Astral Codex Ten

Galen

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Galen

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Galen is a recurring person in the Astral Codex Ten archive, appearing 2 times across 2 issues between April 09, 2021 and August 05, 2022. The archive places it in contexts such as “I don’t know anything about Galen, but I wonder if this was really the whole story”; “Galen’s father was an architect; while rich, he was not considered”; “This is the theory that he would put his weight behind, and which he would eventually be responsible for bringing to the majority of the western world”. It most often appears alongside Darwin, On the Natural Faculties, 1913 Nobel Prize in Physiology or Medicine.

Metadata

  • Category: People
  • Mention count: 2
  • Issue count: 2
  • First seen: April 09, 2021
  • Last seen: August 05, 2022

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Your Book Review: On The Natural Faculties
April 09, 2021 · Original source
Aelius Galenus or Claudius Galenus (henceforth “Galen”) was born in Pergamon, a town in modern-day Turkey, in 129 CE. At the time, it was a part of the Roman empire, and a major intellectual center. Galen’s father was an architect; while rich, he was not considered to be particularly high status. Since there was little pressure for his son to go into a traditional career, instead of the “safe” subjects of literature and rhetoric that most Romans studied, Galen got an unusual education in mathematics and geometry.
It’s hard not to notice just how famous Galen was in his own time. Marcus Aurelius described him as “primum sane medicorum esse, philosophorum autem solum” — first among doctors and unique among philosophers (one wonders if Galen might have influenced the Emperor’s own philosophy). Forgeries and unscrupulous editions of his work were such a problem during his lifetime, he had to write a book called On My Own Books to try to sort it all out. Among other things, he complains that his servants were stealing private letters he had written to friends and circulating bootleg copies of them as medical advice. Galen was an incredibly prolific writer. Wikipedia claims that he produced more works than any other author in antiquity, maybe up to 600 treatises, and possibly employed 20 scribes at one point. While these particular claims are hard to substantiate, he did leave behind a whole lot of books. Fires and the various other mishaps that are guaranteed to happen to classical texts destroyed many of his works. Some of this even happened during his own lifetime, and in On My Own Books he seems surprisingly relaxed about so many of his works being lost: The books of many others perished at that time, as did all those of mine which were located in that storehouse; and none of my friends in Rome admitted to having copies of the first two books. Since, then, my followers prevailed upon me to write the same treatise again, I thought that I should give this explanation regarding the previously distributed books, in case anyone in the future finds them and wonders why I should have written a treatise twice on the same subject. Even with these losses, huge amounts of his work has survived. It’s hard to get an exact count, but Claudii Galeni Opera Omnia by Karl Gottlob Kühn, compiled around 1833 and for a long time the definitive edition, contains 122 different works in 22 volumes. That’s a lot. Despite this, I was surprised how hard it was to get my hands on primary source copies of his works (in English). Because of our own plague, I was limited to finding sources online — but for most classical works, this is pretty easy. Marcus Aurelius was a contemporary of Galen, and it’s not too hard to find multiple different translations of Meditations (though admittedly Marcus may have a slightly wider appeal). Part of this might be that Galen’s works are very badly organized. Every secondary source I read on the Galenic corpus is full of griping about how confusing the whole thing is. Galen wrote in Greek, but many of the original versions of his books are lost, leaving us only with Arabic or Latin translations, or Latin translations of earlier Arabic translations. Some of the books appear under different titles in different places, and sometimes the works are only indexed under abbreviations of those titles. Some of them probably were never intended for publication (those bootleg letters I mentioned above), and so may not have official titles or versions at all. Forgeries of his works in various languages continued well on into the Renaissance. Galen himself was very unclear on how to think about the documents he produced. At one point in On My Own Books, he starts off by talking about a piece of writing he did “as an exercise for myself”, and then immediately turns around and mentions that he gave it to friends, who in turn gave it to their friends. Needless to say, the whole thing is a mess, the scholars seem very agitated. I chose to review the longest piece I could find, which is On the Natural Faculties, specifically the translation by Arthur John Brock, which was the only translation I was able to track down. This also seemed like a good choice because, instead of being a treatise on a more limited topic like diet, the pulse, or bones, this book serves as more of an introductory textbook to what today we would call biology. III. On the Natural Faculties is divided into three books, though if the three books have any structure to them, I wasn’t able to figure it out. Galen is pretty straightforward in naming his pieces, and this book is about him trying to describe all of the “natural faculties”. This doesn’t really correspond to any modern concept, but essentially he means the fundamental or basic biological functions common to all living things. He begins by contrasting the functions of the soul, like feeling and voluntary motion (we might say “mental functions”), which occur only in animals, with the natural functions common to both animals and plants. You could maybe translate “natural faculties” as something like “basic biological functions”. I had always heard that Galen was a Hippocrates stan, but right from the get-go he’s mentioning Aristotle in the very same breath (though he reminds us that Hippocrates “lived much earlier than Aristotle”). When describing the natural faculties, he seems to base them off of Aristotle’s physics more than Hippocrates’ humors. Aristotle’s physics is a system I mostly know secondhand from the descriptions offered by Thomas Kuhn (for an example, take a look at this piece). Kuhn stresses that this system is hard for a modern mind to understand and even harder to explain, so I was surprised at how intelligible Galen’s account is. Maybe reading Kuhn’s description prepared me to understand what Galen has to say, but either way, it’s great. I think Galen does a better job than Kuhn. Basically he says, look, there are different kinds of motion: If that which is white becomes black, or what is black becomes white, it undergoes motion in respect to colour; or if what was previously sweet now becomes bitter, or, conversely, from being bitter now becomes sweet, it will be said to undergo motion in respect to flavour … when a warm thing becomes cold, and a cold warm, here too we speak of motion; similarly also when anything moist becomes dry, or dry moist. He goes on to suggest that the natural faculties are more advanced forms of motion, possibly built up out of the combination of simpler forms of motion. (Kuhn treats the Aristotelian perspective as if it was the common sense of the ancient world, but the fact that Galen has to describe it in such detail makes me wonder if that was really the case.) That’s the framework. What the exact set of natural faculties are, however, is less clear. In book one he focuses on three faculties in particular — genesis, growth, and nutrition — and provides lots of arguments that (for example) the body’s ability to grow is different from its ability to sustain itself. In book three he gives a different list of four — the attractive, retentive, expulsive, and alterative faculties — but he also suggests that these are “handmaids of Nutrition”. Elsewhere he says that genesis is not “a simple activity of Nature” but instead is “compounded of alteration and of shaping.” He also mentions faculties like “adhesion” and “presentation”. The particulars are pretty confusing, but the general gist is clear. Galen wants to lay out all the different faculties and their sub-faculties (and sub-sub-faculties?) so that the reader can understand the workings of the body. Galen makes it pretty plain that he thinks that diseases are caused by failures or overactivity of the different principles. For example, he says that in leprosy “there is adhesion of the nutriment but no real assimilation”. One faculty is working but the other is disordered. If you want to be a good physician, he says, you need to understand all these faculties so you can identify diseases (tell what faculties are misfunctioning) and treat them — “how are you going to be successful in treatment, if you do not understand the real essence of each disease?” he says. The four humors do make their way into this mix eventually, especially in the second and third books. (Though the translator often insists on translating “humor” as “juice”, which makes me very uncomfortable.) The relationship seems to be that the humors are the building material of the body, but that all the activity is carried out through the natural faculties. The student needs to know the humors to understand what is being moved around, but the humors are primitive. To Galen, biology is all about these faculties shuffling, transforming, and combining different humors. VI. Anyways, that’s what Galen wants to be talking about. But about halfway through book one, he goes entirely off the rails and never really gets back on track. The thing that sets him off is other schools of medicine. It’s clear that Galen cannot stop thinking about them. They invade his every thought; he is beleaguered by them. I would seriously believe that he loses sleep over them. Some of the commentators I’ve read suggested that Galen was an arrogant man — one said he saw in Galen “the blind assumption that he alone was graced with the ability to bring Hippocrates’ work to completion”. My sense of Galen was that he is a man who is constantly exasperated. He is just trying to write basic pieces about how to be a good physician and philosopher, and people keep descending on him with the most unbelievably pedantic arguments. Book One of On the Natural Faculties is divided into 17 sections, and he spends half of the first section hedging around ways people could potentially take his words in the wrong ways. These sound more than a little like intrusive thoughts, and it’s tempting to think that he’s blowing this all out of proportion. But from what I know about Galen’s life, it seems likely that he really was getting into disagreements all the time, and probably really did need to worry about people quoting his work out of context. One article in The Lancet describes him as “a public figure, known and recognised by many, accosted in the streets, challenged to debate.” It’s easy to imagine how being accosted in the streets might work its way into your head. Either way, these concerns absolutely consume him. He keeps getting drawn off on different tangents, before trying to return to the main thread with statements like: I said, however, that I was not going to enter into an argument with these people, and it was only because the example was drawn from the subject-matter of medicine, and because I need it for the present treatise, that I have mentioned it. Let us pass on, then, again to another piece of nonsense; for the sophists do not allow one to engage in enquiries that are of any worth, albeit there are many such; they compel one to spend one’s time in dissipating the fallacious arguments which they bring forward. What, then, is this piece of nonsense? Now, we usually refrain from arguing with people whose principles are wrong from the outset. Still, having been compelled by the natural course of events to enter into some kind of a discussion with them, we must add this further to what was said… Since, then, we have talked sufficient nonsense — not willingly, but because we were forced, as the proverb says, “to behave madly among madmen” — let us return again to the subject of urinary secretion. But, as I have said, one is driven to talk nonsense whenever one gets into discussion with such men. Having, therefore, given a concise and summary statement of the matter, I wish to be done with it. Of course, in the very next paragraph, he is immediately drawn back into a discussion of their shortcomings! In some ways, On the Natural Faculties is less of a medical treatise and more of a fascinating snapshot of the state of the academic medical world in the latter half of the second century CE. The tone sounds really contemporary in a lot of ways, and has a quality of acrimonious quibbling that is more than a little familiar, though I don’t think modern physicians are likely to be poisoned by their colleagues (but what do I know). V. We’ve established that Galen has a problem with other experts and schools of medical thought. That leaves us wondering how justified he is. Is he criticizing them for real problems in their work, or is this just partisan squabbling? What are the things that he takes such issue with from these other schools? I think there are two things he’s mostly complaining about. The first thing that really sets Galen off is sectarian dogmatism. “Everyone becomes like the first teacher that he comes across,” he says, “without waiting to learn anything from anybody else.” He bemoans sectarian partisanship and, in classic doctor fashion, uses a weird hygiene metaphor, calling it “excessively resistant to all cleansing process”. It is “harder to heal than any itch”. The fact is that those who are enslaved to their sects are not merely devoid of all sound knowledge, but they will not even stop to learn! This is kind of tragicomic, because two of the main things Galen is accused of are 1) blindly following whatever Hippocrates said about medicine and 2) leading centuries of physicians to blindly follow whatever he wrote! It’s hard to know how blindly Galen is following the teachings of Hippocrates. On the one hand, he does refer to him as “most divine Hippocrates” at least once. On the other hand, he is open to pointing out the (rare) cases where he thinks Hippocrates has overlooked something, and even talks about how he wishes his opponents would criticize Hippocrates more directly! When someone disagrees with a whole suite of his intellectual heroes, he says, “now, one cannot be blamed for not agreeing with all these great men, nor for imagining that one knows more than they; but not to consider such distinguished teaching worthy either of contradiction or even mention shows an extraordinary arrogance.” Maybe other physicians really did follow Galen’s writing blindly in the centuries following his death. I’m not sure anymore. But Galen certainly can’t be blamed for it. He could not be clearer in stating that this is exactly what the student of medicine should avoid doing. It would be tempting to pass this all off as one-sided; “stop listening blindly to your teachers and listen blindly to me!” I don’t get that sense. First, we know that Galen studied all over the ancient world, so he was exposed to all sorts of ways of doing medicine. He practiced what he preached. It’s hard to know how fair a representation he’s giving of the other schools of thought, but he writes as though he has them all memorized, and he certainly was in a position to frequently get into debates with them. When he tells us that they’re uncritical, I’m tempted to believe him. Second, Galen makes a serious point to try to convince the reader of his positions. He’s not just stating “facts” and expecting you to bow down at his feet. He’s engaging with opposing points of view and trying to make compelling arguments that he thinks will convince his readers. VI. Finally, I don’t buy this because nowhere is Galen asking people to listen blindly to anyone, least of all himself. Because the second thing that REALLY sets Galen off is when people aren’t empirical enough! He constantly ridicules, in pretty harsh language, those who remain unconvinced by observation and experiment. Asclepiades, one particularly hated adversary, is charged with “bidding us distrust our senses where obvious facts plainly overturn his hypotheses.” Asclepiades has rather unusual opinions about the urinary system, and in one particularly strong example, Galen asks rhetorically (and sarcastically!), I do not suppose that Asclepiades ever saw a stone which had been passed by one of these sufferers, or observed that this was preceded by a sharp pain in the region between the kidneys and the bladder as the stone traversed the ureter, or that, when the stone was passed, both the pain and the retention at once ceased. It is worth while, then, learning how his theory account for the presence of urine in the bladder, and one is forced to marvel at the ingenuity of a man who puts aside these broad, clearly visible routes, and postulates others which are narrow, invisible—indeed, entirely imperceptible. Other schools are also attacked for denying “observed facts” or even “obvious facts”. Meanwhile, people who draw incorrect conclusions but respect the facts are praised. Galen cares a lot about physicians basing decisions on empirical observation. We know that he’s serious about this because of the many disturbing vivisection experiments he describes in great detail. In discussing digestion, he says, “I have personally, on countless occasions, divided the peritoneum of a still living animal and have always found all the intestines contracting peristaltically upon their contents.” He describes an experiment where you vivisect an animal, cutting away different coats of the esophagus, “then give the animal food and you will see that it still swallows although the peristaltic function has been abolished”. When describing the action of the stomach, he suggests that you can fill an animal with liquid food — “an experiment I have often carried out in pigs” — and cut them open “after three or four hours.” He really seems to want his readers to try these macabre exercises at home. “You may observe this yourself,” he says, “if you will try to hit upon the time at which the descent of food from the stomach takes place.” Fellow physicians are criticized for their lack of anatomical experience in the same way. “If he had ever practised anatomy, he might have known that the outer coat of the bladder springs from the peritoneum and is essentially the same as it.” The most extreme example comes from a debate with the disciples of Asclepiades about the function of the ureters, trying to convince this rival school that urine flows from the kidneys to the bladder through these channels. After exhausting his rhetorical options, Galen turns to empirical anatomy. First he shows them, in a dead animal, that the ureters connect the two structures. This isn’t enough. Next he shows them “in a still living animal, the urine plainly running out through the ureters into the bladder.” This doesn’t change their minds either. Next he takes a live animal, ligates the ureters, bandages the animal up, and lets it go. When he opens it up again later, he finds the ureters “quite full and distended”, and when he removes the ligature, everyone can see the urine flow into the bladder. You’d think the story would end there, but not so. Instead, says Galen, “tie a ligature round [the animal’s] penis and then … squeeze the bladder all over.” He points out that nothing goes back through the ureters to the kidneys, demonstrating that the conveyance is a special, one-way action. He goes on like this for a while. Let the animal urinate and tie a ligature around one ureter but not the other. Cut open both the ureters and see the urine “spurt out of it”. Bandage the animal up and open him up later to discover his insides full of urine and the bladder empty. “Now, if anyone will but test this for himself on an animal,” Galen concludes, “I think he will strongly condemn the rashness of Asclepiades.” Today we know that Galen was wrong, and that humorism isn’t a great way to think about medicine. But whatever Galen might have been lacking, it certainly was not the empirical bent. He was no armchair philosopher, and was more than happy to cut up lots of animals to make a point about the function of the ureters. This is funny because, again, this is the opposite of the story we’re told about Galen. He’s described as a pre-scientific or even unscientific thinker, believing that experimentation and investigation are a waste of time. Clearly this isn’t the case, and he made full use of all the resources available to him. We know that human dissection was prohibited in the empire, but Galen worked with gladiators, so we know that he had firsthand experience with human anatomy. He certainly was unafraid, even eager, to practice animal dissection and vivisection. Other doctors of the time didn’t seem to do either of these things, or at least didn’t do nearly as much, and so Galen starts looking more and more like a lone light of empiricism in the wilderness. (However extreme and disturbing his methods may be.) VII. In view of this, it’s extremely depressing to see Tetlock write, “yet Galen never conducted anything resembling a modern experiment.” Galen isn’t here to respond, but if he were, I imagine he would say: and yet Tetlock never conducted anything resembling a basic literature review! Galen definitely isn’t as charitable as we might want him to be. He calls some of the ideas he disagrees with “impossible, nay, perfectly nonsensical”, or “stupid—I might say insane”. His intellectual rivals “are like slaves” he says, “caught in the act of stealing … quite bewildered, and while the one says nothing, the other indulges in shameless lying.” But I’m pretty sympathetic to Galen’s position, because his contemporaries really do sound like idiots. Of course, all this is being filtered through Galen’s own account, but if he’s describing them with any accuracy, he is totally fair in saying that they have no idea what they are talking about. Some of the positions he argues against include: Urine passes into the bladder in the form of vapors, rather than being secreted by the kidneys and passed through the ureters to the bladder. Galen argues against this first by pointing out that the kidneys and bladder are connected by the ureters (which must have some purpose), and second by the extensive evidence from vivisection that I mentioned above.
Inline links: this piece, https://substackcdn.com/image/fetch/$s_!6Gdb!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Fbb854d87-de36-4173-ab8a-2728bd8605b5_1024x635.jpeg
If you’re looking for the whipping boy for all of medicine, and most of science, look no further than Galen of Pergamon.
Your Book Review: Exhaustion
August 05, 2022 · Original source
She opens her account with Galen’s humoral theory, where exhaustion was linked closely with melancholia, that famous over-production of black bile. I won’t detail Galen’s theories here; instead, I’ll point you towards last year’s ACX review contest entry of On the Natural Faculties. But it is worth noting here that many of the symptoms Galen describes are familiar to us – I described some of them earlier, but there are prominent features of not only what we would now call CFS but also what we have now carved off into the related concept of depression. The link between CFS and psychological distress is fraught with controversy, and we’ll deal with it more later on.
Inline links: On the Natural Faculties
This is particularly pronounced in men, for whom the loss of seminal fluid is allegedly forty times more damaging to vital energy than losing an equivalent amount of blood. Semen-accounting practices aside, the main point is that here we begin to find the tying together of Galen’s humoral imbalances with the idea of a loss of vital energy that cannot be easily replaced. In Schaffner’s account, as technology moved on into the industrial era, we start to see new ideas from science being put into service to explain exhaustion, and many of these theories concerned the expenditure or transfer of finite amounts of energy and a subsequent rest state or energy deficit: that is, we begin to use things up and can’t replenish them. These ideas included the thermodynamic idea of entropy, discoveries in the electrical nature of nerve conduction, and the ideas of genetic and mental degeneration.