Selected Works 0192839373

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OXFORD WORLD'S CLASSICS

GALEN: SELECTED WORKS GALEN, the most influential medical author of antiquity, was born in Pergamum c.AD 129 and died in Rome some time after AD 200. His early studies were in philosophy; after completion of his medical studies, and experience as physician to the gladiators in Pergamum, he came to Rome, where he remained for most of his life. T here he participated in public debates and anatomical demonstrations and (according to his own account) gained renown among the Roman elite, including the emperor Marcus Aurelius, for the success of his diagnosis and cures. Notoriously polemical in character, Galen's immense literary output displays a remarkable breadth of interest, both philosophical and medical: from pure logic, through moral philosophy and the philosophy of the soul, through anatomy and physiology to clinical medicine, pharmacology, and commentaries on Hippocrates. At the same time he opens a fascinating window on medical practice-and everyday life-in ancient Rome. P. N. SINGER was born in Middlesex in 1962 and has studied at the City of London School, Trinity College, Cambridge, and the University of Pavia. He returned to Trinity in 1986 to research ancient medicine, and his Ph.D. dissertation ( I 992) investigated the relationship of philosophy and medicine in the Graeco-Roman world, with particular reference to Galen. He has written a number of articles on aspects of Galenic, Hippocratic, and Platonic thought.

OXFORD W'-1RLD'S CLASSICS For over 1 oo years Oxford World's Classics have brought readers closer to the world's great literature. Now with over 700 titles-from the 4,000-year-old myths ofMesopotamia to the twentieth century's greatest novels-the series makes available lesser-known as well as celebrated writing. The pocket-sized hardbacks ofthe early years contained introductions by Virginia Woolf, T. S. Eliot, Graham Greene, and other literary figures which enriched the experience ofreading. Today the series is recognized for its fine scholarship and reliability in texts that span world literature, drama and poetry, religion, philosophy and politics. Each edition includes perceptive commentary and essential background information to meet the changing needs of readers.

OXFORD WORLD'S CLASSICS

GALEN

Selected Works Translated with an Introduction and Notes by

P. N. SINGER

OXFORD UNIVERSITY PRESS

OXFORD UNIVERSITY PRESS

Great Oarendon Street, Oxford ox2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Athens Auckland Bangkok Bogota Buenos Aires Cape Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris Sao Paulo Shanghai Singapore Taipei Tokyo Toronto Warsaw with associated companies in Berlin Ibadan Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York (0 P. N. Singer 1997 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published as a World's Oassics paperback 1997 Reissued as an Oxford World's Oassics paperback 2001 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system , or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organizations. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Galen. [Selections. English. 1997] Selected works/Galen; translated with an introduction and notes by P. N. Singer. (Oxford world's classics) Includes bibliographical references. 1. Philosophy, Ancient 2. Medicine, Ancient. I. Singer, P. N. (Peter N.), 1962II. Title. Ill. Series. B577.G22ES 1997 61O-----dc20 96--38821 ISBN 0-19-283937-3 1 3 5 7 9 10 8 6 4 2 Printed in Great Britain by Cox & Wyman Ltd. Reading, Berkshire

CONTENTS A ck nowledgements Introduction Note on the Text and Translation Select Bibliography

VI Vll

xliii xiv

Chronology

GALEN: SELECTED WORKS My own books The order of my own books The best doctor is also a philosopher An exhortation to study the arts To Thrasyboulos: is healthiness a part of medicine or of gymnastics? The affections and errors of the soul The soul's dependence on the body The construction of the embryo Mixtures Book I Book II Book III The best constitution of our bodies Good condition The exercise with the small ball The thinning diet The pulse for beginners The art of medicine

3 23 30 35 53 IOO

202

202 231

266

290

29 6 299 3o5 325 345

Explanatory Notes

397

Index

437

ACKNOWLEDGEMENTS Amid many teachers, colleagues, and friends, I must thank a bare minimum of individuals without whose support the present volume-the fruit of several years' research at Cam­ bridge and of the 'leisure hours' of several years since-would not have been a possibility. Geoffrey Lloyd first stimulated my interest in ancient science, and, with his extraordinary combi­ nation of learning and philosophical analysis, shaped my understanding of it; without that initial stimulus I would never have studied the subject. Mario Vegetti and the late Paola Manuli deepened that interest. Costas Valakas was a constantly challenging interlocutor. David Sedley taught and encouraged me at certain crucial stages. Tamsyn Barton gave the project moral, intellectual, and in the end financial support. The institutional support and library facilities of Trinity College, Cambridge and the Cambridge University Classics Faculty were the sine qua non of this enterprise from the beginning; it gives me pleasure, too, to record my indebted­ ness to the Warburg Institute library, a haven of other pos­ sibilities in the heart of London, and, much earlier, to my fine teachers at the City of London School. I am also grateful to Judith Luna of Oxford University Press for showing an im­ mediate interest in the book, and to the copy-editor, T. W. Bartel, for his meticulous and expert contribution. Going back further, I am perpetually indebted to my father, Konrad Singer, for first inducing me to philosophize, and to my late mother, Jean Singer, for her encouragement of my classical studies, and of this project in particular.

INTRODUCTION If the name of Galen is mentioned at all today, it is seldom in tones of respect. His medical system is an outdated curiosity; his was the terrible dogmatism that held up the course of scientific research for centuries. Galen's immense influence on later generations can hardly be denied; with the exception of Aristotle, and the possible exception of Plato, there can be no more historically influen­ tial ancient author in matters scientific. In the translations and interpretations of the great Arab and Syrian scholars his medi­ cine became the foundation of a tradition which survives in the Muslim world to this day (the so-called 'Unani' medicine, for example, which is taught in Islamic schools in India); translated again, into Latin, and established as the textbook of the early Italian and Spanish medical schools, his work came to underlie the theories of medieval doctors and, in the new editions and translation of the Renaissance, to inform the anatomical debates of the Scientific Revolution; for more than a millennium and a half the effects of his thought can be traced, at a variety of levels from philosophically sophisticated to semi-literate, from Byzantium to the Greek-speaking east, from the Arab world to southern and then northern Europe on the one hand, and to India on the other. 1 That, indeed, is the primary justification for the present volume. A secondary one lies in the unique insight Galen's writings give us into social and intellectual life in ancient Rome. But such judgements as those with which we began are Among the literature on this subject see esp. 0. Temkin, Galenism: The Rise and Decline of a Medical Philosophy, London, 1973; also N. H. Keswani (ed.), The Science of Medicine and Physiological Concepts in Ancient and Mediaeval India, New Delhi, c974; M. Ullmann, Islamic Medicine, Edin­ burgh, 1978; P.-G. Otrosson, Scholastic Medicine and Philosophy: A Study of Commentaries on Galen's Tegni (ca. 1300-1450), Naples, 1984; L. Garda Ballester, Los moriscos y la medicina: Un capitulo de la medicina y la ciencia marginadas en la Espana de/ siglo XVI, Barcelona, 1984; and articles in J. Scarborough (ed.), Symposium on Byzantine Medicine, Dumbarton Oaks 1

Papers 38, Washington, DC, 1985.

Vlll

INTRODUCTION

based upon a misconception as well as a fallacy: the former, to confuse Galenism-the regimented system of thought solidi­ fied in the Schools-with Galen; the latter, to blame Galen, as if endowed with the capacity posthumously to bully his pos­ terity, for the uncritical attitude towards him of his successors. Galen lived in a period of public debate and conflict, of an almost chaotic intellectual diversity; a period as far removed from medieval systematization as from the scientific ortho­ doxy of our own time and, considered within that period, emerges as one of the most philosophically intriguing, and not just historically important, figures of antiquity. GALEN AND ANCIENT MEDICAL AND PHILOSOPHICAL THOUGHT

Galen was born about AD 129 in Pergamum, a provincial city of the Roman empire on the western coast of what is now Turkey, the son of one Nicias, an architect and member of the city's educated, Greek-speaking elite. His early education is described in his own texts (pp. 18, 27-8, 119-20), as is the fact that his father turned him to the study of medicine in response to a divine signal. 2 We note at once the variety of influences to which the young Galen subjects himself, ranging not only between diverging medical sects, but between such apparently far-removed domains- as pure logic and Hip­ pocratic anatomy. Galen is impossible to understand without consideration of this co-existence in him of philosopher and doctor; and this co-existence is in turn impossible to under­ stand without reference to the philosophical and medical background of his period. The conception and knowledge of the human body which formed the background to Galen's thought may for con­ venience be summarized under six heads: physical theory; anatomy and physiology; disease classification and clinical 2 For the most up-to-date analysis of dates in the biography of Galen, see V. Nunon, 'The chronology of Galen's early career', Classical Quarterly, 23 ( 197 3 ), 15 8-71 and 'Galen in the eyes of his contemporaries', Bulletin of the History of Medicine, 5 8 ( 1984), 3 15-2.2, both repr. in his From Democedes to Harvey: Studies in the History of Medicine, London, 1988.

INTRODUCTION

IX

practice; scientific methodology; theory of the soul; religious belief and practice. The question of 'background of belief', however, is compli­ cated for two reasons: the great variety of different beliefs and the paucity of medical texts other than those of Galen himself. Galen is our major source for knowledge of medical schools and individuals whose work has not survived in its own right; but this information has two important limitations: it relates largely to persons from much earlier periods and it appears in the context of polemics. By expressing his views in the form of arguments against historical figures, Galen obscures both the current climate of belief and the extent of his own indebted­ ness to those very figures. References to contemporaries occur rather in such forms as 'doctors these days', without specific textual quotations. There are therefore severe problems both for the question of influences on Galen and for that of the contemporary climate of opinion. 3 We are necessarily limited, then, to a general survey of the range of medical beliefs in the ancient world, and of Galen's relationship to these. Physical theory. A variety of theories from pre-Socratic times (c. seventh to fifth centuries BC) onward had identified certain individual elements-earth, for example, or air-as the funda­ mental components of the world, and more specifically of the human body. Such theories were always the province of doc­ tors as well as 'philosophers' (a term which in the ancient world includes the study of the natural world-what we would call 'physics', 'biology', 'cosmology' in general); indeed the two categories themselves overlapped: a 'natural philo­ sopher' could also be a doctor, as in the case of Empedocles, the perpetrator of an early version of an element theory. Some philosophers-and doctors-advocated one principal sub­ stance whose actions would explain the changes that take place in nature, 'air' or 'breath' being a popular candidate; others advocated a plurality. Similarly, there was debate be­ tween advocates of 'atomic' and 'continuum' theories-that 3 As with Grmek and Gourevitch's 'unofficial sect' of Hippocratean anato­ mists (ANR W II 37. 2 ( 1994) )-a theory based on Galen's own accounts of his teachers.

INTRODUCTION

X

is, theories that divide matter into particles separated by a void and those which see the fabric of the universe as a seamless substance-the latter being a feature of, for example, Stoic doctrine, the former associated with Epicureans4 and, in the specifically medical context, with the followers of Asclepiades of Bithynia. Certainly consensus on these ques­ tions had not been reached by Galen's time. .__ ·Galen insists on the theory of four fundamental elements or qualities (hot, cold, wet, and dry), which are related on the one hand to the fundamental substances of the universe (e.g. fire, water) and on the other to the 'humours' formed within the body (blood, phlegm, yellow bile, and black bile), and which undergo mixture with each other to form different 'balances'. The theory of elements is a theory of the funda­ mental constituents of the human body; at the same time it gives an account of different physical types and of different temporary states in an individual, both of which phenomena are due to the particular balance (or i_mba.l�.Q_c-�l-PLth�_e_le­ -�-���-�- ���- t�is __ba�a-�ce ...!!lay be beneficial_!I_ or adversely affected by 'diet'-in thebr�e which incfuae-s-nor;--ust food and drink but also phys1c�f exercise, baths, massage, and · climate. It is Galen's achievement, viewed with hindsight, that this was to become the 'classical' doctrine of the elements and humours. Galen himself attributes- the theory, by means of a selective reading of the relevant texts, to 'Hippocrates' (c. fifth century BC), though his formulation of it actually owes more to Aristotle; in any case it is Galen's own version of the doctrine which was to become so influential.5 4

Stoics and Epicureans were, along with Aristotelians (Peripatetics), Platonists (Academics), and Sceptics, two of the established 'sects' in philoso­ phy by Galen's time; though known chiefly for their conflicting ethical doc­ trines, they also advocated specific physical theories. On medical sects see pp. xiv-xvi, and for Galen's attitude to both medical and philosophical sects cf. pp. 5, 2.3-4, I 44-5. 5 It should however be noted that the related theory of character types-in particular that of the 'melancholic' (related to 'black bile'), which was to be so fruitful in the western literary tradition-is medieval, not Galenic: Galen's use of such terms relates either to particular bodily substances or diseases, or to physiognomical types, not to character types in the broader sense. Nor is the

INTROD UCTION

XI

A natomy and physiology. In spite of his theoretical venera­ tion for 'Hippocrates' and the 'golden age' (including Plato­ Galen asserts that Plato and Hippocrates shared their most important doctrines), Galen's actual views in anatomy and physiology have much more to do with the later, Alexandrian tradition. Dissection of corpses was first practised systemat­ ically in the early to mid-third century BC, in Ptolemaic Alex­ andria, where the major medical figures were Herophilus and Erasistratus; at this period important advances were made in the understanding of the cardio-vascular and nervous systems, as well as in anatomy generally. Arteries were clearly distin­ guished from veins; theories were advanced on the motion of blood in the heart and body; and the existence and function of the nerves were discovered. Galen's own distinctive physiological scheme centres around the notion of three major organs, brain, heart, and liver, which are the 'sources' or 'principles' of three types of faculty of either soul or body. The brain is the source of perception and voluntary motion, as well as the centre of rational thought; the heart is the source of involuntary mo­ tions such as blood-pumping, which sustain life; the liver is the source of nutrition and blood production. This system Galen claims to be Plato's, the three different organs corres­ ponding to the parts of that philosopher's 'tripartite soul': the brain to the rational part, the heart to the 'spirited' (involving the emotions of anger and pride), the liver to the 'desiderative' ( involving the desires for food and drink). But Galen's system involves an understanding of the related functions of nerves, arteries, and veins, which is a development of Alexandrian, not Platonic theories-and of Galen's own researches. It is indeed clear that Galen makes very significant advances on the Alexandrians. Neither they nor he (as is sometimes asserted) 'discovered the circulation of the blood'; but Galen had a clear popular medieval connection of such character types with particu lar star-signs Galenic: though Galen nowhere denies, and at points actually admits, the validity of astrology, it has no significant position within his system . For the later developments see R. Klibansky, E. Panofsky, and F. Sax l , Saturn and

Melancholy: Studies in the History of Natural Philosophy, Religion and A rt, London, 1 964.

XII

INTROD UCTION

conception of the function of the arteries in relation to blood­ pumping and the heart, whereas Erasistratus had held that the arteries contain air (pneuma) and only the veins contain blood-a doctrine for which Galen repeatedly takes issue with him (see e.g. p. 1 8 6). Galen also gained a clearer understand­ ing than his predecessors of the function of the brain and its relationship with the nerves-an understanding backed up by a series of dramatic experiments involving the severing of nerves and compression of parts of the brain in live animals. More generally, he advanced the science of anatomy to a high degree of perfection, the major limitation here being his use of Barbary apes rather than human specimens: the latter were not available for dissection in imperial Rome, as they had been in Alexandria under the Ptolemies. Lest Galen's theory should appear too directly equivalent to our own, however, it should always be borne in mind that for Galen the arteries contain blood as well as pneuma-that, in fact, the theory of pneuma (literally just 'breath' or 'air') was of central importance for him both here and, to an even greater extent, in the context of brain and nerve function. Pneuma has connotations in the ancient world as distant as those of the compressed air that was used in certain Hellenis­ tic mechanical devices and the 'Holy Spirit' (pneuma hagion ) of the New Testament; between the two extremes, it was used to explain a variety of physical and biological events, espe­ cially those which appeared difficult to explain in more 'nor­ mal' terms: in Galen, apart from its role in breathing, it is used to explain the mechanisms of conception and of neurological or psychological function, including the process of perception; it transmits motion from and to the brain via the nerves. Galen even toys with the notion that pneuma is the 'substance of the soul'-the answer, that is, to a metaphysical question regarding the essential nature of that entity. Here again the immediate ancestry of his theories is impossible to trace, espe­ cially as pneuma has some sort of role in physical and physi­ ological theory throughout antiquity; but we may safely say that Galen's theory stands in some relation to those of Hellen­ istic biology, and that he is at pains to distance it from that of the Stoics, who endowed pneuma with religious, arguably pantheistic, significance.

I N T R O D U CT I O N

Xlll

Disease classification and clinical practice. In the clinical side of his work-the conception of diseases, the techniques of diagnosis, and the types of prescription-Galen again stands at the end of a considerable medical tradition, his precise relationship with which is impossible to determine. Two things at least are clear: the enormous amount of information which he has assimilated from the previous tradition, and the fact that he develops certain areas to a level of sophistication previously undreamt of (at least in written form). 6 Examina­ tion of the pulse and of the urine, for example, were standard elements of medical practice long before Galen; but Galen's use of these techniques is highly original, elaborating dis­ tinctions and subdistinctions in their definition which are, to the modern at least, quite mind-boggling. In disease classification, too, the categories employed are those already in existence-entities such as 'fever', 'inflammation', 'melan­ choly', 'phrenitis'. Again Galen's original ity l ies in his refine­ ment of those existing categories: he develops the types of 'fever', for example (the commonest disease category in the ancient world), to a high degree of sophistication; and he writes at length on 'crises' and 'critical days'-again, standard terms in the medical tradition, but not previously treated with such classificatory precision. Galen's role here may be summarized as that of systematizing an existing body of knowledge, and at the same time of adapting it (how com­ pletely is not always clear) to his own fundamental physical and physiological theories. Similarly in the case of pharmaco­ logy, Galen's enormous tomes on the subject are indebted to a long tradition of drug lore, partly folkloric and poetic, which he acknowledges and quotes from; but Galen not only synthesizes this information but attempts to systematize it, even introducing into his scheme certain elements of quantifi­ cation: a drug wil l be classified, for example, as 'two degrees hot, one degree dry'. ft Our other main sou rces for medical theory and practice are, a pa rt from the H ippocratic rexrs, a sma l l a mount of rhe work of Galen's predecessors R u fus and Soranus of Ephesus; a treatise by A retaeus of Cappadocia of uncertain date; and a Latin text by Caelius A urelian us, which, though considerably later than Ga len 's time, is argua bly a source of ( Methodic) theories of the period immed iately before h i m .

XIV

INTROD UCTION

Scientific methodology. In the area of scientific methodology, Galen's contribution is highly distinctive. Debates on the na­ ture of medical knowledge and the relationship of theory and experience had taken place at least since H ippocratic times, and were the province of doctors as well as philosophers; in Gaten's own time the different intellectual positions were represented by the adherents of medical 'sects'. Galen is again the major source for these sects and the niceties of their methodological differences. He identifies three principal sects: Rationalists (sometimes known as 'Dogmatists'), Empirics, and Methodics. Of these it appears that only the latter two represent sects in the sense of discrete historical groups who actually professed allegiance to a sect; the term 'Rationalist' refers rather to someone who approaches the art of medicine with any kind of pre-established hypothesis or theory. The Empiric school, which was founded in the mid-third century BC by a follower of Herophilus, was influenced by Sceptical philosophy, and represented an attempt to engage in the art of medicine with as little as possible in the· way of theoretical postulates. Denying the possibility of true knowledge concern­ ing the body, the Empiric's view is that the doctor must rely on experience (peira) and precise observation (teresis), and proceed in his clinical practice on the basis of metabasis tou homoiou-transition or induction from similar cases. Finally, the Methodic school (founded in the first century AD under the influence of the doctrines of Asclepiades) did have a physi­ ological theory, but one so minimalist as to be almost anti­ theoretical. They believed that all states of the body could be reduced to two essential types, the constricted and the loose; and, according to Galen, that the whole art of medicine could be learned in six months. 7 It is, then, in relation to these three sects that Galen ex­ presses his own theoretical and methodologica_l views on the science of medicine; and here again his contribution is histori­ cally vital, for the sects ceased to exist in this form after his 7 There are other sects occasionally mentioned, such as that of the 'Pneu­ matics' ; but again it is not clear to what extent such a term corresponds to an actual historical group, rather than to a category that the author is construct­ ing for the purposes of a particular context.

I NTROD UCT I ON

xv

time, a development which is traditionally credited to Galen's success in assimilating and rejecting their existing elements. Galen himself insists on the vital importance of theoretical training in logic and the abi lity to present arguments logically; writes works of technical logic; and himself uses these tech­ niques to advance and justify elaborate theoretical positions. But this (to us) abstract science is for Galen intimately connected with empirical knowledge and observation: the securest kind of knowledge for Galen is that based on sound anatomical research in conjunction with a syl logistic presenta­ tion of the argument. 8 And he insists that such knowledge is secure, strongly countering the claims of Sceptic philosophers and Empiric doctors on the impossibility of knowledge: the 'geometric-style' proof is of particular importance to him as a tool to counter such Sceptical or sophistic claims (see pp. 1 81 9 , 1 3 1 -2, 1 3 8-4 1 ) . He also insists on the importance for the doctor of training his perceptive faculties, for example that of touch, which must be highly developed to detect fine distinc­ tions in the pulse. 9 Among the existing sects, he thus has a certain sympathy with the Empirics, who at least acknowledge the importance of observation: they are better off than those who ignore empirical evidence, or who function with a theory which is actually incorrect. 1 0 But some theoretical (i.e. ana­ tomical and physiological) knowledge is also necessary in order not to be deceived by surface appearances. Certain symptoms appearing in the head, for example, may arise from humours which are produced in the stomach. Here the Em­ piric doctor wil l mistakenly apply a remedy to the head; it requires a piece of physiological theory, namely of the process 11 This type of argument reaches its apotheosis in The opinions of Hippocrates and Plato, in relation to the proof that the brain is the 'com­ manding part' of the soul; see esp. Book VIII, K v. 6 5 5 . 9 See Diagnosis by the pulse i . 1 , K v i i . 768 ff., and, on Galen's bewilder­ ing array of classifications and sub-classifications in this area, T. S. Barton,

Power and Knowledge: Astrology, Physiognomies, and Medicine under the Roman Empire, Ann Arbor, 1 994, ch. 3.

1 ° Consider the statement on p. 2 1 4: 'One would be well advised, then, to adopt one of two solutions: either to have no truck with such arguments at all, but rely entirely on experience, or to undergo a preliminary training in logical science.'

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INTRODUCTION

by which melancholic humours may be produced in the stom­ ach and from there transmitted to the head, to know that it is actually the stomach which must be treated. For the Methodics he has nothing but a frequently and virulently expressed contempt; they and their historical founder Thessalus are the targets of his bitterest invective. It is thought by some that this gives an indication of the threat that this 'upstart' or 'lower-class' sect presented to more tradition­ ally trained doctors at this period. Consider the terms of Galen's invective against Thessalus in The method of healing: For if those who are to become doctors have no need of geometry, or of dialectic, or of music, or of any other of the noble studies­ according to the pronouncement of the most venerable Thessalus . . . who believes that anyone can easily become a doctor-then shoe­ makers, carpenters, dyers, and smiths will rush to the practice of medicine, abandoning their previous skills (K x. 5)

and cf. p. 9 7 . The blend of abstract and concrete knowledge, of theoreti­ cal and practical discipline, that results from this methodology of Galen's is a theme that runs throughout his work, enabling him to inveigh against other doctors for 'sophistry' and logic­ chopping on the one hand and to dismiss the crudeness of merely 'manual practitioners' on the other. It is interesting from the modern viewpoint that 'specialism' and surgical skill, two things now associated with a very high status in medicine, in. the ancient world had connotations of the lower-status artisan (connotations which survived into medieval times, in the figure of the barber-surgeon); there were, for example, specialists in eye operations (known to us from inscriptions): these would never have enjoyed anything like the position in elite Roman society of Galen-Galen who not only prides himself on his knowledge of the art of medicine as a whole, but also delights in the description of himself that he attributes to Marcus Aurelius: 'first among doctors, but the only philo­ sopher'. At the same time, Galen was a champion of public displays of anatomical skill, and had his first job as doctor to the gladiators in Pergamum, a post involving regular practice in the surgical treatment of wounds. In the ancient conflict

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between theory and practice, Galen wishes to lay claim to the best of both worlds. Theory of the soul. Much of Galen's wntmg is explicitly addressed to, or incidentally involves, a theory of the soul­ something which may appear strange to a modern. But in the ancient world, belief in a soul (psyche) is common ground between all philosophical and medical theories, and does not in itself have any mystical or other-worldly implications. The same word applies to soul in the Platonic or Pythagorean sense of an entity that survives the death of the body and is transmuted to some other mode of being, and to mind in the (to us) everyday sense of-in Galen's own phrase-the 'source of perception and motion'; and a whole gamut of opinions is available concerning its nature, composition, properties, and fate after death. (We have already seen some ramifications of Galen's theory of the soul in the context of physiology, as relating to the theory of the three major organs and to that of perception.) Between the doctrine of the separate, immortal soul and the out-and-out materialism that equates the soul with physical elements, Galen appears somewhere in the middle, or rather he appears to fluctuate: firmly convinced of the powerful effect on the soul of bodily factors (conceived in humoral terms)--even, at times, of the identity between the two (see The soul 's dependence on the body in this volume)­ he also admits a certain independence of the soul, both in the sense that it is the entity 'for the sake of which' the body is formed in the way that it is, and in the sense that certain pedagogic and even dietetic practices are indicated for the benefit of the soul considered in its own right, rather than for the sake of the body as a whole. (We see in this area again the attempt to marry Platonic and Aristotelian ideas with more obviously medical ones.) And, in The affections and errors of the soul (translated in this volume), we see Galen adopting a moral-psychological discourse which is almost devoid of medical connotations, and has much more in common with the work of popular moralists, such as Plutarch or Epictetus. In the context of what we would term 'mental illness', on the other hand, Galen adopts the language of the existing

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INTRODUCTION

medical tradition to describe a range of complaints-such items as phrenitis, derangement and of course melancholy. In line with his physical and physiological views, these illnesses are conceived in terms either of 'impairment of a faculty of the soul' (such as memory, reasoning, or voluntary motion) or of imbalanced states of the humours. As regards cure, dietetic factors which influence this balance are generally preferred to 'psychotherapeutic' approaches which are found in some authors. (Caelius Aurelianus recommends such practices as reading to a disturbed patient, or decorating his room in certain ways to induce tranquillity.) Religious belief and practice. Galen appears to have little place in his thought for conventional religion, and in fact describes his anatomical work as the best form of worship of the Creator; but he does acknowledge Asclepius, the god of healing, as his patron god and attributes his own education in medicine to a divinely inspired dream on the part of his father. He also participated in the culture of the Temple of Asclepius at Pergamum, the resort of priests and of religious devotees in search of healing. More broadly, there were institutional con­ nections between religion and medicine, even of the Galenic variety; these are seen not just in the case of Pergamum, but also, for example, in the fact that the person who appointed Galen doctor to the gladiators at. Pergamum was the high priest of Asia. In general, temple medicine-which involved such practices as making votive offerings to a god, and sleeping within the precincts of the sanctuary, seems to have had less of a rivalry with Galenic medicine than we might expect; both increased in popularity in late antiquity, rather than one at the expense of the other, and it is rival practitioners of 'rational' medicine-not priests or religious healers-that are the targets of Galen's polemics. (We get a good insight into the temple atmosphere of superstition and 'faith healing' from the writ­ ings of Aelius Aristides, an exact contemporary of Galen and one who actually frequented the Pergamum temple during the same period. ) One may consider also the 'Hermetic' writings, which address the subject of 'healing' in an anti-intellectual, mystical manner, and which also date from Galen's time.

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G A LE N I C M E D I CI N E A N D R O M A N S O CI ETY

For the modern reader, what is perhaps most interesting about Galen is the vivid insight his works give us into intellectual and everyday l ife in ancient Rome, and into the status and practice of doctors within that l ife. To understand this status one must consider a litt le of the historical background. Medi­ cine was essentially a Greek import to Rome, and doctors in the Galenic mould foreign intellectuals, with the positive and negative connotations which that term might bear. Tradition­ ally minded patrician Romans were suspicious of medicine in the same way that they were of philosophy, an attitude best exemplified by the elder Pliny in his Natural History: both were un-Roman practices which sapped the age-old native virtues. On the other hand, the culture of the cultured Roman gentleman was largely Greek; the educated Roman, interested in the ' liberal arts', was inevitably versed in Greek and a patron of Greek forms of knowledge; and it was on the patronage of such philhellene members of Roman high society that a doctor like Galen depended. This applied at the state level too: certain public offices or titles were available to doctors in their capacity as practitioners of the artes Libera/es, and the level of such state support tended to be increased by philhellene emperors and decreased by less culturally inclined rulers. The emperor for most of Galen's career was the su­ premely philhellene man of letters Marcus Aurelius; and Galen, by his own account, had great success in impressing him and gaining his patronage. We should consider also the nature of this patronage. A doctor was to an elite Roman more a part of his dai ly entour­ age-as there might also be philosophers and litterati-than a person to be called upon when something went wrong. And this pheJ!QID_enon is in turn related to the concept of health which hag_ _existed since Hippocratic times: the concept 0£. sorn�tE�i . ."Yhidi_jnxlyes_·__