XENOPHONTOS, MEDICINE AND PRACTICAL ETHICS

In this book Xenophontos argues that practical ethics do not simply form a minor element in Galen’s wide-ranging interests but are central for his overall project and concerns. Xenophontos is not ignoring the obvious fact that Galen saw himself as, first and foremost, a doctor, and, distinctively, one whose medical expertise was grounded in thoroughly researched knowledge, informed by serious study of philosophy. However, she maintains that Galen’s conception of this project and its execution were underpinned by a genuine concern with ethics and a clear understanding of its importance.

What does (practical) ethics mean for this study? Nothing very complex or technical. Galen’s concern is with ethics, as generally understood in his culture: right and wrong action, based on possession or lack of good qualities (virtues or vices), and expressed in management of desires and emotion and in relationships with others. His interest is in the ethical qualities that can enable people (particularly, wealthy adult male members of the Graeco-Roman social elite) to lead full lives and play a leading role in their communities. Especially, he is concerned with ethics as it bears on one’s effectiveness as a doctor and on patients’ ability to take care of their health. But, according to Xenophontos, he sees ethics as intrinsically important and not just as a means of self-advertisement or social ‘positioning’ (aspects of Galen that have been stressed in some recent scholarly treatments).

What is the basis for Xenophontos’s view? In On My Own Books Galen lists 23 works on ethical philosophy (though this is only a small fraction of his overall output). The two works that survive in Greek (Avoiding Distress and Affections and Errors of the Soul) are examined in-depth (Chapters 4 and 6). Xenophontos does not correlate Galen’s ethical approach with standard ancient philosophical theories or modes of ‘psychotherapy’ (topics fully discussed by other scholars). She aims at a more rounded account of Galen’s contribution to practical ethics in these works, exploring the way in which he tries to communicate these to a broad readership. In relation to Avoiding Distress she suggests that his detailed autobiographical treatment gives more immediacy and detail to support the response (thoughtful resilience) he recommends. In relation to Affections she stresses the wide-ranging character of his advice, covering topics such as frankness and insatiability, and the scope for anyone to improve his capacity for rational and emotional self-management.

Xenophontos’s treatment of these works is illuminating; the more innovative dimension of the book consists in the way in which she shows how ethical concerns inform Galen’s medical writing more generally. As she stresses, this marks a strong contrast with most other ancient medical writings. In the first three chapters Xenophontos begins with striking examples of moralising statements, before showing how Galen embeds comments on practical ethics in a wide range of technical medical writings. Chapter 3, ‘Moral Medicine’, sums up Galen’s view of medicine as a fundamentally ethical project and the reiterated contrast between his probity (which he sees as integrally linked with his expertise) and that of other doctors. In the second part of the book, ‘Case Studies’, Xenophontos develops the theme in-depth in connection with three medical works: Exhortation to the Study of Medicine, Recognising the Best Physician and Prognosis. Her focus (and Galen’s) is on the significance for healthcare of the doctor; but she does not neglect the correlated importance of ethics as a key factor in the patient’s self-management (in Matters of Health, above all).

Xenophontos’s case is clear and strongly supported. Is it also convincing? Some may feel her reading of Galen is over-generous and that she understates his egoism, overwhelming sense of superiority and showmanship; she certainly tends to take him at his own (high) valuation. Also, Xenophontos might, perhaps, have explored more fully the significance of Galen’s wealthy background (unlike that of many doctors), which enabled his extensive education, his capacity to carry out experiments, accumulate drugs and so on; this also underpinned his ethical outlook, characteristic of the more thoughtful members of his class. In any case, we think, her main points are convincing: ethics did matter to Galen, and he conceived his own commitment and expertise in moral (as well as medical) terms. Practical ethics in the early Roman Empire has been much examined in recent years, and Xenophontos made a significant contribution in her 2016 study Ethical Education in Plutarch (cf. CR 67 [2017], 370–2). Xenophontos locates Galen effectively in this context, while also underlining the significance of practical ethics for his medical writing. The book is written in a lucid and accessible style and is excellently supported with documentation and scholarship; it is a valuable study.

ČELKYTĖ, GALEN ON HUMAN PHYSIOLOGY

This is a study of Galen’s account of human physiology, centred on the question of the relationship between part and whole (this was also a key theme in Čelkytė’s The Stoic Theory of Beauty [2020]). This is a major topic for Galen; it is the subject of one of his most substantial works, On the Usefulness of Parts, and crucial for another, On the Doctrines of Hippocrates and Plato, both of which draw on his pioneering experimental work on anatomy. Physiology has, of course, figured prominently in previous Galenic scholarship. Čelkytė’s study is both comprehensive (drawing on relevant texts from Galen’s vast corpus) and focused (on the part–whole relationship); it takes account of other recent work, while formulating its own distinctive line of argument.

Čelkytė presents her analysis as, first, examining Galen’s understanding of the parts of the body (in Chapters 2–4) and then bringing these together as a whole (Chapter 5); and, in a broad sense, this is what she does. However, as she underlines, Galen always conceives the parts as constituents of a unified whole; thus, questions about interconnection and coherence are built into his thinking about parts. The key idea, one might say, is not so much ‘part’ as ‘system’ (or subsystem, since the body forms a single system). Chapter 1 provides an illuminating discussion of Galen’s thinking about ‘part’ (meros or morion), which makes especially good use (in 1.3) of a little-known passage on the differentiation of parts in the Art of Medicine. A salient point that emerges is that Galen conceives a bodily ‘part’ as that which initiates and completes a single activity (within the nexus of activities characteristic of the body in question).

The next three chapters set out the three organic systems that enable the human body’s characteristic set of activities, partly shared with plants and other animals. These systems are those of nutrition and growth (vegetative activities), respiration and transpiration (breathing through the skin), perception and voluntary motion. Although, in Galen’s view, these systems are based on specific organic parts, liver, heart and brain (which form their archē, ‘starting point’ or ‘principle’), they operate through networks, of veins, arteries and nerves, which, collectively and in co-ordination, enable the body’s vitality and activities. In each case Čelkytė examines questions about anatomy, the operation of the system and its contribution to the overall bodily whole. She also explores certain puzzling or problematic ideas or distinctions that arise in each area, for instance, (in Chapter 2) the idea of the vegetative soul as a demiurge (‘craftsman’) of the activity, (in Chapter 3) the distinction between vital and psychic pneuma, and (in Chapter 4) pain, the relationship between internal and external perception and the sensitivity of nervous tissue.

Chapter 5 centres on ‘putting the body back together’, especially the role of the three systems in this regard, examined in the three preceding chapters. Some scholars have questioned whether Galen’s adoption of Platonic-style tripartition is consistent with his view of the body as a unified organism. Čelkytė acknowledges but does not pursue this criticism; instead, she considers how Galen deploys his analysis in a way that accommodates and explains this unity, for instance, by reference to the co-ordination and co-dependence of the three systems. In addition, Čelkytė explores Galen’s conception of life or vitality – after all, the key concern of the practising doctor – as dependent on this co-working. She also explores how Galen uses ideas such as the material flux and the cohesive cause to define the elusive and transient nature of life and the related idea of the pulse.

Čelkytė’s study tackles a major topic in Galenic studies and does so, throughout, in a way that is lucid, well-argued, thoughtful and highly informative. Her analysis is conceptually clear even when dealing with Galenic material that is puzzling, diffuse or widely scattered. For anyone wanting to get to grips with Galenic thinking on human physiology – an essential topic for those working on Galen – her book is a helpful starting point.

TROMPETER, GALEN ON ETHICS AND HUMAN NATURE

This book is subdivided into two parts. The first part, ‘The Natural Foundations of Ethics: Galen’s Moral Psychology’, consists of four chapters: ‘Galen’s Psychological Model’, ‘Voluntary Motion in Galen’, ‘The Physical Causes of Affections: the Substance of Anger’ and ‘Heating and Cooling the Brain – Emotions and Mental Diseases in Concert’. The second part, headed ‘Galen’s Ethical Approach’, is also made up of four chapters: ‘The Rationality of Non-rational Beings’, ‘Moral Character and its Therapeutical Consequences’, ‘Affections and Errors in Galen’s Moral Psychology’ and ‘Psychology and Theology in Galen’s Ethics’. As in the other two books, the study ranges widely across Galen’s (huge) body of writings; as with Xenophontos (though from a different standpoint), the two extant Greek works presented as ethical in On My Own Books (Avoiding Distress and Affections and Errors of the Soul) receive special attention (in 2.3), while one preserved in Arabic (Character Traits) is also fully discussed (in 2.2).

What, exactly, is the main subject of the book? ‘Ethics’ and ‘Human Nature’ are very broad categories (though Trompeter has a distinctive view on them). In many ways, as indicated by the summary, moral psychology is the key subject and might have made a more obvious title for the book. In particular, Trompeter (like Čelkytė) stresses the centrality for Galen of the tripartite psychology and its physiological correlates. Although this model has sometimes been criticised on various grounds by scholars, Trompeter maintains its conceptual coherence and presents it as crucial for Galen’s distinctive ideas (brought out clearly in the conclusion, which I would recommend reading before the rest of the book). For instance, in 1.2 (on voluntary motion) she meets head-on the criticism that Galen’s tripartite theory is inconsistent with his brain-centred model. She highlights indications that liver and heart influence the brain (the sole centre for nerves) by determining the quality of the blood and vital pneuma reaching the brain.

In 1.4 Trompeter explores the complex, and rather fluid, relationship between mental disease and intense emotions, especially rage. She suggests that the tripartite model is crucial here too, for instance, in explaining how the boiling of the heart in an irascible patient affects and damages cognitive activity in the brain. Trompeter (in 2.1) sees the tripartite theory as relevant for understanding Galen’s thinking on the low-level kinds of rationality, such as imagination, achievable by ‘non-rational’ creatures such as non-human animals. She also sees tripartition as relevant for Galenic thinking on the development of ethical character in human beings; it can, for instance, explain limitations or obstacles in ethical development (2.2). In addition, Galen’s self-presentation as exceptionally resilient (expressing megalopsuchia) in Avoiding Distress depends on his view of the heart in establishing stability of tonos, even in situations that give strong grounds for distress. Similar considerations determine Galen’s preference for ‘moderation of passions’, rather than ‘freedom from passions’, as the achievable emotional ideal (2.3). Trompeter’s wide-ranging claims about the significance for Galen of the tripartite model, supported throughout by close and detailed discussion, constitute much of the originality of the study. She tackles certain long-standing cruces in Galenic interpretation from a similar standpoint, which depends on recognising the explanatory weight Galen gives to basic or elemental levels rather than higher ones. These cruces include Galen’s surprising presentation of boiling in the heart as the substance (ousia) of anger (1.3) and his apparent readiness in one work (but not elsewhere) to adopt a purely physiological analysis of the soul.

What about the choice of ‘Ethics and Human Nature’ as the title? How far does this choice square with the fact that Galen only discusses the core topics of Graeco-Roman ethics (the concepts of good, virtue and happiness) in a limited way, although, certainly, moral psychology figures prominently in ancient ethical writings? Trompeter addresses this question directly in the introduction. For Galen, as she reads him, the study of ethics is also the study of human nature (viewed as part of nature as a whole). In this he follows Plato, who makes the human tripartite psyche central for his great ethical work, the Republic, especially Book 4. Plato analyses human nature in tripartite terms in his ethically framed account of nature as a whole (presented as the work of a craftsman god) in the Timaeus (especially 69–72). The Platonic model partly explains why Trompeter ends her study of Galen’s ethics and human nature with theology (2.4), stressing the role of the demiurge in shaping natural reality at different levels, including those of elemental qualities.

As indicated, Trompeter’s monograph is complex in its overall concept and organisation and less straightforward than the other two studies discussed. However, the detailed argumentation is consistently clear in formulation and fully supported with textual references. Overall, it is an ambitious and innovative book that repays close study and makes a strong contribution to work on Galenic ethics and psychology.

WITTWER, GALENI DE LOCIS AFFECTIS III–IV

Wittwer’s CMG edition of Galen’s On Affected Parts III–IV complements the editions by F. Gärtner of Books I–II (2015) and by C.W. Brunschön of Books V–VI (2021). This magnificent undertaking by the CMG team includes introductions (mainly on the manuscripts) of 221 pages by Gärtner and 279 by Brunschön. They are extensive with good reason since the latter, for example, focuses on Laurentianus Plut. 74,30, a twelfth-century text from the scriptorium of Ioannikios, with annotations by Burgundio of Pisa, the early translator of Galen into Latin, or his associates. The manuscript was in Rome by 1470, for Joannes Rhosos to make his copy (Z). Wittwer reviews these magna opera of his colleagues with six pages of his own introduction, the three volumes together giving palaeographers much to reflect upon, following N.G. Wilson’s pioneering work on Ioannikios 40 years ago and numerous subsequent studies on the contributions of the recentiores, of which Wittwer lists seventeen. Wittwer, like his fellow editors, does not include endnotes, as they are found in some other CMG volumes. There are, however, excellent indexes on Greek vocabulary and citations, with a smaller index of topics.

CMG volumes are state-of-the-art editions, meticulous, with extensive apparatus. Other good editions are available, such as early Teubner volumes, for example, but nothing on this scale. Until the present three volumes of De locis affectis, translators faced the difficult task of using Kühn and early editions, with all the accompanying doubts about the former. Once an edition is in place, scholars can work on a firm basis (with disagreement where necessary). Is it a coincidence that people now cite Gärtner’s edition rather than later books of De locis affectis? We think not.

Galen’s text deals with medical conditions that are not clearly evident to external inspection, leaving much room for diagnosis from symptoms, to link external signs such as sweating in fever to the part affected and the cause of the affection. In some cases Galen finds the cause in a proximate part rather than the apparent part. We may compare De locis affectis with his 14 therapeutic books in The Therapeutic method, where much more of the condition is evident, as in the books on wounds. Unlike most of the pharmacological works, De locis affectis has been translated into several modern languages, here into German by Wittwer. When we are dealing with such difficult topics as χυμός (52.11), ‘Saft’, μελαγχολία (52.24), ‘Melancholie’, and ἐπιληψία (52.24), ‘Epilepsie’ – difficult for Galen as well as for us –, Galen tells us that some doctors see epilepsy as ‘einen dritten Unterscheidungstyp von Melancholie’, calling such a condition ‘hypochondriumsbezogene’ und “blähende” Krankheit’. This needs quite a lot of thinking through: Wittwer gives a lead with a translation consistently close to the Greek, even where there may be a danger of confusion with modern terminology. Earlier, on ‘Melancholie’, Galen referred (52.6–7) to the first book of his own treatise on nutrition, De alimentorum facultatibus, which gives quite a positive account of the ancient diet, though beef contributes to black bile there too. In De locis affectis Galen warns of all the other foods that may contribute to ‘Melancholie’, such as the meat of camels, foxes, hares and dogs (50.19–22), tuna and dolphin, and the drinking of thick black wine (50.24–52.10). More widely, the treatise is replete with references to himself and to other medical writers as Galen wrestles with possible causes for complex conditions affecting the head, spine, thorax, and the abdomen and its internal organs.

HAVRDA AND KOETSCHET, GALEN, ON DEMONSTRATION

Havrda and Koetschet provide an invaluable addition to Galenic studies, an edition of the fragments of De demonstratione, the first since I. von Müller’s in an article published in 1895. Galenists with Greek and Latin and Galenists with Arabic and Syriac need to collaborate wherever possible, the latter being in short supply. Knowledge of Arabic is needed in this case since many of the testimonia come from numerous texts in Arabic. The super-translator of Galen into Arabic, Hunayn, used his own translation into Syriac as the basis of his Arabic version, but the full text was not available to him (A2). Koetschet deals with the Arabic, which was little used by von Müller (only five citations), while Havrda, assisted by S. Coughlin, provides the Greek materials, some from other texts of Galen, where he makes his intentions clear: at Testimonium A28, for example, from Simple Medicines 2.4, 11.470–1 K., Galen says in Havrda’s version, ‘false pretension is detected only by those trained in demonstrative methods. And this is why we discussed it at length in our books On Demonstration’. In keeping with Galen’s vigorous comments on the errors of his predecessors, much comment on De demonstratione comes in turn from vigorous challenge to Galen, in particular, from Alexander of Aphrodisias and al-Rāzī’s Doubts about Galen. The editors have come to the project after Koetschet’s edition of Doubts about Galen and Havrda’s work on the Stromateis of Clement of Alexandria, Book 8, whose method has interesting affinities with Galen’s method of demonstration.

The volume shows the impact of Galen on his near contemporaries and the challenges he faced over the next millennium, particularly in matters of physics such as substance and time. The volume brings out beautifully Galen’s contribution to Western and Islamic thought, always as an authority but also as a basis for intellectual development. None of this would disturb Galen greatly since he saw some aspects of physics as beyond the doctor’s brief, even though he sometimes ventured into Aristotelian and Stoic physics, the former the subject of Alexander’s attack. Furthermore, Galen saw all knowledge as provisional and in need of extensive testing.

The introduction, nearly half the book, gives a clear summary of the Greek and Arabic sources for the testimonia; this summary is much needed to explain some of the Arabic sources in particular. Galen refers to this treatise about 40 times in 20 different works (p. 3), sometimes making much of the method, based on the combination of an appropriate starting point and appropriate premisses. He refers to it in the theoretical books of Simple Medicines, On the Therapeutic Method and On the Doctrines of Hippocrates and Plato, for example, and in other works just alludes to it. Galen shows (p. 4) that certain topics appeared in certain books of On Demonstration, such as embryology in 1–3 and generation and corruption in 5. The elements appeared in 13 and 14, and syllogisms in 11–12. The Greek sources go up to the Alexandrian Neoplatonists of the sixth century, Arabic from Hunayn in the ninth to Maimonides in the twelfth. Albertus Magnus is the sole witness in Latin.

Von Müller had placed great emphasis on Books 1–3, even though few testimonia referred to them (p. 19). Havrda and Koetschet give a clear steer, beginning their arrangement with 30 key testimonia of no known location. They divide the testimonia into seven sections, A–G, identifying those linked to a particular group of books within the treatise, and those not so linked. This arrangement makes it clear what is known and which parts of Galen’s work enjoyed most discussion in later centuries. Section A comprises 30 general and unlocated testimonia, such as A28 quoted above; B the contents of Books 1–3, with 7 testimonia; C Book 4, 16 testimonia; D Book 5, 3 testimonia; E Books 8–9a, 11 testimonia; F Books 9b, and 11–12; and G Books 13–14, with 31 testimonia.

The testimonia follow Galen’s practice of citing book numbers when necessary, but not systematically. Nothing is known of the contents of Books 6, 7, 10 and 14. Numbers count in these sections, so Havrda and Koetschet have been able to reshape von Müller’s reconstruction of the early books, which was based on few testimonia and much creative thinking (pp. 20–1). Such big issues as time and the elements may well have been used in the treatise to discuss the boundaries between medicine and philosophy, as we see in the extant works SMT, MM and PHP. This resonated in the Islamic world (p. 64): ‘Book thirteen fortunately attracted the attention of Rāzī and so we possess a wealth of information about its contents, both from Rāzī and his opponent’. Much of this debate, as earlier with Alexander, concerned Galen’s differences with Aristotle. Notes to the text are short and pithy, designed mainly to link Clement, for example, with Galen’s technique, or to link an Arabic author with a Greek or Arabic predecessor, and to refer to secondary literature. An index of sources is given, and an index locorum, though not of Greek and Arabic words.

The five books reviewed here, combining new editions with innovative interpretative monographs, give an excellent, and representative, impression of the vitality and range of current work on Galen.