The question of Galen's relationship with his predecessors in humoral theory is a difficult one. He lays out his views in a variety of long, digressive texts, of problematic consistency, blending scientific argument, polemic and compendious but evasive scholarship, and presents his own, substantially Aristotelian, views as authentically Hippocratic. Further challenges lie in the range and, frequently, obscurity of relevant earlier sources and – in the particular case of black bile – its difficult-to-trace early history and problematic relationship both with the other humours and with the concept (itself famously multivalent and complex) of melancholy.
It is through this thorny textual and intellectual-historical thicket that S. bravely cleaves a path in this book. It is a highly worthwhile undertaking, which he accomplishes admirably, in terms of both argumentative analysis and breadth of detailed scholarship. Black bile constitutes an important but surprisingly neglected topic in modern Galenic studies (in spite of a number of more general surveys of his physical theory, well laid out and engaged with here). The book gives thorough coverage of the relevant texts, especially Hippocratic and Galenic, the most important of the latter cited in extenso and explicated in detail, and a penetrating account of Galen's engagement with his predecessors (mainly Hippocratic, but also later); and attention is drawn to the problematic shifts in content of Galenic arguments according to context.
Chapter 1 gives a valuable overview of the pre-Galenic history and a perceptive account of Galen's complex, distortive engagement with Hippocratic texts. My only reservation is that the latter in a sense does not go far enough: the transition from humours as constituents in the Hippocratic Nature of Man to their essentially different role in Galen seems crucial in a way not quite brought out here. To say that black bile is ‘a fundamental substance to explain health and disease’ (p. 13) somewhat sidesteps the question: are Galenic humours really elements or just by-products of digestion? True, Galen does in some passages speak of them as ‘elements’ (p. 14); but close attention to these shows, first that the context is a dialectical one, the aim being precisely to occlude the nature of his distance from ‘Hippocrates’, second that the actual proposition made concerns origin, not composition: we are formed in the womb from blood, which is (a) itself a humour, (b) never completely pure, always having some admixture of the others. (S. cites all the relevant texts, see esp. Hipp. Elem. 8–9 [I.479–81 K.] with 10–11 [I.493–4 K.]; HNH 1.19–20 [XV.59–61 K.]; PHP 8.4 [V.671–2 K.], but without bringing out this point.) Otherwise, fundamental to Galen's element theory, of which S. indeed gives a strong historical account, are four qualities (hot, cold, wet and dry), not four humours.
Both doxography and Galen's argumentative strategy are explored further in Chapter 2, which highlights his tendentious backward attribution of his own views to Hippocrates, especially in relation to nature and teleology. Chapter 3 continues the analysis with close attention to differences between the Hippocratic and Galenic accounts: Galen adds certain features to the Hippocratic black bile in line with his own element theory (it is ‘earth-like’, p. 63) and characterises it as a sort of ‘lees’, ‘sediment’ or ‘mud’ (pp. 68–72). S.’s focus is, importantly, on the role of such precise physical descriptions for diagnostic purposes; but, again, there is surely a more fundamental transformation in play, such descriptions of a residue showing how far Galen is from the Hippocratic understanding of humours as basic constituents.
Chapter 4, ‘Galen's Distinction of Different Types of Black Bile’, begins an impressive, and intricately argued, attempt to bring clarity to this complex area, with a tripartite division, elaborated further through the rest of the book, into ‘ideal natural’, ‘non-ideal natural’ and ‘altered’ forms. Here the initial proposition (p. 76, based on Affected Places 3.9), that μέλαινα χολή properly corresponds to the first of these, seems to me insufficiently established or at least insufficiently clarified. Certainly the text shows that there are innate variations in the amount of black bile people accumulate; but it is still, both here and in the next text, from the Aphorisms commentary, a by-product of digestion; moreover μέλαινα χολή seems to refer rather to the fuller (and therefore potentially more dangerous) form of the substance, μελαγχολικὸς χυμός representing its presence as a mere admixture in blood, not yet to be referred to as black bile. The understanding of black bile as ‘innate’ in the sense of natural and healthy, then, seems problematic. (Cf. the usage of Black Bile, cited e.g. at p. 87, where the humour seems in itself harmful.) It is undoubtedly relevant, as S. argues, that each humour may have a natural (κατὰ φύσιν) or unnatural (παρὰ φύσιν) form; but (as he also brings out) the main point of this distinction is that the altered form of black bile (‘arising from yellow bile’, ‘putrefied’ or ‘combusted’) is implicated in certain specific diseases.
S. is sensitive to Galen's relationship with the post-Hippocratic tradition, for example with the work of Diocles and Rufus; and he gives a helpful account (here and in Chapter 7) of the different disease aetiologies as presented by Galen, exploring further texts that distinguish between normal and ‘acidic’ forms of black bile (e.g. Nat. Fac. 2.9, cited at p. 79).
Responding to doubts cast in previous scholarship (especially by J. Jouanna) on the authenticity of Black Bile, S. argues convincingly that this particular problem is soluble through the clear Galenic distinction between hot and cold versions of the substance. His broader defence of a consistent overall Galenic position on terminology and demarcation, however, as well as of a positive or elemental role for the substance, seems less convincing. The former depends, by his own admission, on the allowance of considerable verbal inconsistency on Galen's part; and it seems that the only clear positive function for black bile that emerges consistently is that it should not be present in excess.
Chapter 6 proceeds to an important account of black bile in physiological terms, in relation to the liver and spleen; central here is the way in which these organs deal with the ‘non-ideal’ black bile. But again the question arises, what is the theoretical role of the ‘ideal’ version? The problem is ultimately Galen's, not S.’s; nor is the latter unaware of the extent of the challenge. ‘Understanding of the distinction between the three types’ is, as he says, ‘hindered by Galen's … “looseness of language”’ (p. 127); but he does seem to me over-optimistic in his presentation of the solution.
The last chapter examines diseases caused by black bile and its relationship with two in particular: quartan fever and melancholy (the latter conceptualised in terms of particular ‘mental’ diagnostic features and enjoying a rich pre- and post-Galenic history), and offers a helpful account, both of the previous tradition and of the most important Galenic texts in this area.
This is a cogently argued study, with a wealth of careful and dense textual justification. There are just a few points where the presentation of the argument could be clearer. There is also an unfortunate number of errors in Greek accentuation (a trivial enough point, although I find it hard to rid myself entirely of the fantasy that a publisher of Brill's classical credentials – not to mention prices – might stretch to editorial resources that would help eliminate such avoidable blemishes).
This work will be of great value, both as a textual resource, assembling and commenting on the most important texts on this topic, and as a stimulating and penetrating discussion of Galen's intellectual strategy and his views in this medically significant area.
