ancient authors whom his contemporaries claim as authorities. In the process, Galen recasts antiquity in Galenic terms, presented now with the imprimatur of the hallowed past. Like Galen, Vesalius’ authority in part depends on being a unique hermeneut of the Greco-Roman past. And, like Galen, Vesalius recasts past authorities in Vesalian terms. It is with the most delicious irony that Vesalius is so often seen as a break with the Galenic past. In many respects, Vesalius stands as a Galen redivivus, evidence for and coda to the power of Galen’s cutting words.

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General Index activities (Aristotelian) 12, 33n50, 88, 92– 95, 116–119, 127–130, 135, 205–210, 216–218, 222 addressee 9, 25–28, 32–34, 44–45, 114n35 Adrian of Tyre 45, 100 aesthetics (of surgery) 57, 179 agonism 1–9, 49–50, 56–59, 68–69, 73–81, 97–100, 156, 167, 179–181 Alexander of Damascus 45, 99–102 amazement 31–32, 41n66, 61, 97, 128, 149, 199 analogy 33, 103–119, 133–136, 146–147, 150– 151, 239, 254 anatomy 3, 7n20, 12–13, 19, 76, 83–85, 97, 103–105, 108, 118, 120, 128–129, 133, 146, 160–165, 238, 266, 273–274, 276–277, 281–282 animal classes 33, 109–119, 129–143, 152 scala naturae 114, 143 ape 33–36, 56–57, 76n46, 80–83, 107, 111– 116, 133, 137, 163, 281 apodeixis 30 Aristotle 7, 25, 51n93, 70, 109–161, 213–215, 234–238, 251, 286 artery 13–14, 175–176, 182, 186–266, 283, 286–287 Asclepiades of Bithynia 93, 170–171 Asclepiadeans 11, 72, 92–97, 138, 171–172, 286 auditoria 36–37 authority 2–3, 6, 10–11, 14–15, 21, 24, 29, 42, 51, 57, 60, 70, 86, 100–101, 174, 184, 197, 233, 264, 266–274, 285–287 bear 257–260 book culture 267–270 book learning 82–86, 193–194, 278–282 cardiocentrism 89, 128–129, 144–168, 172, 175, 286 cannula 196, 198, 201–203, 209, 212, 228, 252, 261–262 capacities 171, 205–212, 216, 224–225, 246, 250, 255, 263 charlatan 23, 50, 59–60, 69, 85–86, 175, 188, 192–193

Charles v 15, 265–269, 283 comedy 13, 68n32, 169–172 competition 1–3, 13, 30, 44, 53, 56, 58, 70– 72, 78–79, 96, 99–100, 182, 185 credentialing 5, 9–12, 15, 31, 59–67, 73, 77, 102–103, 267, 270 credibility 10, 34, 77 decline 23, 271–279 didactic 1, 10, 23–25, 27–36, 41–42, 45, 49, 59, 73–77, 81, 167, 172, 185, 193, 202, 280, 282–283, 285 dissection 6–7, 24–30, 35, 73, 104–105, 111, 120, 133, 147–150, 156, 185–186, 237, 239, 265, 271–276, 280–282 doxographical polemic 51–54, 135, 172, 176– 195, 197 surrogate target 138 drachma 182, 184n36 elephant 2, 12, 103–168, 198, 286–287 empirical observation 2, 8, 13, 89, 91, 97, 108, 118, 147, 151–152, 157, 166–167, 188, 190, 194 Empiricists 80, 85, 120–121, 126, 270–272, 280–282 encephalocentrism 121, 144, 166 epideixis 29–30, 86, 192 Erasistratus of Ceos 12–14, 51–54, 86, 92, 138–140, 169–171, 177, 183, 186, 192–197, 202–206, 213–214, 226–231, 248–264, 286 PTKA 204–205, 209, 252–257, 262 Erasistrateans 12–14, 51–54, 69–70, 92–94, 129, 138–140, 169–196, 204–205, 213, 226, 243, 250–251, 261, 264, 280 experiment 2–4, 8–15, 33–36, 43, 45–46, 58– 59, 81n55, 95, 103–105, 167n80, 175–181, 188–194, 196–205, 211–212, 219, 225–230, 233, 241, 249, 252, 257–264, 283–284, 286–287 procedure 228–230, 263–264 theoretical context 228–230, 262–264 femoral artery 10, 13–14, 175, 191, 193, 196– 226, 261–264, 283, 286–287

311

general index Flavius Boethus 20, 36, 41, 45–46, 67, 100– 101, 184n36 Galen life gladiatorial physician 56–57 Imperial family 7, 287 patrons 2, 43–44, 60, 184n36 storerooms 16, 19, 22, 38 students 42–44 writings avoidance of hiatus 149 audience 48, 70–72, 101, 150n24, 167, 178, 191 authenticity 22–24 copies 16–20, 268 dissemination 1, 11, 17–24, 26, 90, 102–103, 187, 268–270, 284 illustrations 15, 25–27, 267, 269–270, 274–276, 283–284 preservation 1, 70, 285–286 self-representation 21 reading audience 8, 11–12, 15, 31, 59, 64, 72, 75, 80, 191, 269–270, 274, 277, 284, 286 No Redundancy Assumption 127, 210n35 Principle of Creative Economy 127n69, 159, 210n35 gallbladder 103, 129–150 goat 35, 46, 133, 163, 189, 192, 197–198, 282 Great Asclepieia 1–3, 7, 78 hand 47, 71, 84, 96, 104, 113–116, 122–126, 148, 177–178, 266–267, 271, 277, 280 prehension 114, 116, 121–123, 127 digits 113–116 heart 10–13, 87–91, 110, 117, 121, 128–131, 138– 142, 144–168, 174–181, 203–261, 283, 287 bone (os cordis) 144–147, 152–153, 159, 161–163, 166 chambers 117, 153, 157, 165–166 diastole/systole 175, 177, 214–217, 224, 241–245, 250, 254–256, 262 hēgemonikon 88–91, 110, 144–145, 175, 181, 198, 283, 286 Herophilus 44, 50, 68, 89n78, 104, 203, 212– 213, 236–262, 272

Hippocrates 51, 58, 151, 170–171, 203–204, 236–237, 246–248, 269, 273–274 hook 28–29 humor 47, 71, 110, 129–132, 135–136, 138, 143, 215 blood 51–52, 56, 81n55, 92, 110, 135, 170, 186–191, 201, 206, 209, 213, 217–226, 237–238, 241–243, 249, 256 yellow bile 129–130, 134, 136–138, 140– 143 black bile 130, 136, 138, 140 phlegm 130, 136, 220n68 hymn 122n55 hypothetical necessity 118 intercostal nerves 27–34, 88–90, 101 intellectuals 3, 11, 15, 23, 37, 42, 45, 49, 53, 56–57, 68, 70, 229, 286 knot 31, 283 knowledge 8–9, 46, 60–61, 70, 78, 80, 87, 108, 162, 175, 185–186, 193, 271–282 legitimacy 6, 10–12, 57–61, 69–72, 85, 143 lenses 106 library 11, 16–18 ligation 3, 27–34, 76n46, 90, 95, 166n79, 175–178, 182, 186, 189–190, 201–203, 210–213, 228, 251n90, 261–262 liver 38–39, 110, 121, 131–137, 142, 222, 224 logiatros 82–86, 264, 279 Lycus of Macedon 73–77 magnification 13, 103–107, 133, 141, 163 Marinus 76–77, 122, 148, 277 Maryllus 173–176 mechanism 70–71, 92–94, 177, 190, 201, 205–209, 217, 222–224, 249–256, 261, 263 medical malpractice 61–62 medical marketplace 6, 59–60 Methodism 12, 38, 49, 66, 138, 270–272 Mnesitheus of Athens 120, 129–135, 145, 147 multiple consultation 11, 43, 65–66, 173 needle 29 ox 105, 120, 141, 146, 153, 157, 159–165, 189, 199

312 paideia 40, 46, 52, 69, 103, 172, 178, 195–197, 266–267, 284 pepaideumenos 11, 15, 23, 27, 41, 45–48, 52, 57, 68, 82, 97, 172, 195, 198, 233, 277 performance 1, 9–11, 15, 29–32, 53–55, 71– 72, 78–79, 99–102, 167, 178–179, 191–192, 219, 286 oratorical 27, 43, 79, 193 medical 25, 27–28, 36–44, 56, 70, 78, 87, 182, 185, 199–200, 265, 270, 284 Pergamum 2, 7, 17–18, 56, 74, 79, 273 Peripatetics 47–48, 67–68, 89, 90, 101, 140, 145–147, 156, 166, 172, 250–251, 271 phonation 31–34, 88, 198 physiology 12, 14, 33, 92, 108, 128, 143, 163, 203, 205–225, 228–238, 247, 255–258, 262–263, 282 pig 2–3, 33–36, 94–95, 111, 116, 198, 283– 284 pneuma 12, 40, 110, 128–129, 176–177, 181, 189, 207, 210, 214–218, 220–225, 233– 263 polemics 5, 11, 38, 50–55, 70, 197, 211, 287 Praxagoras of Cos 229–249, 261–262 prognosis 48, 61–62, 174 proposed topic 53–54, 58, 71, 86, 192 public/private distinction 2, 7, 11, 30, 32–50, 63, 65, 178, 187 pulse 47, 201–205, 208–214, 216, 218–221, 225–230, 238–263 purposelessness 98, 134, 142, 160n61 Quintus 74, 76, 285 reasoning (logical) 47–48, 82, 91, 97–98, 113, 116 modus tollens 88, 137, 262 recurrent laryngeal nerve 46, 87–90, 101, 198, 266, 283 respiration 14, 24, 127–128, 207, 214–219, 221–222, 234, 242, 247, 256–257, 260 rete mirabile 146, 163, 218, 224 retrospective diagnosis 162

general index Rome 2–3, 8, 11–12, 16–23, 33, 45–46, 66–72, 82, 89, 100–101, 148–150, 163, 184n36, 266–267, 286 great fire 11, 16–22, 68 Horrea Piperataria 17 Sacred Way 8, 16, 22 Rufus of Ephesus 7, 33, 114–116, 248 Second Sophistic 29–30, 42, 49 antiquarianism 11, 15, 49–55, 68 sheep 105, 146, 163, 189 slave 13, 38, 54, 76n46, 97, 114n35, 170–179, 196, 273 sophist 37, 40, 42–43, 45, 58, 71, 79, 83, 96, 185 spontaneity 79 Stoics 50, 89–90, 140, 145, 156, 166 surgical implements 78, 81n55, 187–188, 196, 199, 210 surgery (physician’s workshop) 63, 65 technē 174 teleology 2, 12–13, 92–93, 98, 109–110, 117–152, 158–160, 165, 168, 209–210, 250–251, 286 Theagenes the Cynic 38–41, 49, 66 theater 43, 78–79 torture (as metaphor) 178–179 ureters 10–11, 92–99, 149, 206n21, 286–287 ureterovesical junction 11, 92–95, 286–287 vein 56–57, 106, 110, 114, 139, 153, 175–177, 189, 206, 217, 222, 224, 230, 237–239, 253–254 Vesalius 14–15, 200, 227, 265–287, 287 vivisection 2, 4, 6–7, 30, 35, 57, 73, 179, 182, 239, 249, 265–266, 282–283 voice production 10–11, 28, 88–90, 156, 198 wrestling (as metaphor) 69, 96, 187 witness 9–10, 25, 34, 39, 66, 72, 73, 75, 79, 125, 127, 166, 190–193, 275, 286 chorus (as metaphor) 38–39, 71, 182

Index Locorum Aelian De natura animalium 7.14

281n39

Anonymus Londinensis (Anon.Lond.) 20 (27.45–47 Ricciardetto) 247n73 23.8–18 (30–31 Ricciardetto) 231n13 23 (31.12–36 Ricciardetto) 254n96 28–29 (40.46–41.34 Ricciardetto) 239n51 33.44–51 (48.44–51 Ricciardetto) 258n110 Apollonius of Perga Conica (Con.) 1.pr.

20n14

Aristophanes Nubes (Nub.) 766–768

106n7

Aristotle De anima (DA) 2.2–3 109n18 3.12 109n18 De generatione animalium (GA) 2.3, 736b33–37 234n24 2.3, 736b37–737a1 234n25 2.6, 741b37–742a16 215n52 2.6, 743b35–744a6 235n29 2.7, 746a14–15 25n27 3.11, 762a18–28 234n23 5.7, 787b17–19 157n49 De iuventute et senectute (Iuv.) 2, 468a13–17 109n18 26, 479b30–32 215n52 De motu animalium (Mot.An.) 10 235n29 De partibus animalium (PA) 1.1, 639b21–640a9, 642a1–13, and 642a31– b4 118n44 1.4, 644b3–4, 644b1–9 112n28 1.5, 644b21–645b14 121n54

1.6, 645a4–7 2.9, 654b27–32 2.10, 655b29–32 2.10 656b26–31 2.11, 657a11–17 2.16 2.16, 658b27–659a36 2.16, 658b33–659a2 2.16, 659a11–15 2.16, 659a19 2.17, 661a25–29 3.2, 663a8–14 3.3, 664a35–665a26 3.4, 665b9–16 3.4, 665b9–21 3.4, 665b9–667b14 3.4, 665b28–33 3.4, 666a18–24 3.4, 666b1–35 3.4, 666b6–11 3.4, 666b13–17 3.4, 666b14–35 3.4, 666b17–19 3.4, 666b17–21 3.4, 666b17–667a6 3.4, 666b21–35 3.4, 666b27–35 3.4 668a18–24 4.2, 676b29–35 4.2, 677a11–18 4.2, 677a19–b10 4.10, 687a7–22 4.10, 689b31–34 4.13, 697a29–b4 De respiratione (Resp.) 16, 478b3 20, 479b26–480a15 Ethica Nicomachea (EN) 10.9, 1181b2–6 Historia animalium (HA) 1.11, 492b17–21 1.12, 493a8 1.16, 494b19–24 1.17, 496a4–27 1.17, 497a30–32

104n2 158n57 109n18 119n45 119n45 120n48 124n60 124n60 124n61, 126n67 159n58 120n48 159n58 119n45 139n101 157n50 153n33 157n50 158n56 153n35 157n53 155n42 156n48 153n34 120n48, 147n16, 154n39 145n7 153n36 153n34 158n56 134n88 134n92 135n93 123n58 116n38 116n38 157n52 213n44 84n66 123n59 231n13 104n2 153n35 25n27

314

index locorum

Historia animalium (HA) (cont.) 2.1, 497b26–29 126n64 2.1, 497b27 127n68 2.1, 499b6–15 113n31 2.1, 499b7–9 114n34 2.9, 502b25–27 113n30 2.15, 506a8–10 154n39, 156n49 2.15, 506a9–10 145n7, 147n16, 153n34 2.15, 506a20–506b24 134n91 2.15, 506a30–b4 147n14 2.15, 506b1–4 120n49, 131n80, 134n88 2.17, 506b32–507a10 157n52 2.17, 507a2ff. 157n51 2.17, 507a34–36 112n29 2.17, 507b37–508a2 132n84 3.1, 510a29–35 25n27 3.1, 511a11–14 25n27 3.2, 511b10–18 237n42 3.2, 511b18–24 237n41 3.3, 513a12–15 237n40 3.3, 513a27–b1 153n35 3.19, 521a6–7 213n44 4.1, 525a6–8 25n27 5.18, 550a23–27 25n27 6.11, 566a10–15 25n27 8.1, 588b4–23 114n34 [Aristotle] De spiritu (Spir.) 1, 481a22 and 2, 481b13 4, 482b36–483a5 4, 483b15–19 4, 483a5–8

231n13 248n80 248n80 248n80

Aulus Gellius Noctes Atticae (Noct.Att.) 5.21.19 11.17.1 16.8.2

37n57 38n59 37n57

Celsus De medicina (Med.) 1.pr.4–5 1.pr.5 1.pr.9 1.pr.23–44 1.pr.23–26

82n59 271n16 270n15, 271n19 104n2 239n46

1.pr.49–50 5.26.1 7.pr.1 7.pr.2

174n14 174n12 271n19 273n23

Dio Cassius 73.24.1–3

16n1

Dio Chrysostom Orationes (Or.) 7 33.6.1–7

185n38 40n64

Diocles of Carystus fr. 80 vdE fr. 95 vdE fr. 98 vdE fr.102 vdE fr. 182.37–38 vdE

244n80 247n76 244n80 247n76 244n80

Diogenes Laertius 5.57

250n85

Empedocles B100 DK (Aristotle Resp. 473b9–474a6) 246n72 Erasistratus fr. 5 Garofalo fr. 6 Garofalo fr. 7 Garofalo fr. 8 Garofalo fr. 49a Garofalo fr. 54 Garofalo fr. 74 Garofalo fr. 93 Garofalo fr. 99 Garofalo fr. 105 Garofalo fr. 109 Garofalo fr. 110 Garofalo fr. 111 Garofalo fr. 112 Garofalo fr. 112b Garofalo fr. 113 Garofalo fr. 136 Garofalo fr. 198 and 212 Garofalo fr. 247.22–30 Garofalo

250n85 250n85 250n85 250n85 253n93 254n98 253n93 254n93 254n102 254n97 253n93 253n93 249n83 254n99 254n99 255n106 253n93 253n93 183n33

index locorum Fallopius De partibus similaribus (1575: ch. 13 = 1606: 15.168) 227n1 Galen Ad Glauconem de methodo medendi (MMG) 1.1 (xi.3 K.) 120n49 An in arteriis sanguis contineatur (Art.Sang.) ed. Furley, D.J. and Wilkie, J.S. (1984). Galen on Respiration and the Arteries. Princeton: Princeton University Press. = F-W. 2 (148 F-W= iv.706 K.) 254n96 2 (150 F-W = iv.709 K.) 186n41, 253n93 3 (152.35–154.1 F-W = iv.711 K.) 224n77 5 (160.1–10 F-W = iv.717 K.) 69n34, 187n42 6 (164–166 F-W = iv.721–722 K.) 226n82 6 (166.14–168.8 F-W = iv.724 K.) 215n55 6 (168–170 F-W = iv.723– 725 K.) 251n90 7 (172.1–4 F-W = iv.727 K.) 187n42 7 (174 F-W = iv.729 K.) 250n85 7 (174.5–8 F-W = iv.729 K.) 191n47 7 (176 F-W = iv.731 K.) 204n14 7 (176.6–9 F-W = iv.731 K.) 204n15 8 (176 F-W = iv.731–732 K.) 244n63 8 (176–178 F-W = iv.731–732 K.) 247n76 8 (178 F-W = iv.732 K.) 213n46, 252n92 8 (178.12–180.2 F-W = iv.733–734 K.) 191n48, 210n36 8 (178.20–21 F-W = iv.733 K.) 212n42 8 (178–180 F-W = iv.733–734 K.) 169n2, 228n6 8 (180.2–7 F-W = iv.734 K.) 213n45 8 (180.5–7 F-W = iv.734 K.) 219n66

315 8 (180.14–19 F-W = iv.734–735 K.) 211n37 8 (180.19–25 F-W = iv.735 K.) 211n39 8 (180.28–182.4 F-W = iv.735 K.) 194n56 8 (182.9–10 F-W = iv.736 K.) 194n56 De alimentorum facultatibus (Alim.Fac.) 1.2 (CMG v 4,2 216.19–21 = vi.480.6 K.) 84n65 De anatomicis administrationibus (AA), books 1–9 in Greek. ed. Garofalo, I. (1991). Procedimenti Anatomici, 3 vols. Milano: Rizzoli.= G. 1.1 (78–80 G. = ii.215–216 K.) 9n24, 21n15, 184n36 1.2 (82–84 G. = ii.218–219 K.) 158n57 1.2 (84 ff. G. = ii.220 K.ff.) 84n64 1.2 (88.8–11 G. = ii.222 K.) 111n22 1.2 (90 G. = ii.223–224 K.) 80n531.2 1.2 (90 G. = ii.224 K.) 276n28 1.2 (94.17–20 G. = ii.226–227 K.) 111n23 1.3 (94–96 G. = ii.227–228 K.) 76n46 1.3 (102–104 G. = ii.233–234 K.) 273n24 1.3 (104–106 G. = ii.234–235 K.) 91n82 1.5 (118 G. = ii.243 K.) 86n73 1.11 (162 G. = ii.273–274 K.) 25n25 2.1 (174–176 G. = ii.280–281 K.) 277n32 2.1 (174–178 G. = ii.280–283 K.) 277n31 2.1 (176–178 G. = ii.282–283 K.) 1n1, 285n1 2.2 (178 G. = ii.283 K.) 76n46 2.3 (186 G. = ii.289 K.) 281n37 3.1 (264–266 G. = ii.343–344 K.) 76n46 3.5 (324 G. = ii.384 K.). 81n56

316 De anatomicis administrationibus (AA), books 1–9 in Greek. ed. Garofalo, I. (1991). Procedimenti Anatomici, 3 vols. Milano: Rizzoli.= G. (cont.) 3.5 (324 G. = ii.384–385K.) 104n2 3.5 (324–326 G. = ii.385–386 K.) 76n46 3.9 (338–340 G. = ii.395–396 K.) 76n46 4.1 (370–378 G. = ii.416–421 K.) 76n46 4.3 (390.5–392.7 G. = ii.430–431 K.) 111n25 4.3 (390.19–23 … 30–31 and 392.1–3 G. = ii.430–431 K.) 111n25 4.6 (410–412 G. = ii.444–446 K.) 25n25 4.6 (416–418 G. = ii.449–450 K.) 74n40 4.6 (420 G. = ii.451 K.) 76n46 4.10 (446 G. = ii.470 K.) 77n47 6.1 (544–546 G. = ii.537–538 K.) 118n43 6.3 (558–560 G. = ii.547–548 K.) 130n77 6.3 (560.3–10 G. = ii.548 K.) 111n24 6.3 (560.3–5, 8–16 G. = ii.548 K.) 112n27 6.8 (590.5–17 G. = ii.569 K.) 130n76, 132n86, 147n13 6.8 (590 G. = ii.569 K.) 132n86, 135n97, 147n13 6.13 (606–608 G. = ii.581–582 K.) 93n87, 94n91 7.1 (620 G. = ii.589–590 K.) 216n57 7.1 (620–622 G. = ii.589–590 K.) 169n1 7.1 (620–622 G. = ii.590 K.) 175n75, 212n41 7.1 (620–622 G. = ii.590–591 K.) 165n75 7.3 (628–630 G. = ii.596 K.) 244n66 7.4 (630.23–632.4 G. = ii.597 K.) 254n95

index locorum 7.4 (630.23–632.9 G. = ii.597 K.) 262n115 7.5 (636–638 G. = ii.601–602 K.) 208n35 7.10 (660–662 G. = ii.618 K.) 151n26, 151n28 7.10 (660–662 and 664–666 G. = ii.618 and 621 K.) 153n35 7.10 (660–662 G. = ii.618–619 K.) 147n17 7.10 (660–668 G. = ii.618–622 K.) 165n75 7.10 (662 G. = ii.618 K.) 155n40, 166n76 7.10 (662 G. = ii.619 K.) 146n8, 152n31, 152n32 7.10 (662–666 G. = ii.619–621 K.) 2n4, 144n2, 148n20 7.10 (664 G. = ii.619–620 K.) 156n43 7.10 (664 G. = ii.620 K.) 151n27, 162n65, 183n33 7.10 (664 G. = ii.621 K.) 156n47 7.10 (664 and 666 G. = ii.620 and 622 K.) 161n62 7.10 (664–668 G. = ii.620–621 K.) 150n25, 173n9 7.10 (666 G. = ii.621–622 K.) 151n29 7.11 (668–670 G. = ii.624 K.) 157n54, 164n73 7.11 (670 G. = ii.624 K.) 157n51 7.12 (672–680 G. = ii.626–632 K.) 165n75 7.12 (674 G. = ii.627 K.) 196n1, 199n6 7.13 (680–684 G. = ii.632–634 K.) 173n10 7.13 (682 G. = ii.632–633 K.) 174n11 7.13 (682 G. = ii.633 K.) 174n13 7.13 (682–684 G. = ii.633 K.) 174n14 7.13 (684 G. = ii.634 K.) 76n46, 175n15 7.14 (684–686 G. = ii.635 K.) 212n41, 250n84 7.14 (686 G. = ii.635 K.) 9n24, 219n67 7.14 (686 G. = ii.636 K.) 176n18 7.14 (686–688 G. = ii.636 K.) 176n18

index locorum 7.14–15 (686–692 G. = ii.636–639 K.) 76n46 7.14 (688 G. = ii.636–637 K.) 177n21, 182n29, 193n53 7.14 (688 G. = ii.637 K.) 183n34 7.14 (688 G. = ii.637–638 K.) 180n26, 193n52 7.14 (688–690 G. = ii.638 K.) 177n20 7.15 (692 G. = ii.640 K.) 175n16 7.16 (694 G. = ii.641–642 K.) 180n27, 226n81 7.16 (694–700 G. = ii.641–646 K.) 76n46 7.16 (696 G. = ii.642 K.) 182n29, 184n36 7.16 (696 G. = ii.642–643 K.) 9n24, 182n32, 186n40 7.16 (696–698 G. = ii.642–643 K.) 183n34 7.16 (698 G. = ii.643–644 K.) 187n43, 187n44 7.16 (698 G. = ii.644 K.) 188n45 7.16 (698–700 G. = ii.644–645 K.) 2n5, 189n46 7.16 (698–704 G. = ii.645–648 K.) 169n2 7.16 (700 G. = ii.645 K.) 192n49 7.16 (700 G. = ii.645–646 K.) 192n50, 198n3 7.16 (700–704 G. = ii.646–648 K.) 202n10, 228n6 7.16 (704 G. = ii.648 K.) 76n46, 194n55, 228n7, 262n116 8 (710–788 G. = ii.651–706 K.) 2n6, 88n76 8.1 (710 G. = ii.651–652 K.). 276n29 8.1 (710.1–10 G. = ii.651–652 K.) 9n24, 24n23 8.3–8 (724–766 G. = ii.661–690 K.) 166n79 8.4 (732.16–734.1 G. = ii.667 K.) 29n40 8.4 (734.6–16 G. = ii.668 K.) 28n36 8.4 (734.29–736.3 G. = ii.669 K.) 28n35

317 8.4 (736.3–23 G. = ii.669–670 K.) 8n23, 31n46 8.6 (754 G. = ii.682–683 K.) 8n21 8.8 (766 G. = ii.690 K.) 3n7, 9n24, 34n51 8.8 (766–768 G. = ii.691 K.) 196n1 9.1 (792 G. = ii.707–708 K.) 282n41 9.1 (794 G. = ii.708 K.) 8n22, 163n68 De anatomicis administrationibus (AA), books ix–xv survive only in Arabic translation. ed. Duckworth, W.L.H. (trans.) (1962). Galen on Anatomical Procedures: The Later Books, M.C. Lyons and B. Towers (eds.). Cambridge: Cambridge University Press. ix.6 (2 Duckworth) 133n87 ix.7 (4 Duckworth) 108n14, 108n15 ix.9 (10 Duckworth) 84n64, 84n65 ix.11 (15 Duckworth) 8n22, 35n52 xi.4 and 11 (81–87 and 104–107 Duckworth) 2n6 xi.4 (81–87 Duckworth) 88n76, 166n79 xi.11 (104–107 Duckworth) 166n79 xi.12 (107–108 Duckworth) 19n13 xii.7 (123 Duckworth) 133n87 xii.7 (127 Duckworth) 133n87 xiii.8 (171 Duckworth) 106n6, 120n50, 133n87, 141 xiv.1 (183 Duckworth) 74n41 xiv.4 (196 Duckworth) 133n87 xiv.6 (204 Duckworth) 133n87 xiv.6–7 (203–214 Duckworth) 166n79 xiv.6–8 (203–217 Duckworth) 2n6, 88n76 xv.2 (228 Duckworth) 8n22, 107n10, 108n13, 109n16, 118n43, 147n18 xv.3 (236 Duckworth) 120n50, 133n87 De animi cuiuslibet peccatorum dignotione et curatione (Pecc.Dig.) 3 (CMG v 4,1,1 47 = v.68 K.) 89n78

318 De antidotis (Ant.) 1.13 (xiv.66 K.) 16n1 De atra bile (At.Bil.) 1 (CMG v 4,1,1 71 = v.105 K.) 138n99 8 (CMG v 4,1,1 89.11–23 = v.139–140 K.) 130n78 8 (CMG v 4,1,1 93 = v.147 K.) 157n55 8 (CMG v 4,1,1 93.16–22 = v.147 K.) 136n96 9 (CMG v 4,1,1 93.17 = v.147 K.) 134n91 De causis morborum (Caus.Morb.) 1 (vii.2 K.) 278n34 De causis procatarcticis (CP) ed. Hankinson, R.J. (1998) Galen: On Antecedent Causes (CP) (ed., trans. and comm.) Cambridge Classical Texts and Commentaries (Cambridge). 1.2 (70.7–10 Hankinson) 185n37 De causis respirationis (Caus.Resp.) ed. Furley, D.J. and Wilkie, J.S. (1984). Galen on Respiration and the Arteries. Princeton: Princeton University Press. = F-W. 1–2 (240–242 F-W = iv.465–467 K.) 221n70 2 (240.9–15 F-W = iv.466 K.) 231n13 De compositione medicamentorum per genera (Comp.Med.Gen.) 1.1 (xiii.362 K.) 16n1 1.1 (xiii.362–363 K.) 22n17, 54n102 1.4 (xiii.376 K.) 89n78 3.2 (xiii.599 K.) 273n24 3.2 (xiii.604–605 K.) 281n39 3.2 (xiii.605 K.) 84n65 De compositione medicamentorum secundum locos, vii–xi (Comp.Med.Loc.) 8.3 (xiii.160 K.) 184n36 De constitutione artis medicae (CAM) 5 (CMG v 1,3 66.5–17 = i.238 K.) 278n34 De crisibus (Cris.) ed. Alexanderson, B. (1967). Galeni de Crisibus. Studia Graeca et Latina Gothoburgensia, 23. Göteborg = Alex. 2.2 (129.10–15 Alex. = ix.645 K.) 185n37

index locorum De differentiis pulsuum (Diff.Puls.) 3.6 (viii.673 K.) 204n14 4.1 (viii.696 K.) 54n102 4.2 (viii.711 K.) 91n82 4.2 (viii.703 K.) 204n14 4.6 (viii.733 K.) 262n115 De dignoscendibus pulsibus (Dig.Puls.) 1.2 (viii.784 K.) 204n14 De elementis ex Hippocrate (Hipp.Elem.) 9 (CMG v 1,2 138.18–140.1 = i.492 K. and 140.1–14 = i.492–493 K.) 140n105 11 (CMG v 1,2 142.17–144.7 = i.495–497 K.) 220n68 De experientia medica (Med.Exp.) ed. Walzer, R. (1944). Galen on Medical Experience: Arabic Text with an English Translation. Oxford: Oxford University Press. 9 (98–100 Walzer) 84n65, 85n69 De foetuum formatione (Foet.Form.) 5 (CMG v 3,3 82.18–84.6 = iv.679–680 K.) 262n115 De indolentia (Ind.) ed. Boudon-Millot, V., Jouanna, J. (eds. and trans.) with A. Pietrobelli (2010). Galien: Tome 4: Ne pas se chagriner. Paris: Les Belles Lettres = BJP. 4–6 = 3–4 BJP 16n4 12b = 5 BJP 16n2 12b–19 = 5–8 BJP 16n3 14–15 = 6 BJP 16n5 17–18 = 7–8 BJP 16n2 20 = 8 BJP 18n11 20–22 = 8–9 BJP 17n8 21 = 8–9 BJP 18n9 47 = 15.13–18 BJP 184n36 De libris propriis (Lib.Prop.) ed. BoudonMillot, V. (2007). Galien, Tome 1, Introduction générale. Sur l’ Ordre des ses propres Livres. Sur ses propres Livres. Que l’excellent Médecin est aussi Philosophe. Paris: Les Belles Lettres = B-M. prol. (134.8 B-M = xix.8 K.) 23n19 prol. (134–136 B-M = xix.8–10 K.) 23n20, 151n26, 166n77

index locorum 1 (136–137 B-M = xix.11–12 K.) 22n18 1 (138–139 B-M = xix.14 K.) 192n51 1 (138.21–139.3 B-M = xix.14 K.) 53n99, 82n60 1 (139.13–14 B-M = xix.15 K.). 53n98 1 (139.14–24 B-M = xix.15 K.) 83n61 1 (139.19 B-M = xix.15.10 K.) 83n62 2 (141 B-M = xix.17 K.). 23n20 2 (141.3–15 B-M = xix.17 K.) 22n18 3 (142.25–143.4 B-M = xix.19 K.) 16n2 3 (143–144 B-M = xix.20–21 K.) 73n38 3 (144.7–19 B-M = xix.21 K.) 37n55 3 (144.19–21 B-M = xix.21 K.) 50n65 3 (145.9–15 B-M = xix.22 K.) 74n43 3 (145.15– 25 B-M = xix.22–23 K.) 22n18, 23n21 4 (153.4–21 B-M = xix.30 K.) 74n42 8 (158.24–26 B-M = xix.33 K.) 84n65 14 (164–169 B-M = xix.39–45 K.) 82n58 20 (173.5–11 B-M = xix.48 K.) 18n11 20 (173.5–15 B-M = xix.48 K.) 68n32 De locis affectis (Loc.Aff.) 3.5 (viii.148 K.) 17n7 De methodo medendi (MM) 1.1–2 (x.5–7 K.) 73n38 1.1–2 (x.5–8 K.) 85n71 1.4 (x.31–32 K.) 89n78 1.4 (x.36–37 K.) 166n78 1.7 (x.53–54 K.) 27n34 2.5 (x.107 K.) 89n78 7.1 (x.458 K.) 54n102 8.6 (x.582.14 K.) 83n62, 85n71 9.4 (x.612 K.) 67n31

319 13.2 (x.876 K.) 259n111 13.15 (x.909–910 K.) 38n60 13.15 (x.909–916 K.). 66n26 13.15 (x.914–915 K.) 39n62 13.22 (x.941–943 K.) 8n21 De naturalibus facultatibus (Nat.Fac.) ed. Helmreich, G. (1893). Claudii Galeni Pergameni Scripta Minora, vol. 3. Leipzig: Bibliotheca Teubneriana = SM 3. 1.4 (SM 3, 107 = ii.9–10 K.) 231n12 1.4 (SM 3, 107.14–20 = ii.9–10 K.) 208n31 1.5 (SM 3, 108 = ii.10 K.) 207n28 1.5–9 (SM 3, 107.24–115.9 = ii.10–20 K.) 207n28 1.7 (SM 3, 112.23–113.18 = ii.17–18 K.) 95n93 1.13–16 (SM 3, 122–150 = ii.30–67 K.) 206n20 1.13 (SM 3, 122.25–125.12 = ii.30–34 K.) 92n86 1.13 (SM 3, 124.24–125.1 = ii.33 K.) 149n21 1.13 (SM 3, 125–126 = ii.34 K.) 96n96, 244n66 1.13 (SM 3, 126.8–10 = ii.35 K.) 98n98 1.13 (SM 3, 126–127 = ii.35–36 K.) 97n97 1.13 (SM 3, 126.10–16 = ii.35 K.) 98n99 1.13 (SM 3, 126.14–16 = ii.35 K.) 92n85 1.13 (SM 3, 127.10–128.23 = ii.36–38 K.) 95n94 1.13 (SM 3, 127.19–21= ii.37 K.) 244n66 1.13 (SM 3, 127.24–128.1 = ii.37 K.) 95n95 1.13 (SM 3, 131.9–133.10 = ii.41–44 K.) 70n35 1.14 (SM 3, 133–138 = ii.44–51 K.) 206n23 1.15 (SM 3, 142.15–16 = ii.56–57 K.) 206n21 1.15 (SM 3, 142.22–23 = ii.57 K.) 206n21

320 De naturalibus facultatibus (Nat.Fac.) ed. Helmreich, G. (1893). Claudii Galeni Pergameni Scripta Minora, vol. 3. Leipzig: Bibliotheca Teubneriana = SM 3. (cont.) 1.16 (SM 3, 145.7–16 = ii.60–61 K.) 204n16 1.16 (SM 3, 146.27–147.6 = ii.62–63 K.) 204n16 1.16 (SM 3, 147.19–148.2 = ii.64 K.) 204n16 1.16 (SM 3, 149–150 = ii.66–67 K.) 170n3 1.17 (SM 3, 150.10–20 = ii.67–68 K.) 171n4 1.17 (SM 3, 150.20–152.13 = ii.68–70 K.) 92n84 1.17 (SM 3, 150.24–25 = ii.68 K.) 92n84 1.17 (SM 3, 151.25–152.13 = ii.69–70 K.) 92n84 1.17 (SM 3, 154.14–18 = ii.73 K.) 209n34 2.1 (SM 3, 155.8–14 = ii.75 K.) 209n33 2.1 (SM 3, 155.17–21 … 25–156.8 = ii.75–76 K.) 253n94 2.1 (SM 3, 156.21–157.4 = ii.77 K.) 254n96 2.2 (SM 3, 157–159 = ii.78–80 K.) 139n102 2.2 (SM 3, 157.15–158.24 = ii.78–79 K.) 204n16 2.2 (SM 3, 157.21–25 = ii.78 K.) 139n103 2.4 (SM 3, 165.7–12 = ii.88 K.) 250n85 2.6 (SM 3, 171.5–10, 171.26–172.3, 173.9–15, 177.4–10 = ii.96, ii.97, ii.99, ii.104–105 K.) 259n111 2.8 (SM 3, 181.11–182.11 = ii.110–112 K.) 92n84 2.8 (SM 3, 186.10–187.8 = ii.117–118 K.) 140n105 2.9 (SM 3, 194–197 = ii.129–133 K.) 140n105 3.1 (SM 3, 204–205 = ii.143–145 K.) 208n30, 255n104 3.3 (SM 3, 207–208 = ii.147–149 K.) 207n29

index locorum 3.3 (SM 3, 207 = ii.147 K.) 244n66 3.3 (SM 3, 208.24– 209.6 = ii.149 K.) 244n66 3.4 (SM 3, 211.11–19 = ii.152–153 K.) 244n66 3.4–5 (SM 3, 214–215 = ii.157–158 K.) 207n25 3.4 (SM 3, 214.21–215.5 = ii.157 K.) 244n66 3.5 (SM 3, 215.6–17 = ii.157–158 K.) 140n105 3.9 (SM 3, 229–230 = ii.177–178 K.) 207n25 3.9 (SM 3, 229.23–230.7 = ii.177–178 K.) 140n105 3.9 (SM 3, 230 = ii.178 K.) 208n30, 255n104 3.11 (SM 3, 232.10–24 = ii.181 K.) 244n66 3.13 (SM 3, 245.11–17 = ii.199 K.) 244n66 3.13–14 (SM 3, 249.6–250.4 = ii.204–205 K.) 205n17 3.14 (SM 3, 249.14–17 = ii.204 K.) 262n115 3.14 (SM 3, 250.1–6 = ii.205 K.) 244n66 3.14 (SM 3, 250.5–13 … 25–26 = ii.205–206 K.) 217n59 3.15 (SM 3, 251–252 = ii.206–208 K.) 207n24 3.15 (SM 3, 251.4–12 = ii.206–207 K.) 207n25 3.15 (SM 3, 253.3–10 = ii.209 K.) 215n51 3.15 (SM 3, 253.16–254.1 = ii.210 K.) 222n74 3.15 (SM 3, 254.1–19 = ii.210–211 K.) 222n72 De nominibus medicis (Med.Nom.) ed. Meyerhof, M. and Schacht, J. (1931). Galen über die medizinischen Namen. Berlin: Verlag der Akademie der Wissenschaften. [Abhandlungen der preussischen Akademie der Wissenschaften. Philosophisch-historische Klasse. 31–32 Meyerhof-Schacht 18n11

index locorum

321

De optima doctrina (Opt.Doc.) 7.1 (CMG v 4,1,2 428.17–21 = v.587 K.) 3–4 (CMG v 1,1 102–104 = i.48–49 K.) 262n115 166n78 7.1 (CMG v 4,1,2, 428–430 = v. 587–588 K.) De optimo medico cognoscendo (Opt.Med.Cogn.) 156n44 9.4–5 (CMG Suppl.Or.iv 103.10–105.3 7.3 (CMG v 4,1,2 440.20– 442.18 = v.602– Iskandar) 57n4, 83n63 604 K.) 254n100 9.4–7 (CMG Suppl.Or.iv 103.10–105.19 7.3 (CMG v 4,1,2 444.12–446.10 = v.606– Iskandar) 182n30, 273n24 609 K.) 219n63 9.6–7 (CMG Suppl.Or.iv 105.4–15 Iskan7.3 (CMG v 4,1,2 444.29–446.3 = v.608 K.) dar) 56n2 221n69 De ordine librorum propriorum (Ord.Lib.Prop.) 7.3 (CMG v 4,1,2 444.33–446.2 = v.608 K.) ed. Boudon-Millot, V. (2007). Galien, Tome 215n53 1, Introduction générale. Sur l’Ordre des ses 7.4 (CMG v 4,1,2 448.4–24 = v.611–612 K.) propres Livres. Sur ses propres Livres. Que 262n115 l’excellent Médecin est aussi Philosophe. 7.5 (CMG v 4,1,2 454.29–456.4 = v.620–621 Paris: Les Belles Lettres = B-M. K.) 262n115 1 (88–89 B-M = xix.49–51 K.) 8.1 (CMG v 4,1,2 480 = v.648–560 K.) 24n22 88n76 1–2 (88–92 B-M = xix.49–54 K.) 8.1 (CMG v 4,1,2 484–485 = v.655 K.) 151n26, 166n77 141n105 1–2 (90–92 B-M = xix.52–54 K.) 8.1 (CMG v 4,1,2 484–486 = v.655 K.) 82n58 88n76 4 (99–100 B-M = xix.58–60 K.) 8.4 (CMG v 4,1,2 498.17–504.2 = v.671–677 81n57 K.) 140n105 De placitis Hippocratis et Platonis (PHP) 8.8–9 (CMG v 4,1,2 528–538 = v.707–719 2.3 (CMG v 4,1,2 108–110 = v.219–220 K.) K.) 247n74 88n76 8.8 (CMG v 4,1,2 528.30–34 = v.709 K.) 2.4 (CMG v 4,1,2 116.34–118.21 = v.228–229 224n78 K.) 157n51 9.1 (CMG v 4,1,2, 540–542 = v.722–723 K.) 2.6 (CMG v 4,1,2 148–150 = v.262–265 K.) 166n78 88n76 9.5 (CMG v 4,1,2 564.19–30 = v.751–752 K.) 2.8 (CMG v 4,1,2, 160 and 162 = v.276 and 185n37 278 K.) 156n44 De praenotione ad Epigenem (Praen.) 2.8 (CMG v 4,1,2 166.20–23 = v.283–284 K.) 1 (CMG v 8,1 68–72 = xiv.599–603 K.) 89n78 59n6 3.8 (CMG v 4,1,2 230.14– 27 = v.356 K.) 1 (CMG v 8,1 68–74 = xiv.599–605 K.) 218n60 73n38 3.8 (CMG v 4,1,2 232.3–12 = v.357–358 K.) 1.1 (CMG v 8,1 68–74 = xiv.601–605K.) 89n78 85n71 6.4 (CMG v 4,1,2 384.23–386.16 = v.534– 1 (CMG v 8,1 70–72 = xiv.602–603 K.) 546 K.) 140n105 74n41 6.6 (CMG v 4,1,2, 396 = v.548–550 K.) 1 (CMG v 8,1 72.13–74.11 = xiv.603–605 K.) 155n41 185n38 6.6 (CMG v 4,1,2 396.3–33 = v.548–550) 1–2 (CMG v 8,1 72–74 = xiv.604–606 K.) 254n96 59n6 6.6 (CMG v 4,1,2 396–398 = v.549–551 K.) 2 (CMG v 8,1 74.12–17 = xiv.605–606 K.) 211n38 9n24 6.6 (CMG v 4,1,2 398.7–10 = v.550–551 K.) 2 (CMG v 8,1 74.12–80.25 = xiv.605–612 K.) 224n79 67n27

322 De praenotione ad Epigenem (Praen.) (cont.) 2 (CMG v 8,1 74.16–17 = xiv.606 K.) 48n82 2 (CMG v 8,1 78.3–10 = xiv.609 K.) 9n24 2 (CMG v 8,1 80.21–82.7, 82.22–31 = xiv.612–614 K.) 41n66 2 (CMG v 8,1 80.25–82.7 = xiv.612 K.) 45n73 3 (CMG v,8,1 82–86 = xiv.613–618 K.) 32n48 3 (CMG v 8,1 84.5–10, 88.1–13 = xiv.615, 618–619 K.) 41n66 3, 4 (CMG v,8,1 82, 92 = xiv.613 K., xiv.624 K.) 47n80 3 (CMG v 8,1 84.8 = xiv.615 K.) 47n81 3 (CMG v 8,1 86.2–16 = xiv.616–617 K.) 47n79 3 (CMG v 8,1 86.29–30 = xiv.618 K.) 48n83 4 (CMG v 8,1 90.1–4 = xiv.620 K.) 41n66 4 (CMG v 8,1 92.11–20 = xiv.623 K.) 185n37 5 (CMG v 8,1, 94–100 = xiv.624–630 K.) 156n45 5 (CMG v 8,1 94–100 = xiv.625–630 K.) 167n79 5 (CMG v 8,1 94.24–96.2 = xiv.626 K.) 9n24, 90n79 5 (CMG v 8,1, 94.25–26 = xiv.626 K.) 156n46 5 (CMG v 8,1 96–100 = xiv.627–630 K.) 182n31 5 (CMG v 8,1 96.5–23 = xiv.627–628 K.) 45n73 5 (CMG v 8,1 96.9–15 = xiv.627 K.) 36n53 5 (CMG v 8,1 96.11–15. = xiv.627 K.) 33n49 5 (CMG v 8,1 96.19–98.4 = xiv.627–628 K.) 46n76 5 (CMG v 8,1 96.27–98.4 = xiv.628 K.) 90n80 5 (CMG v 8,1 96.27–98.26 = xiv.628–630 K.). 2n6 5 (CMG v 8,1 98.6–11 = xiv.628–629 K.) 99n101

index locorum 5 (CMG v 8,1 98.12–13 = xiv.629 K.) 46n75 5 (CMG v 8,1 98.16–23 = xiv.629 K.) 99n102 5 (CMG v 8,1 98.11–16 = xiv.629 K.) 100n104 5 (CMG v 8,1 98.27–100.1 = xiv.630 K.) 46n77 5 (CMG v 8,1 98.27–100.6 = xiv.630 K.) 101n108 5 (CMG v 8,1, 100.2–3 = xiv.630 K.) 150n24 7 (CMG v 8,1 104.24–26 = xiv.635 K.) 41n66 8 (CMG v 8,1 110.13–116.19 = xiv.641–647 K.) 67n28 8 (CMG v 8,1 110.16–17 = xiv.641 K.) 41n66 8 (CMG v 8,1 110.18–22 = xiv.641 K.) 67n29 8 (CMG v 8,1 116.16–19 = xiv.647 K.). 184n36 11 (CMG v 8,1 126.16–130.10 = xiv.657–661 K.) 67n30 13 (CMG v 8,1 134.9–11 = xiv.665 K.) 9n24 13 (CMG v 8,1 134.9–138.12 = xiv.665–669 K.) 67n31 14 (CMG v 8,1 138.13–23 = xiv.670 K.) 67n31 De purgantium medicamentorum facultate (Purg.Med.Fac.) 2 (xi.328 K.) 70n35, 253n93 3 (xi.332 K.) 71n36, 92n83 5 (xi.339.15 K.) 83n62 De sanitate tuenda (San.Tu.) 1.12 (CMG v 4,2 31 = vi.67 K.) 255n107 De semine (Sem.) 2.1 (CMG v 3,1 146.11–13 = iv.595 K.) 183n34 De simplicium medicamentorum [temperamentis ac] facultatibus, i–vi (SMT) 1.12 (xi.402 K.) 186n41 2.1 (xi.459–461 K.) 89n78 6.pro. (xi.797.2 K.) 84n65 De symptomatum causis (Caus.Symp.) 1.8 (vii.140 K.) 262n115 2.2 (vii.159 K.) 262n115

index locorum De symptomatum differentiis (Symp.Diff.) 4 (CMG v 5,1 228.19–230.2 = vii.63 K.) 208n30, 255n104 5 (CMG v 5,1 246 = vii.75 K.) 247n75 De temperamentis (Temp.) ed. Helmreich, G. (1904). De Temperamentis. Leipzig: Bibliotheca Teubneriana. 2.2 (50 Helmreich = i.588 K.) 89n78 2.2 (51–52 Helmreich = i.590–591 K.) 166n78 De usu partium (UP) ed. Helmreich, G. (1907– 1909). De Usu Partium, 2 vols. Leipzig: Bibliotheca Teubneriana = H. 1.3 (i.3.25–4.5 H. = iii.5 K.) 123n58 1.4 (i.6.15–17 Helmreich = iii.9 K.) 123n57 1.5 (i.7.16–18 Helmreich = iii.10 K.) 244n66 4.2 (i.196.14–23 Helmreich = iii.268 K.) 142n108 4.7 (i.203–206 Helmreich = iii.278–281 K.) 88n76 4.7 (i.205.23–206.3 = iii.280–281 K.) 244n66 4.9 (i.214.2–6 Helmreich = iii.291–292 K.) 244n66 4.12–13 (i.217.13–228.10 = iii.296–311 K.) 140n105 4.12 (i.218.21–23 Helmreich = iii.298 K.) 136n95 5.13 (i.285.4–286.12 Helmreich = iii.389– 391 K.) 93n87 5.13 (i.285.13–24 = iii.390 K.) 93n88 5.13 (i.285.24–286.5 Helmreich = iii.390– 391 K.) 94n89 6.2 (i.301.3–10 Helmreich = iii.412 K.) 219n64 6.8 (i.320.10–17 Helmreich = iii.438–439 K.) 208n32 6.8 (i.320.17–22 Helmreich = iii.439 K.) 165n75 6.9 (i.323.3–9 Helmreich = iii.442–443 K.) 164n74 6.10 (i.326.4–10 Helmreich = iii.446–447 K.) 223n76

323 6.10 (i.327 Helmreich = iii.449 K.) 219n65 6.10 (i.332.14–23 Helmreich = iii.455–456 K.) 215n55 6.15 (i.350.15–351.5 Helmreich = iii.480– 481 K.) 205n17 6.16 (i.357–358 Helmreich = iii.490–492 K.) 215n51 6.16 (i.358.3–18 Helmreich = iii.491–492 K.) 220n68 6.17 (i.361.20–24 Helmreich = iii.496 K.) 220n68 6.17 (i.362.14–20 Helmreich—iii.497–498 K.) 215n51 6.18–19 (i.364.5–366.13 Helmreich = iii.500–503 K.) 165n75 6.19 (i.365.14–365.22 Helmreich = iii.501– 502 K.) 161n63 6.19 (i.365.14–366.13 Helmreich = iii.501– 503 K.) 144n3, 152n32 6.19 (i.365.22–366.13 Helmreich = iii.502– 503 K.) 160n60 6.19 (i.366.6 Helmreich = iii.502 K.) 146n8 6.21 (i.371.1–4 Helmreich = iii.509–510 K.) 215n55 6.21 (i.372.7–11 Helmreich = iii.511 K.) 220n68 7.4 (i.380 Helmreich = iii.523 K.) 214n48 7.4 (i.380.12–381.14 Helmreich = iii.523– 525 K.) 205n17 7.8 (i.390.21–391.7 Helmreich = iii.537– 538 K.) 259n111 7.8 (i.392.25–393.6 Helmreich = iii.540 K.) 255n105 7.8 (i.393.23– 394.6 Helmreich = iii.541– 542 K.) 215n55 7.9 (i.396–399 Helmreich = iii.545–549 K.) 215n51 7.9 (i.396.5–10 Helmreich = iii.544–545 K.) 221n70 7.9 (i.397.11– 399.27 Helmreich = iii.546– 549 K.) 205n17, 214n48 7.14 (i.414–425 Helmreich = iii.570–585 K.) 167n79 8.6 (i.470.22–471.20 Helmreich = iii.649– 650 K.) 108n14

324 De usu partium (UP) ed. Helmreich, G. (1907–1909). De Usu Partium, 2 vols. Leipzig: Bibliotheca Teubneriana = H. (cont.) 8.6 (i.471.20–472.21 Helmreich = iii.650– 651 K.) 108n14 8.6–7 (i.471.20–473.2 Helmreich = iii.650– 652 K.) 218n63 9.1 (ii.2.18 Helmreich = iii.686 K.) 256n108 9.1 (ii.3–4 Helmreich = iii.687–688 K.) 256n108 9.4 (ii.13.20–14.12 Helmreich = iii.701–702 K.) 220n68 9.4 (ii.14.20–15.1 Helmreich = iii.702 K.) 223n75 10.12 (ii.97–98 Helmreich = iii.819–822 K.) 25n25 10.15 (ii.111–113 Helmreich = iii.839–841 K.) 25n25 14.6 (ii.298.7–299.2 Helmreich = iv.160– 161 K.) 113n33 14.9 (ii.315–316 = iv.183 K.) 220n68 15.8 (ii.367 Helmreich = iv.251 K.) 117n39 16.1 (ii.376.18–25 Helmreich = iv.264–265 K.) 216n56 16.2 (ii.377.24–378.10 Helmreich = iv.266– 267 K.) 216n56 16.4 (ii.386.10–388.11 Helmreich = iv.278– 281 K.) 2n6, 167n79 17.1 (ii.438–440 Helmreich = iv.348–350 K.) 145n6 17.1 (ii.438.9–439.3 Helmreich = iv.348– 349 K.) 125n63 17.1 (ii.439.8–17 Helmreich = iv.349 K.) 128n72 17.1 (ii.439.17–440.3 Helmreich = iv.349 K.) 126n65 17.3 (ii.451.20–27 Helmreich = iv.365–366 K.) 121n54 De usu pulsuum (Us.Puls.) ed. Furley, D.J. and Wilkie, J.S. (1984). Galen on Respiration and the Arteries. Princeton: Princeton University Press. = F-W. 2 (198 F-W = v.154 K.) 214n50 2 (198 F-W = v.153–154 K.) 221n70 3 (200 F-W = v.155 K.) 218n62

index locorum 3–4 (206 F-W = v.160–161 K.) 218n63 3 (206.17–17 F-W = v.160–161 K.) 218n60 4 (208.17–210.6 F-W = v.163–164 K.) 203n12 5 (210–212 F-W = v.164–166 K.) 216n58 5 (214 F-W = v.167–168 K.) 249n83, 252n92 5 (214 F-W = v.168–169 K.) 250n84 De utilitate respirationis (Ut.Resp.) ed. Furley, D.J. and Wilkie, J.S. (1984). Galen on Respiration and the Arteries. Princeton: Princeton University Press. = F-W. 2 (82.5–84.20 F-W = iv.473–474 K.) 177n19 2 (92.19–94.3 F-W = iv.481 K.) 177n19 2 (96 F-W = iv.483 K.) 254n102 3 (108 F-W = iv.492 K.) 221n70 5 (120–122 F-W = iv.502 K.) 214n50, 221n69 5 (122.5–9 F-W = iv.502 K.) 218n63 5 (132.5–13 F-W = iv.511 K.) 215n55 De venae sectione adversus Erasistratum (Ven.Sec.Er.) 3 (xi.153–154 K.) 186n41 4 (xi.158 K.) 139n103 9 (xi.183–184 K.) 259n12 De venae sectione adversus Erasistrateos Romae Degentes (Ven.Sec.Er.Rom.) 1 (xi.194 K.) 37n56 1 (xi.194–195 K.) 54n101 6 (xi.224–225 K.) 51n94 6 (xi.225 K.) 51n95 9 (xi.247–248 K.) 52n97 In Hippocratis aphorismi (Hipp.Aph.) 50 (xviiia.86 K.) 254n100 In Hippocratis de Acutorum Morborum Victu (HVA) 1.16 (CMG v 9,1 132.20– 23 = xv.450 K.) 185n37 In Hippocratis de Natura Hominis (HNH) 2.10 (CMG v 9,1 78 = xv.152 K.) 166n78

325

index locorum 2.16 (CMG v 9,1 81.24 = xv.159.15 K.) 83n62 In Hippocratis Epidemiarum libri, i–vi (Hipp.Epid.) 3.2 (CMG v 10,2,1 60.4–11 = xviia.576–577 K.) 54n102 In Hippocratis Epidemiarum libri, i–vi (Hipp.Epid.) 6.3.20 (CMG v 10,2,2 156 = xviib.61–62 K.) 89n78 6.4.9 (CMG v 10,2,2 203.19–22 = xviib.145 K.) 44n71 6.4.22 (CMG v 10,2,2 232–233 = xviib.193– 194 K.) 255n107, 259n111 6.4.22 (CMG v 10,2,2 233 = xviib.194–195 K.) 17n7 6.4.22 (CMG v 10,2,2 232.20–233.4 = xviib.193–194 K.) 258n111 6.6.1 (CMG v 10,2,2 321 = xviib.311–312 K.) 246n72 In Hippocratis Prognosticum (Hipp.Prog.) 3.15 (CMG v 9,2 344.12–13 = xviiib.258.9 K.) 83n62 3.15 (CMG v 9,2 344.15 = xviiib.258.12 K.) 83n62 In Platonis Timaeum (Plat.Tim.) CMG Suppl. i.22.32–34 247n75 Protrepticus (Protr.) ed. Boudon-Millot, V. (2007). Galien, Tome 1, Introduction générale. Sur l’Ordre des ses propres Livres. Sur ses propres Livres. Que l’excellent Médecin est aussi Philosophe. Paris: Les Belles Lettres = B-M. Protr. 151n26, 166n77 6 (91 B-M = i.9 K.) 184n36 Quod optimus medicus sit quoque philosophus (Opt.Med.) ed. Boudon-Millot, V. (2007). Galien, Tome 1, Introduction générale. Sur l’Ordre des ses propres Livres. Sur ses propres Livres. Que l’excellent Médecin est aussi Philosophe. Paris: Les Belles Lettres = B-M. 1 (284.3–9 B-M = i.53 K.) 58n5 2–3 (287.7–291.21 B-M = i.56–61 K.) 185n37 3 (289–291 B-M = i.59–61 K.) 82n58

[Galen] Definitiones Medicae (Def.Med.) 109 (xix.375 K.) 246n71, 260n114 Harvey Ad Riolanum 2 (1649: 47–51) 200n8, 227n1 De Motu Prooemium (1628: 12–13) 227n1 Herodian 1.14.3–6

16n1

Herodotus Hist. 3.129–137

59n8

Herophilus frs. 80–85 vS fr. 81 vS fr. 85 (= 140b) vS fr. 116 vS fr. 117 vS fr. 118 vS fr. 125 vS fr. 144 vS fr. 140a vS fr. 141 vS fr. 143b vS fr. 143c vS fr. 144 vS

fr. 145a vS fr. 149 vS fr. 154 vS fr. 155 vS fr. 157 vS fr. 158 vS fr. 164 vS fr. 193 vS

239n48 239n49 239n50 239n47 254n96 239n47 239n49 203n12 239n50 240n53 240n53, 242n57 241n56, 248n77, 248n79 203n12, 213n44, 240n54, 245n67, 248n77 241n55, 244n62, 248n77 248n77, 248n79 240n54, 248n77 240n54 242n58, 248n77 242n58 240n53 240n53

326 Hippocrates De articulis (Artic.) ed. Kühlewein, H. (1894). Hippocratis Opera quae feruntur omnia. Leipzig: Bibliotheca Teubneriana. 1 (111.12–112.4 Kühlewein = 4.78.9–80.1 Littré) 64n19 1 (112.4–17 Kühlewein =4.80.1–11 Littré) 64n20 42–43 (167–170 Kühlewein = 4.182–186 Littré) 65n22 42 (167.10–16 Kühlewein = 4.182.15–20 Littré) 65n23 (228–230 Kühlewein = 4.296–300 Littré) 65n21 De carnibus (Carn.) 5 (8.590.11 Littré = 191.20 Joly) 231n13 De decenti ornatu (Dec.) 1–3 (9.226–228 Littré) 66n25 De morbis popularibus (Epid.) 2.4.1 (5.124.3–4 Littré = 64.22 Smith) 231n13 6.6.1 (5.323 Littré) 246n72 De flatibus (Flat.) 3 (105.14–106.2 = 6.94 Littré) 234n22 De fracturis (Fract.) ed. Kühlewein, H. (1894). Hippocratis Opera quae feruntur omnia. Leipzig: Bibliotheca Teubneriana. 36 (101.8–12 Kühlewein = 3.540.9–12 Littré) 62n15 De morbis (Morb.) 1.1 (6.140–142.12 Littré) 60n12 De morbo sacro (Morb.Sacr.) ed. Jouanna, J. (2003). Hippocrate, Tome 2.3, La Maladie Sacrée. Paris: Les Belles Lettres. 1.4–6 (3.18–6.5 Jouanna = 6.354–358 Littré) 60n12 4 (12.10–20 Jouanna = 6.368 Littré) 234n20 16 (29.4–30.2 Jouanna = 6.390–392 Littré) 234n21 De natura hominis (Nat.Hom.) 1 (CMG i 1,3 164.3–5 … 166.1–9 = 6.32–34 Littré) 5n14, 60n12, 63n18 Praecepta (Praec.) 7–8 (CMG 1.1 32.14–33.16 = 9.258–264 Littré) 66n25

index locorum 12 (CMG 1.1 34.5–9 = 9.266.16–268.5 Littré) 63n18, 66n25 Prognosticon (Prog.) ed. Jouanna, J. (2013). Hippocrate, Tome 3.1, Pronostic. Paris: Les Belles Lettres. 1.1, 1.3 (1–2.2, 3.5–11 Jouanna = 2.110–112 Littré) 6n16, 61n14 Prorrheticon 2 (Prorrh. 2) 2.10 (9.10.8–13 Littré) 62n16 De vetere medicina (Vet.Med.) ed. Schiefsky, M. (2005). Hippocrates: On Ancient Medicine. Translation with Introduction and Commentary. Leiden: Brill. 20 (100.17–102.15 Schiefsky = 145.14–146.15 Jouanna) 60n12 Homer Iliad 4.193–218 11.514–515

278n33 278n33

Isocrates Orationes (Orat.) 13

180n26

Justinian Digesta seu Pandectae (Dig.) 27, 1, 6, 8 59n8 Juvenal Saturae (Sat.) 3 3.77 11.1–55

185n38 82n59 185n38

Leonicenus De Plinii et plurium aliorum Medicorum in medicina erroribus, libri quatuor, 1 (1532: 4r–5r) and 2 (14v–15r) 279n35 Lucian Nigrinus (Nig.)

185n38

Martial Epigrammata (Ep.) 3.38 5.9 6.31, 11.71

185n38 66n24 82n59

327

index locorum Maximus of Tyre Orationes (Or.) 4 Menander Epitrepontes (Epit.) 218–375 Perinthia (Per.) 1–16 Perikeiromene (Pk.) 267–396

185n38

171n5

171n5

84n65

Philostratus Vitae Sophistarum (Vit.Soph.) 537–539 101n107 Plato Phaedrus 274c5–277a4 74n44 276d1–5 75n45 Republic 368c–369d 107n11 368d8–369a4 107n12 Timaeus 44d3–6, 69d6–70a2, 70d7–71e2 121n53 70d2 231n13 77d–79a 247n73 78c4–5 231n13 Pliny Historia Naturalis (NH) 11.89 25.8 29.11 29.15–18 29.6 29.8.16 36.199 7.29

185n38

Plutarch Moralia (Mor.) 70f9–71a5 71a

79n51 43n69

Polemo Logoi epitaphioi (Ep.) 2

180n26

Polybius Historiae (Hist.) 1.13.6 2.59.5 12.25d 12.25.e4

193n54 193n54 84n65, 85n67 85n70

Porphyry Vita Plotini (Plot.) 15.11

37n56

171n5

Philo of Judaea De congressu eruditionis gratia 53.2 83n62 Philodemus P.Herc. 1005 iv.8

Pliny Iun. Epistulae (Ep.) 1.9

249n81 26n31 66n24 267n4 82n59 82n59 106n7 106n7

Praxagoras fr. 1 Lewis fr. 3.16–25 Lewis fr. 3.17–24 Lewis fr. 6.19–40 Lewis fr. 7 Lewis fr. 8.1–7 Lewis fr. 9.9–14 Lewis fr. 10 Lewis fr. 11.1–5 Lewis fr. 12 Lewis fr. 13 Lewis fr. 14 Lewis fr. 16 Lewis fr. 25 Lewis fr. 25.2–4 Lewis fr. 27 Lewis

235n35 236n33 232n14 232n15 232n15 229n10 231n11, 240n52, 247n76 232n15, 247n76 236n34, 247n76 233n16 233n16 233n16 236n32 244n65 236n35 244n65

Rufus of Ephesus De appellationibus partium corporis humani (Onom.) 9 114n35 24–26 (136.7–10 Daremberg/Ruelle) 231n13

328

index locorum

De appellationibus partium corporis humani (Onom.) (cont.) 127 7n20, 33n50, 114n35, 152n30 208–210 (163.3–12 Daremberg/Ruelle) 231n13 Scribonius Largus Compositiones medicae (Comp.) 97 20n14 Seneca Epistulae morales ad Lucilium (Ep.) 76.1–7 185n38 Naturales quaestiones (QN) 1.6.5 106n9 Sophocles Trachiniae (Trach.) 1054

231n13

Strabo Geographiae chrestomathia (Chr.) 3.1.5 106n9 Tacitus Dialogus de oratoribus (Dial.) 11 185n38 Themistius Orationes, ad Constantinum (Ad Const.) 26c3 37n56

Theophrastus De igne (Ign.) 73

106n7

Vesalius De humani corporis fabrica libri septem (1543: fol. 2r) 271n17, 272n21 (1543: fol. 2r–2v) 273n22 (1543: fol. 2v) 274n26 (1543: fol. 3r) 280n36 (1543: fol. 4r) 275n27 (1543: 658 [662]) = (1555: 824) 283n44 (1543: 658–661, [662–663]) = (1555: 818– 824) 265n1 (1543: 659) = (1555: 819) 283n42, 283n43 (1543: 659–660) 227n1 (1543: 660–661) = (1555: 821–822) 283n44 (1543: 661–658 [662]) = (1555: 822–823) 283n45 Documentary Texts I.Ephesos iv (IKA 14), 1980: 1161–1169, 4101b (= Samama 2003: 210–215) 1n2, 78n49 Samama (2003: no. 341) 38n59, 185n39